Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach

International Breastfeeding Journal - Tập 15 Số 1 - 2020
Sonia Hernández‐Cordero1, Ana Lilia Lozada-Tequeanes2, Ana Cecilia Fernández‐Gaxiola2, Teresa Shamah‐Levy3, Matthias Sachse4, Paula Veliz4, Izchel Cosío-Barroso1
1Universidad Iberoamericana, Ciudad de México, Mexico
2Ana Cecilia Fernández-Gaxiola- Universidad Iberoamericana, Ciudad de México, Mexico
3Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
4Fondo de las Naciones Unidas para la Infancia, Ciudad de México, Mexico

Tóm tắt

Abstract Background Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals. Methods Mixed methods were conducted between May and July 2017, including surveys (n = 543) and semi-structured interviews (n = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15–49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico. Results Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%; p < 0.05) and those who received information during pregnancy (OR 1.07; p = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05; p < 0.001) and the fact that the mothers had received more information about breastfeeding during pregnancy (OR 1.13; p = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46; p = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists. Conclusions Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.

Từ khóa


Tài liệu tham khảo

WHO/UNICEF. Protecting, promoting and supporting breast feeding: the special role of maternity services / a joint WHO/UNICEF statement. Ginebra: WHO; 1989.

Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491–504.

Al-Nuami N, Katende G, Arulappan J. Breastfeeding trends and determinants. Implications and recommendations for gulf cooperation council countries. Sultan Qaboos Univ Med J. 2017;17(2):e155–61.

González de Cosío T, Escobar-Zaragoza L, González-Castell LD, Rivera-Dommarco JA. Prácticas de alimentación infantil y deterioro de la lactancia materna en México [infant feeding practices and deterioration of breastfeeding in Mexico]. Salud Publica Mex. 2013;55 Suppl 2:170–S179.

Bonvecchio A, Theodoré F, González W, Lozada AL, Alvarado Casas R, Blanco GI. Barreras de lactancia materna en México [barriers of breastfeeding in Mexico]. In: González de Cosio Martínez T, Hernández-Cordero S, editors. Lactancia Materna en México [breastfeeding in Mexico]. Mexico City: Academia Nacional de Medicina de México; 2016. Retrieved from: https://www.anmm.org.mx/publicaciones/ultimas_publicaciones/LACTANCIA_MATERNA.pdf Accessed: 9 Sept 2019.

Instituto Nacional de Salud Pública & UNICEF México. Encuesta Nacional de Niños, Niñas y Mujeres 2015 - Encuesta de Indicadores Múltiples por Conglomerados 2015, Informe final [multiple indicator cluster survey. Final report]. Ciudad de México: Instituto Nacional de Salud Pública y UNICEF México; 2016. Retrieve from: https://www.unicef.org/mexico/spanish/UNICEF_ENIM2015.pdf. Accessed: 9 Sept 2019.

Takahashi K, Ganchimeg T, Ota E, Vogel JP, Souza JP, Laopaiboon M, et al. Prevalence of timely initiation of breastfeeding and determinants of delayed initiation of breastfeeding: secondary analysis of the WHO global survey. Sci Rep. 2017;7:44868.

Veile A, Kramer K. Birth and breastfeeding dynamics in a modernizing indigenous community. J Hum Lact. 2015;31(1):145–55.

Diario Oficial de la Federación. Norma Oficial Mexicana NOM-007-SSA2–2016, Para la atención de la mujer durante el embarazo, parto y puerperio, y de la persona recién nacida. Secretaría de Salud [official Mexican norm for the care of women during pregnancy, childbirth and the puerperium, and of the newborn. Health secretary]. Ciudad de México; 2016. Retrieved from: http://www.dof.gob.mx/nota_detalle.php?codigo=5432289&fecha=07/04/2016. Accessed: 9 March 2020.

Kuri MP. Voluntad política. Estrategia de la lactancia de la Secretaría de Salud [political will. National Strategy for breastfeeding]. In: González de Cosio T, Hernández Cordero S, editors. Lactancia materna en México [breastfeeding in Mexico]. Mexico City: Academia Nacional de Medicina de México; 2016. Retrieved from: https://www.anmm.org.mx/publicaciones/ultimas_publicaciones/LACTANCIA_MATERNA.pdf Accessed: 9 Sept 2019.

World Health Organization. International code of Marketing of Breastmilk Substitutes. Geneva: WHO; 1981.

González de Cosío T, Hernández-Cordero S, Rivera-Dommarco JA, Hernandez-Ávila M. Postura de la Academia Nacional de Medicina en torno a la Lactancia Materna en México [position of the National Academy of medicine regarding breastfeeding in Mexico]. En: Lactancia Materna en México [breastfeeding in Mexico]. Mexico City: Academia Nacional de Medicina; 2016. Retrieved from: https://www.anmm.org.mx/publicaciones/ultimas_publicaciones/LACTANCIA_MATERNA.pdf Accessed: 9 Sept 2019.

Hernández-Cordero S, Lozada-Tequeanes AL, Shamah-Levy T, Lutter C, González de Cosío T, Saturno P, et al. Violations of the international code of marketing of breastmilk substitutes in Mexico. Matern Child Nutr. 2019;15(1):e12682.

World Health Organization. Indicators for assessing infant and young child feeding practices. Part 1. Definitions. In: Conclusions of a consensus meeting held 6–8 November 2007 in Washington, DC, USA. Geneva: WHO; 2008.

Resano-Pérez E, Méndez-Ramírez I, Shamah-Levy T, Rivera JA, Sepúlveda-Amor J. Methods of the National Nutrition Survey 1999. Salud Publica Mex. 2003;45(Suppl 4):558–64.

Creswell JW. Research design: qualitative and quantitative approaches. London: Sage; 1994.

Strauss AL, Corbin J. Bases de la investigación cualitativa. Técnicas y procedimientos Para desarrollar la teoría fundamentada [basic of qualitative research. Techniques and procedures to develop grounded theory]. Medellín: Universidad de Antioquía; 2002.

Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.

Kling D, Haile ZT, Francescon JO, Chertok I. Association between method of delivery and exclusive breastfeeding at hospital discharge. J Am Osteopath Assoc. 2016;116(7):430–9.

Teich AS, Barnett J, Bonuck K. Women's perceptions of breastfeeding barriers in early postpartum period: a qualitative analysis nested in two randomized controlled trials. Breastfeed Med. 2014;9(1):9–15.

Johnson AM, Kirk R, Rooks AJ, Muzik M. Enhancing breastfeeding through healthcare support: results from a focus group study of African American mothers. Matern Child Health J. 2016;20(Suppl 1):92–102.

Stuebe A, Bonuck K. What predicts intent to breastfeed exclusively? Breastfeeding knowledge, attitudes, and beliefs in a diverse urban population. Breastfeed Med. 2011;6(6):413–20.

Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113–35.

Soto EV, Urrutia-Osorio M, Arellano-Valdez F, Lopez IY, Hernández CH. The epidemic of the cesarean section in private hospital in Puebla, México. Obstet Gynecol Int J. 2015;2(6):184–7.

Forster DA, McLachlan HL, Rayner J, Yelland J, Gold L, Rayner S. The early postnatal period: exploring women’s views, expectations and experiences of care using focus group in Victoria, Australia. BMC Pregnancy Childbirth. 2008;8:27.

Sipsma HL, Magriples U, Divney A, Gordon D, Gabzdyl E, Kershaw T. Breastfeeding behavior among adolescents: initiation, duration, and exclusivity. J Adolesc Health. 2013;53(3):394–400.

Suárez-López L, de Castro F, Hubert C, de la Vara-Salazar E, Villalobos A, Hernández-Serrato MI, et al. Maternal and child healthcare and adolescent maternity in under 100 000 inhabitants communities. Salud Publica Mex. 2019;61(6):753–63.

Patel A, Banerjee A, Kaletwad A. Factors associated with prelacteal feeding and timely initiation of breastfeeding in hospital-delivered infants in India. J Hum Lact. 2013;29(4):572–8.

Boccolini CS, Carvalho ML, Oliveira MI. Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review. Rev Saude Publica. 2015;49:91.

Hall H, McLelland G, Gilmour C, Cant R. ´It’s those first few weeks´: women’s views about breastfeeding support in an Australian outer metropolitan region. Women Birth. 2014;27(4):259–65.

Kavle JA, LaCoix E, Dau H, Engmann C. Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications. Public Health Nutr. 2017;20(17):3120–34.

Sinha B, Chowdhury R, Sankar MJ, Martines J, Taneja S, Mazumder S, et al. Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):114–34.

Dunn RL, Kalich KA, Fedrizzi R, Phillips S. Barriers and contributors to breastfeeding in WIC mothers: a social ecological perspective. Breastfeed Med. 2015;10(10):493–501.

Théodore F, Bonvecchio A. Papel de la familia y apoyo social durante la lactancia [role of the family and social support during breastfeeding]. En: González de Cosío T, Hernández Cordero S. Lactancia materna en México [breastfeeding in Mexico]. Academia Nacional de Medicina de México, Mexico City. 2016. Retrieved from: https://www.anmm.org.mx/publicaciones/ultimas_publicaciones/LACTANCIA_MATERNA.pdf Accessed: 9 Sept 2019.

Rempel LA, Rempel JK. The breastfeeding team: the role of involved fathers in the breastfeeding family. J Hum Lact. 2011;27(2):115–21.

Pinzari L, Mazumdar S, Girosi F. A framework for the identification and classification of homogeneous socioeconomic areas in the analysis of health care variation. Int J Health Geogr. 2018;17(1):42.