Breastfeeding practices and associated factors in Hong Kong Chinese mothers

Abstract

There has been increasing recognition of the unparalleled benefits of breastfeeding, and since the end of last century, a growing number of mothers have initiated breastfeeding. The duration of any and exclusive breastfeeding, however, remain far short of WHO recommendations of exclusive breastfeeding for the first six months with continued breastfeeding up to two years or more. Breastfeeding is a complex process influenced by a number of factors such as maternal and family characteristics, hospital practices, and support variables. This thesis took advantage of a large (n=2560), prospective cohort of Hong Kong Chinese mothers to assess and compare breastfeeding practices in two time periods, 2006-07 and 2011-12, to investigate the prevalence, predictors, and consequences of expressed breast milk feeding, and to examine the effects of a number of factors on breastfeeding duration and exclusivity, including previous breastfeeding experience, maternal employment-related factors, intrapartum interventions and breastfeeding support from the mother’s social networks.

Two cohorts of participants were recruited from the obstetric units of four public hospitals in Hong Kong in 2006-07 (n=1320) and 2011-12 (n=1240). Participants were followed up through telephone interviews at 1, 2, 3, 6, 9, and 12 months after birth or until they stopped breastfeeding, whichever came first. Multiple methods were employed in data analysis throughout the thesis such as chi-square tests, logistic regression models, and Cox proportional hazards models. The breastfeeding rates were higher in the 2011-12 cohort at each time point across the first year after birth compared with the 2006-07 cohort. There was a substantial increase in the rates of exclusive expressed breast milk feeding for infants receiving breast milk at each follow-up time point within the first six months, which was shown to be negatively associated with the total duration of breastfeeding compared with direct feeding at the breast. Multiparous mothers with no or a short previous breastfeeding duration were more likely to stop breastfeeding than those with a longer previous breastfeeding duration. In mothers who returned to work postpartum, later return to work, shorter working hours, parental childcare, and higher maternal education were associated with lower risks of stopping any or exclusive breastfeeding. Although there was no effect of individual intrapartum interventions on the breastfeeding duration, experiencing multiple interventions significantly increased the hazards of discontinuation of breastfeeding. Preferences for exclusive breastfeeding from significant family members and having a role model played important roles in reducing the risks of early breastfeeding cessation. Breastfeeding practices in this population remain far from optimal. Additional attention and support should be provided to mothers who exclusively feed their infants expressed breast milk, had no or a short previous breastfeeding experience, have unfavorable working environments, had multiple intrapartum interventions, or received negative breastfeeding support. Both observational and interventional studies are needed for in-depth understanding of breastfeeding practices and associated factors and for further breastfeeding promotion.