Breastfeeding Practices and Associated Factors in Shanghai: A Cross-Sectional Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Study Participants
2.2. Questionnaire, Data Collection and Management
2.3. Breastfeeding Indicators
2.4. Statistical Analysis
3. Results
3.1. Demographic Characteristics
3.2. Breastfeeding Indicators
3.3. Determinants of Exclusive Breastfeeding
3.3.1. Maternal Educational Level and Feeding Intentions in Pregnancy (or the Prenatal Period)
3.3.2. Workplace and Employment
3.3.3. Health Professional Support
3.3.4. Marketing of Formula Milk and Exclusive Breastfeeding
4. Discussion
4.1. Current Situation of Breastfeeding Practices in Shanghai
4.2. Workplace and Employment
4.3. Health Professional Support
4.4. Marketing of Formula Milk
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | N (%) |
---|---|
Maternal age at delivery | |
20–24 y | 110 (6.5) |
25–29 y | 578 (34.5) |
30–34 y | 694 (41.4) |
≥35 y | 295 (17.6) |
Ethnicity | |
Han | 1636 (97.6) |
Minorities | 41 (2.4) |
Marital status | |
Married/co-habiting | 1656 (98.8) |
Other | 21 (1.2) |
Educational level | |
Senior high or below | 241 (14.4) |
Bachelor’s degree | 1209 (72.1) |
Master’s or above | 213 (12.7) |
Don’t know/refuse to answer | 14 (0.8) |
Employment status | |
Full-time employed | 1177 (70.2) |
Work informally/Part-time employed | 97 (5.8) |
Housewife | 403 (24.0) |
Type of employee | |
State civil servant | 231(18.1) |
State-owned enterprise | 203(15.9) |
Multinational company | 240(18.8) |
Private enterprise | 375 (29.4) |
Self-employed | 79 (6.2) |
Others | 146 (11.5) |
Annual household income | |
<150,000 CNY | 682 (40.7) |
150,000–300,000 CNY | 514 (30.6) |
>300,000 CNY | 288 (17.2) |
Don’t know/refuse to answer | 193 (11.5) |
Antenatal feeding intentions | |
Exclusive breastfeeding | 1036 (61.8) |
Mixed milk feeding | 513 (30.6) |
Not breastfed | 16 (0.9) |
No plan | 112 (6.7) |
The first child | |
Yes | 1290 (76.9) |
No | 387(23.1) |
Gender of child | |
Boy | 859 (51.2) |
Girl | 818 (48.8) |
Delivery mode | |
Vaginal birth | 1066 (63.6) |
Caesarean section | 611 (36.4) |
Gestational age | |
Pre-term (28–36+6 gestational weeks) | 96 (5.7) |
Full-term (≥37 gestational weeks) | 1581 (94.3) |
Birth weight | |
<2500 g | 74 (4.4) |
2500–3499 g | 1507 (89.9) |
≥4000 g | 96 (5.7) |
BMS marketing massage received * | |
Pre-conception | 474(28.3) |
Pregnancy | 1602(95.5) |
Postnatal | 1614(96.2) |
Indicators | Percentage (%) | |
---|---|---|
1 | Ever breastfed (EvBF) | 96.4 (2569/2665) |
2 | Early initiation of breastfeeding (EIBF) | 60.3 (1608/2665) |
3 | Exclusive breastfeeding under 6 months (EBF) | 43.4 (727/1677) |
0–1 month | 43.2 (235/544) | |
2–3 months | 47.3 (320/676) | |
4–5 months | 37.6 (172/457) | |
0–3 months | 45.5 (555/1220) | |
4 | Mixed milk feeding under six months (MixMF) | 24.8 (416/1677) |
0–1 month | 28.7 (156/544) | |
2–3 months | 21.8 (147/676) | |
4–5 months | 24.7 (113/457) | |
5 | Continued breastfeeding 12–23 months (CBF) | 18.4 (100/543) |
12–15 months | 25.3 (61/241) | |
16–19 months | 13.2 (26/197) | |
20–23 months | 12.4 (13/105) |
Variable | Percentage of EBF | Univariable Model | |
OR (95% CI) | p-Value | ||
Maternal age at delivery, years | 0.546 | ||
≤24 | 40.91% | 1.02 (0.66, 1.50) | |
25–29 | 45.16% | 1.22 (0.92, 1.62) | |
30–34 | 43.52% | 1.14 (0.86, 1.53) | |
≥35 | 40.34% | 1.00 | |
Educational level | <0.001 | ||
Master’s or above | 51.17% | 2.56 (1.74,3.78) | |
Bachelor’s degree | 45.08% | 2.00 (1.48,2.71) | |
Senior high or below | 29.05% | 1.00 | |
Employment status | 0.004 | ||
Housewife | 43.18% | 0.94 (0.75, 1.18) | |
Part-time employed | 26.80% | 0.45 (0.28, 0.72) | |
Full-time employed | 44.77% | 1.00 | |
Type of employee | 0.047 | ||
State civil servant | 49.78% | 1.00 | |
State-owned enterprise | 48.77% | 0.96 (0.66,1.40) | |
Multinational company | 43.75% | 0.79 (0.55,1.13) | |
Private enterprise | 38.73% | 0.64 (0.46,0.89) | |
Self-employed | 37.50% | 0.61 (0.36,1.02) | |
Others | 40.27% | 0.68 (0.45,1.03) | |
Annual household income | <0.001 | ||
>300,000 CNY | 50.00% | 1.70 (1.28,2.24) | |
150,000–300,000 CNY | 47.28% | 1.52 (1.21,1.92) | |
<150,000 CNY | 37.10% | 1.00 | |
Gestational age | 0.005 | ||
Full-term | 44.21% | 1.92 (1.23, 3.02) | |
Pre-term | 29.17% | 1.00 | |
Delivery mode | 0.003 | ||
Vaginal birth | 46.06% | 1.36 (1.11, 1.66) | |
Caesarean section | 38.63% | 1.00 | |
Paid maternity leave | 0.029 | ||
≥120 days | 47.07% | 1.35 (1.03,1.77) | |
<119 days | 39.74% | 1.00 | |
Antenatal feeding intention | <0.001 | ||
Exclusive breastfeeding | 57.05% | 5.70 (4.44, 7.32) | |
Mixed milk feeding | 18.90% | 1.00 | |
Viewpoint on the statement “Breast milk is beneficial to children intellectual development” | <0.001 | ||
Beneficial | 38.94% | 1.62 (1.07, 2.45) | |
Beneficial with proper raising environment | 48.67% | 2.41 (1.61, 3.60) | |
Not related | 28.24% | 1.00 | |
Viewpoint on the statement “Lower risk of obesity and diabetes for breast milk” | <0.001 | ||
Yes, I agree | 55.31% | 2.09 (1.65,2.65) | |
Partly agree, Need further verification | 45.03% | 1.38 (1.09,1.76) | |
I have never heard of it before | 37.19% | 1.00 | |
Participation in breastfeeding classes | 0.021 | ||
Yes | 45.78% | 1.26 (1.04, 1.53) | |
No | 40.11% | 1.00 | |
Overall satisfaction of information and support provided by healthcare system after delivery | 0.014 | ||
Satisfied | 46.12% | 1.98 (1.15, 3.43) | |
Not satisfied | 30.16% | 1.00 | |
Initiated early breastfeeding within an hour after birth | <0.001 | ||
Yes | 1.88 (1.54,2.30) | ||
No | 1.00 | ||
Advertisement state that “formula milk can make children sleep well and reduce crying at night” | 0.3250 | ||
Will try | 36.56% | 1.38 (0.89,2.14) | |
Will gather more information before making decisions | 42.65% | 1.29 (0.82,2.03) | |
Won’t try | 44.33% | 1.00 |
Adjusted OR (95% CI) * | p-Value | |
---|---|---|
Antenatal feeding intention | <0.001 | |
Exclusive breastfeeding | 4.87 (3.46, 6.84) | |
Mixed milk feeding | 1.00 | |
Viewpoint on the statement “lower risk of obesity and diabetes for breast milk” | 0.007 | |
Yes, I agree | 1.56 (1.08,2.25) | |
Partly agree, Need further verification | 1.31 (0.88,1.96) | |
I have never heard of it before | 1.00 | |
Overall satisfaction of information and support provided by healthcare system after delivery | 0.030 | |
Satisfied | 2.56 (1.13, 5.80) | |
Not satisfied | 1.00 |
EBF | MixMF | Not Breastfed | p-Value | |
---|---|---|---|---|
% | % | % | ||
Educational level | N1 = 724 | N2 = 416 | N3 = 534 | <0.0001 |
Senior high or below | 70 (29.1) | 52 (21.6) | 119 (49.4) | |
Bachelor’s degree | 545 (45.1) | 295 (24.4) | 369 (30.5) | |
Master’s or above | 109 (51.2) | 68 (31.9) | 36 (16.9) |
EBF | MixMF | Not Breastfed | p-Value | |
---|---|---|---|---|
% | % | % | ||
Attitude toward benefits of breast milk and formula | 0.863 | |||
Different | 600 (86.2) | 345 (85.2) | 412 (85.3) | |
Almost the same | 96 (13.8) | 60 (14.8) | 71 (14.7) | |
Viewpoint of relationship between breastfeeding and children intellectual development | <0.0001 | |||
Beneficial | 250 (34.4) | 132 (31.7) | 260 (48.7) | |
Beneficial with proper raising environment | 440 (60.5) | 237 (57.0) | 227 (42.5) | |
Not related | 37 (5.1) | 47 (11.3) | 47 (8.8) | |
Viewpoint of lower risk of obesity and diabetes for breastfed children | <0.0001 | |||
I have never heard of it before | 331 (45.5) | 220 (52.9) | 339 (64.5) | |
Need further verification | 172 (23.7) | 101 (24.3) | 109 (20.4) | |
Yes, I agree | 224 (30.8) | 95 (22.8) | 86 (16.1) | |
Attitude toward “Formula milk can make children sleep well and reduce crying at night” | <0.0001 | |||
Will try | 34 (5.0) | 10 (2.5) | 49 (9.9) | |
Will gather more information before making decisions | 186 (27.3) | 123 (30.8) | 133 (26.9) | |
Won’t try | 461 (67.7) | 266 (66.7) | 313 (63.2) |
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Hao, Y.; Wang, L.; Wang, C.; Peng, A.; Gao, W.; Marc, I.; Semenic, S.; Fraser, W.D.; Narayan, A.; Wu, Y.; et al. Breastfeeding Practices and Associated Factors in Shanghai: A Cross-Sectional Study. Nutrients 2022, 14, 4429. https://doi.org/10.3390/nu14204429
Hao Y, Wang L, Wang C, Peng A, Gao W, Marc I, Semenic S, Fraser WD, Narayan A, Wu Y, et al. Breastfeeding Practices and Associated Factors in Shanghai: A Cross-Sectional Study. Nutrients. 2022; 14(20):4429. https://doi.org/10.3390/nu14204429
Chicago/Turabian StyleHao, Yanhui, Lulu Wang, Caifeng Wang, Aiping Peng, Wei Gao, Isabelle Marc, Sonia Semenic, William D. Fraser, Anuradha Narayan, Yanting Wu, and et al. 2022. "Breastfeeding Practices and Associated Factors in Shanghai: A Cross-Sectional Study" Nutrients 14, no. 20: 4429. https://doi.org/10.3390/nu14204429