Abstract
Objectives
According to Health Canada and the Canadian Paediatric Society, infants should be exclusively breastfed for the first six months with continued breastfeeding for two years and beyond. This study examined the relationship between a mother’s intention to supplement with infant formula and the risk of discontinuing breastfeeding during the 12 months postpartum.
Methods
Surveys were administered to a cohort of mothers at 6 weeks, 6 months and 12 months postpartum as part of York Region’s Infant Feeding Survey. Those who initiated breastfeeding were included in the analysis (n=345). The relationship between a mother’s prenatal intention to supplement with infant formula and breastfeeding duration was examined using Cox proportional hazards regression controlling for mother’s age, prenatal education, immigration status, parity, household income, mother’s ethnicity and education.
Results
Nearly one third of mothers intended to supplement with infant formula. Of those mothers, 69% actually supplemented their baby with infant formula within 12 months postpartum. Intention to supplement was found to be associated with shorter breastfeeding duration (HR=2.64, 95% CI 1.83-3.81). First-time mothers experienced shorter breastfeeding duration compared to experienced mothers (HR=2.13, 95% CI 1.39-3.27). Mothers who identified as European experienced shorter breastfeeding duration compared to East, Southeast or South Asian mothers (HR=1.79, 95% CI 1.05-3.06).
Conclusions
Continued breastfeeding is not only beneficial for the infant, but it also has important benefits for the mother. The analysis indicates that a mother’s prenatal intent to supplement may be associated with shorter breastfeeding duration. Further research is required to confirm these findings and to address the underlying assumptions and limitations.
Key Words: Breastfeeding, cessation, intention, supplementation, risk factors, Proportional Hazards Models
Résumé
Objectifs
Selon Santé Canada et la Société canadienne de pédiatrie, les nourrissons devraient être exclusivement allaités pendant les six premiers mois, et l’allaitement maternel devrait se poursuivre pendant deux ans et plus. Nous examinons la relation entre l’intention d’une mère de compléter le lait maternel avec de la préparation pour nourrissons et le risque qu’elle cesse d’allaiter au cours des 12 mois qui suivent l’accouchement.
Méthode
Des sondages ont été administrés à une cohorte de mères à 6 semaines, 6 mois et 12 mois du post-partum dans le cadre du sondage «Infant Feeding Survey» de la Région de York. Les mères ayant commencé à allaiter leur enfant étaient incluses dans l’analyse (n=345). À l’aide du modèle de régression à effet proportionnel de Cox, nous avons étudié la relation entre l’intention prénatale d’une mère de compléter le lait maternel avec de la préparation pour nourrissons et la durée de l’allaitement, après avoir apporté des ajustements pour tenir compte des effets de l’âge de la mère, de l’enseignement prénatal, du statut d’immigration, de la parité, du revenu du ménage, ainsi que de l’ethnicité et du niveau d’instruction de la mère.
Résultats
Près du tiers des mères avaient l’intention de compléter leur lait avec de la préparation pour nourrissons. De ces mères, 69 % offraient en effet de la préparation pour nourrissons à leur bébé en plus du lait maternel dans les 12 mois post-partum. L’intention de compléter le lait maternel était associée à une durée d’allaitement abrégée (indice de risque (IR)=2,64, intervalle de confiance (IC) de 95 %: 1,83-3,81). La durée de l’allaitement était plus courte chez les mères primipares que chez les mères multipares (IR=2,13, IC de 95 %: 1,39-3,27). Cette durée était aussi plus courte chez les mères s’identifiant comme d’ascendance européenne que chez les mères venant de l’Asie de l’Est, du Sud-Est ou du Sud (IR=1,79, IC de 95 %: 1,05-3,06).
Conclusions
L’allaitement continu est bénéfique pour le nourrisson, mais comporte aussi d’importants avantages pour la mère. Notre analyse montre que l’intention prénatale de compléter le lait maternel peut être associée à une durée d’allaitement abrégée. Il faudrait pousser la recherche pour confirmer ces constatations et aborder les hypothèses et les contraintes sous-jacentes.
Mots Clés: allaitement maternel, arrêt, intention, compléments alimentaires, facteurs de risque, modèles à risques proportionnels
Footnotes
Acknowledgements: This study was supported by York Region Public Health. The authors are grateful to Caitlin Johnson for assistance with the analysis and review of the manuscript.
Conflict of Interest: None to declare.
References
- 1.Health Canada. Nutrition for Healthy Term Infants: Recommendations from birth to six months. 2012. [DOI] [PubMed] [Google Scholar]
- 2.Pound C, Unger S. The baby-friendly initiative: Protecting, promoting and supporting breastfeeding. Paediatr Child Health. 2012;17(6):317–21. [PMC free article] [PubMed] [Google Scholar]
- 3.WHO. Maternal, Newborn, Child and Adolescent Health: Breastfeeding. 2012. [Google Scholar]
- 4.American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–e841. doi: 10.1542/peds.2011-3552. [DOI] [PubMed] [Google Scholar]
- 5.Al-Sahab B, Lanes A, Feldman M, Tamim H. Prevalence and predictors of 6-month exclusive breastfeeding among Canadian women: A national survey. BMC Pediatrics. 2010;10(20):1–9. doi: 10.1186/1471-2431-10-20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Kehler HL, Chaput KH, Tough SC. Risk factors for cessation of breastfeeding prior to six months postpartum among a community sample of women in Calgary, Alberta. Can J Public Health. 2009;100(5):376–80. doi: 10.1007/BF03405274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Semenic S, Loiselle C, Gottlieb L. Predictors of the duration of exclusive breastfeeding among first-time mothers. Res Nurs Health. 2008;31(5):428–41. doi: 10.1002/nur.20275. [DOI] [PubMed] [Google Scholar]
- 8.Simard I, O’Brien H, Beaudoin A, Turcotte D, Damant D, Ferland S, et al. Factors influencing the initiation and duration of breastfeeding among low-income women followed by the Canada Prenatal Nutrition Program in 4 regions of Quebec. J Hum Lact. 2005;21(3):327–37. doi: 10.1177/0890334405275831. [DOI] [PubMed] [Google Scholar]
- 9.Dennis CL, Gagnon A, Hulst AV, Dougherty G, Wahoush O. Prediction of duration of breastfeeding among migrant and Canadian-born women: Results from a multi-center study. J Pediatr. 2013;162(1):72–79. doi: 10.1016/j.jpeds.2012.06.041. [DOI] [PubMed] [Google Scholar]
- 10.Clifford TJ, Campbell MK, Speechley KN, Gorodzinsky F. Factors influencing full breastfeeding in a southwestern Ontario community: Assessments at 1 week and at 6 months postpartum. J Hum Lact. 2006;22(3):292–304. doi: 10.1177/0890334406290043. [DOI] [PubMed] [Google Scholar]
- 11.Dubois L, Manon G. Social determinants of initiation, duration and exclusivity of breastfeeding at the population level. Can J Public Health. 2003;94(4):300–5. doi: 10.1007/BF03403610. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality (US); 2007. [PMC free article] [PubMed] [Google Scholar]
- 13.Gagnon A, Leduc G, Waghorn K, Yang H, Platt R. In-hospital formula supplementation of healthy breastfeeding newborns. J Hum Lact. 2005;21(4):397–405. doi: 10.1177/0890334405280835. [DOI] [PubMed] [Google Scholar]
- 14.Biro MA, Sutherland GA, Yelland JS, Hardy P, Brown SJ. In hospital formula supplementation of breastfed babies: A population based survey. Birth. 2011;38(4):302–10. doi: 10.1111/j.1523-536X.2011.00485.x. [DOI] [PubMed] [Google Scholar]
- 15.Holmes AV, Auinger P, Howard CR. Combination feeding of breast milk and formula: Evidence for shorter breast-feeding duration from the National Health and Nutrition Examination Survey. J Pediatr. 2011;159(2):186–91. doi: 10.1016/j.jpeds.2011.02.006. [DOI] [PubMed] [Google Scholar]
- 16.Azjen I, Fishbein M. Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. J Exper Soc Psych. 1986;22:453–74. doi: 10.1016/0022-1031(86)90045-4. [DOI] [Google Scholar]
- 17.Donath S, Amir L. The ALSPAC Study Team. Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: A cohort study. Acta Paediatr. 2003;92:352–56. doi: 10.1111/j.1651-2227.2003.tb00558.x. [DOI] [PubMed] [Google Scholar]
- 18.Martens P, Young T. Determinants of breastfeeding in four Canadian Ojibwa communities: A decision-making model. Am J Hum Biol. 1997;9(5):579–93. doi: 10.1002/(SICI)1520-6300(1997)9:5<579::AID-AJHB6>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
- 19.Kronborg H, Væth M. The influence of psychosocial factors on the duration of breastfeeding. Scand J Public Health. 2004;32(3):210–16. doi: 10.1080/14034940310019218. [DOI] [PubMed] [Google Scholar]
- 20.Chalmers B, Levitt C, Heaman M, O’Brien B, Sauve R, Kaczorowski J. Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth. 2009;36(2):122–32. doi: 10.1111/j.1523-536X.2009.00309.x. [DOI] [PubMed] [Google Scholar]
- 21.Corak M, Lipps G, Zhao J. Family income and participation in post-secondary education. Ottawa, ON: Statistics Canada; 2003. [Google Scholar]
- 22.Picot G, Hou F. The rise in low-income rates among immigrants in Canada. Ottawa: Statistics Canada; 2003. [Google Scholar]
- 23.Statistics Canada. Forty-year-old mothers of pre-school children: A profile. 2009. [Google Scholar]
- 24.Peduzzi P, Concato J, Feinstein A, Holford T. Importance of events per independent variable in proportional hazards regression analysis: Accuracy and precision of regression estimates. J Clin Epidemiol. 1995;48(12):1503–10. doi: 10.1016/0895-4356(95)00048-8. [DOI] [PubMed] [Google Scholar]
- 25.Thulier D, Mercer J. Variables associated with breastfeeding duration. JOGNN. 2009;38:259–68. doi: 10.1111/j.1552-6909.2009.01021.x. [DOI] [PubMed] [Google Scholar]
- 26.Adams C, Beger R, Conning P, Cruikshank L, Dore K. Breastfeeding trends at a community breastfeeding center: An evaluative survey. JOGNN. 2001;30:392–400. doi: 10.1111/j.1552-6909.2001.tb01558.x. [DOI] [PubMed] [Google Scholar]
- 27.Salt M, Law C, Bull A, Osmond C. Determinants of breastfeeding in Salisbury and Durham. J Pub Health Med. 1994;16(3):291–95. [PubMed] [Google Scholar]
- 28.Bourgoin GL, Lahaie NR, Rheaume BA, Berger MG, Dovigi CV, Picard LM, Sahai VF. Factors influencing the duration of breastfeeding in the Sudbury region. Can J Public Health. 1997;88:238–41. doi: 10.1007/BF03404789. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.World Health Organization. World Health Statistics 2009. Geneva: WHO Press; 2009. [Google Scholar]
- 30.Whalen B, Cramton R. Overcoming barriers to breastfeeding continuation and exclusivity. Curr Opin Pediatr. 2010;22(5):655–63. doi: 10.1097/MOP.0b013e32833c8996. [DOI] [PubMed] [Google Scholar]