Breastfeeding Practices & Determinants

The assignment delves into a comprehensive analysis of breastfeeding practices worldwide. It examines various aspects, including global trends, cultural influences, socioeconomic determinants, and the impact of marketing practices on breastfeeding choices. The analysis aims to identify key factors that contribute to both successful and suboptimal breastfeeding practices. Furthermore, it emphasizes the importance of implementing evidence-based interventions to promote and support breastfeeding globally.

Running Head: Health Advancement and Promotion
Health Advancement and Promotion
Name of the Student
Name of the University
Author Note

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Introduction
The best form of preventive medicine is known to be breastfeeding. It is the natural form
of medicine for the child. However, globally 1.5 million deaths are reported due to the
breastfeeding practices that are inappropriate or suboptimal. Children who are breastfeed
exclusively in 4 months constitute only 38% of the infants (Victora et al., 2016). According to
Lind et al. (2014), breastfeeding if universally practices in the first six months of life could save
under 5 deaths of infants (approximately 13%). According to World Health organisation,
breastfeeding should start within one hour after giving birth (Piwoz & Huffman, 2015).
However, the breastfeeding rate internationally is extremely variable. In the low and the middle-
income countries, the challenge is to start breastfeeding within one hour. In the high-income
countries it is observed that highly educated women and those well of are like to start this
practice (Sutton et al., 2016). The aim of the assignment is to understand the factors that will
work best to promote the breastfeeding for women and society. For this purpose, a systematic
review is conducted. The results are concluded with the clear and succinct objectives for a new
health promotion intervention based on the assessment of the evidence that is collected.
What motivated this review?
The systematic review on this topic is conducted because the children who are breastfeed
are more likely to survive the first few months of life. This issue is important because women
face several challenges to breastfeeding. These may include busy schedule of working women,
lack of flexible working days, lack of appropriate spaces for this practice without feeling of
embarrassment, poor policy formulation pertaining to this area, excess advertisement of the
substitutes for breast milk (Ogbo et al., 2015). Thus, it is important to have new ways for

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prompting breastfeeding. Although, there is a good amount of research pertaining to
breastfeeding, there is hardly any systematic review on new ways of its promotion. It is
therefore, important to know that the understand the factors that will work best to promote the
breastfeeding for women and society. The review would contribute to the better promotion of the
breastfeeding practices. It will also help the policy makers to deliver future interventions and
target subpopulation.
Search strategy
The database sources for the systematic review are the CINAHL, Google scholar,
PubMed, Scopus, and Web of science. These databases were searched to retrieve articles that are
published in English Language on different breastfeeding practices. The period chosen for the
review of the article includes 2010-2017. The rationale for this timescale is the aim of getting
latest information on the chosen topic (Moher et al., 2015). The rationale for choosing these
electronic databases are the wide range of articles that are available on different filed of subjects.
These databases give full text articles on life science and biomedical topics. The web of science
database provides citations of each article along with the references and the link on who has cited
it. The PubMed and the CINAHL databases contains more than 2900 journals, along with
number of government documents covering nursing, complementary medicines, biomedicine,
and 17 more allied health disciplines (Abdulla et al., 2016). Other than the electronic databases
government websites were also selected for additional information.
The main search terms used were “breastfeeding promotion”, “breastfeeding or feeding
practices interventions”. Other search terms includes “breastfeeding practices”, “infant or young
child” “suboptimal or optimal breastfeeding practices”, “complementary feeding practices” etc.

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To ensure effective search Boolean operators (mainly AND, OR) were used (Haroon et al.,
2013).
Inclusion and exclusion criteria (Haroon et al., 2013)
 The articles that were considered were ensured that they are related to
breastfeeding practices or feeding practices, early initiation of breastfeeding
practices, exclusive breastfeeding bottle feeding, or complementary feeding
practices and promotion techniques
 Articles that deviated from the selected concept such as feeding practices in HIV
mothers were excluded from the review
 Articles that updated on increase in breastfeeding practices in high income
countries after any type of promotion were included
 Studies that mentioned about early initiation of breastfeeding were included
 Feeding practices as per the specifications of WHO/UNICEF and as defined for
the infant and young child feeding indicators were considered (Piwoz & Huffman,
2015)
 The research methodology and the study design were also taken into the
consideration such as randomised controlled trials (with or without blinding),
cohort studies etc. on any breastfeeding promotion intervention
 Only articles with English publications were considered

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Records from database “breastfeeding practice” or “breastfeeding promotion” n = 700 Additional searches from Google scholar n = 350
Inclusion (n= 400) and Exclusion criteria (n =84) Excluded duplicated Records
n = 350
Access eligibility for full-text papers n = 134 Excluded article that were not full text n=95
Full text articles selected n = 39 Excluded articles from case reports, opinion pieces, and reviews n=29
Included articles from different sources (5 mix methods, 4 cohort, 8 cross sectional studies) n= 10 Website source
n = 1
Total articles included in this systematic review
11
Flow Chart
The figure given below shows the PRISMA diagram on how the articles were selected for
review.

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Summary evidence from the research findings
After reviewing about 11 articles, it was found that the poor growth and morbidity in the
children was attributed to the inappropriate breastfeeding and complementary feeding practices.
In low-income countries (such as Nigeria, Ghana, and Malawi), the feeding practices are very
poor when compared to middle and high-income countries (such as USA, Australia, UK). The
poor feeding practices were related with socio-economic factors such as household wealth,
maternal education, and individual parameters such as age of the mother and maternal and other
factors such as place of delivery and others. Breastfeeding practices were influenced by the
cultural belief. In Australia, poor breastfeeding practices were found in Aboriginal and Torres
Strait Islanders group. Australia is falling very short in meeting the exclusive breastfeeding
recommendations of WHO. Other than that 96% of the women in Australia initiate
breastfeeding. In countries like India, counselling initiatives taken by specific communities
considering the socioeconomic factors for example the peer counselling of mothers were found
to improve the breastfeeding practices. Other than that use of the change agents such as
volunteers, nurses, physicians for counselling improved the breastfeeding rate. Women receiving
education on breastfeeding showed significant improvement in both the high and the low income
countries. However, the rate of breastfeeding within the first hour after birth did not improve.
The baseline breastfeeding rates were significantly low in minority ethnic women and low-
income women in USA and Australia. There was overall little evidence on the strategies related
to social media or multimedia, community group for breastfeeding or early mother-infant contact
in improving the breastfeeding initiation.

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Conclusion
The conclusion from the evidence includes success of community-based interventions
and facility based promotions in improving the breastfeeding practices. It can be concluded from
the evidence collected that there is need of identifying the specific interventions that are likely to
be effective in different population groups. This needs high quality research. The set of
interventions that were found to be most effective in increasing the breastfeeding practices are
use of trained volunteers, midwives, nurses, for delivering the education sessions for new
mothers and counselling sessions can increase the breastfeeding sessions. Thus, a new health
promotion intervention is required that will encompass all of them as each of them are effective.
Hence, overall this intervention will be effective.
New health promotion intervention based on the evidence
The study objective is to- Introduce a new health promotion intervention.
This intervention will comprise of set of other effective promotion strategies. The steps of
intervention will be to –
 Provide prenatal breastfeeding education – It will include antenatal classes for
each intervention group. It will also involve addressing family concerns. Further,
education will also comprise of video classes and breastfeeding pamphlet. It will
create awareness on the importance of breastfeeding soon after birth and hazards
associated with formula
 Professional lactation support- Members of intervention group will be visited by
the lactation expert for 15-30 minutes. The rationale is to provide hand on support
on breastfeeding positioning and concerns related to it. Experts will visit the

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house of the individual mothers in the intervention group to ensure continuity of
breastfeeding after discharge. Visiting days may include 1, 3, 7 and 15. Monthky
visits will be provided until 6 months postpartum. For reaching other women
living in remote area a 24 hour hotline service via telephone will be given
 Use of social media for increase promotion by mass awareness and social
network. Use of Facebook pages and Twitter for strengthening existing social
linkages. Develop new social linkages through flyers for inviting mother who
want to support the cause.
This health promotion technique involves multiple methods and it is suggested to deliver
by an informal approach such as face-to-face contact, home visit, hospital visit, telephone call for
giving detailed set of information and instructions to the new mothers. This intervention is based
on the review of various other strategies merged from literature.
Study objectives from the evidence
To improve the feeding practices of mothers in high and low income regions and ethnic
minorities in Australia-
 Use of intervention that encompass all the other health promotion strategies that
were individually effective as suggested above
 To liase with the non-government and the government bodies on how to
formulate policies for new health promotion intervention and for implementation
of current policies and guidelines for the infant feeding practices

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Need of future research
There is a need of more research in low and the middle-income countries to know the
factors that can promote breast-feeding right after birth in low-income women. There is need of
identifying the specific interventions that are likely to be effective in different population groups
(Sutton et al., 2016).

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