Leung Gabriel M, Ho Lai-Ming, Lam Tai-Hing
Department of Community Medicine, The University of Hong Kong, Hong Kong, China.
Birth. 2002 Sep;29(3):162-8. doi: 10.1046/j.1523-536x.2002.00183.x.
Low breastfeeding rates are an issue of international public health concern. Anecdotal reports suggest very low breastfeeding rates in Asia, but no population-based studies have been conducted in the region. To determine the secular trend in breastfeeding practice in an Asian postindustrialized metropolitan community, we examined data from two population-based birth cohorts of Hong Kong infants in 1987 and 1997.
Annual population rates of breastfeeding initiation and duration were estimated from the birth cohorts, considering the change in breastfeeding rates over 10 years with correction for sociodemographic and birth characteristics. Factors associated with breastfeeding practice were identified using multivariate logistic regression modeling in a pooled analysis of individual data of both cohorts.
Overall, 26.8 percent of mothers initiated breastfeeding in 1987, and the rate increased to 33.5 percent in 1997. The rate would have been 27.4 percent in 1987 if the distributions of method of delivery, birthweight, birth order, maternal age, education, and employment status had been the same as in 1997. Only 7.6 percent of infants remained on the breast for more than 1 month in 1987 compared with 20.4 percent a decade later. Similarly, the rate for breastfeeding more than 3 months increased from 3.9 to 10.3 percent. Total breastfeeding duration was significantly longer in 1997 than 10 years earlier.
This is the first systematic report of secular variations of breastfeeding rates in Asia. Hong Kong should set higher but realistic goals for breastfeeding that emphasize both initiation and maintenance. Given the wide latitude for improvement in terms of readily modifiable risk factors, such as smoking and cesarean section, these new goals should focus on improving rates in these targeted groups where breastfeeding rates are lowest.
低母乳喂养率是一个国际公共卫生关注的问题。轶事报道表明亚洲的母乳喂养率极低，但该地区尚未开展基于人群的研究。为了确定亚洲一个后工业化大都市社区母乳喂养习惯的长期趋势，我们研究了1987年和1997年香港婴儿两个基于人群的出生队列的数据。
根据出生队列估计母乳喂养开始和持续时间的年度人口率，同时考虑10年间母乳喂养率的变化，并对社会人口学和出生特征进行校正。在对两个队列的个体数据进行汇总分析时，使用多变量逻辑回归模型确定与母乳喂养习惯相关的因素。
总体而言，1987年26.8%的母亲开始母乳喂养，1997年这一比例增至33.5%。如果1987年的分娩方式、出生体重、出生顺序、母亲年龄、教育程度和就业状况分布与1997年相同，那么该年的母乳喂养率将为27.4%。1987年只有7.6%的婴儿纯母乳喂养超过1个月，而十年后这一比例为20.4%。同样，母乳喂养超过3个月的比例从3.9%增至10.3%。1997年的纯母乳喂养总持续时间显著长于10年前。
这是亚洲母乳喂养率长期变化的首份系统报告。香港应为母乳喂养设定更高但切实可行的目标，同时强调开始和持续进行母乳喂养。鉴于在如吸烟和剖宫产等易于改变的风险因素方面仍有很大的改进空间，这些新目标应着重提高这些母乳喂养率最低的目标群体的母乳喂养率。
