National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China.
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China.
Int Breastfeed J. 2020 Nov 3;15(1):92. doi: 10.1186/s13006-020-00334-4.
The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months.
Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses.
Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included "breastfeeding within one hour after birth" (74.29% vs. 59.09%), "breastfeeding on demand" (86.48% vs. 75.00%), and "never use a pacifier" (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563).
These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.
婴儿友好医院倡议通常被认为是促进母乳喂养的有效途径。尽管中国拥有世界上数量最多的婴儿友好型医院，但针对中国婴儿友好实践的研究有限，而 6 个月时的纯母乳喂养率（EBF）为 20.7%，低于全球 2025 年 50%的目标。因此，确定在中国仍然是 EBF 显著障碍的因素非常重要。为了探讨关键的婴儿友好实践如何影响中国的 EBF 持续时间，我们使用病例对照研究比较了婴儿友好相关实践对 3 个月时 EBF 和非母乳喂养（NBF）母亲的影响，并调查了单一和综合婴儿友好实践在促进 3 个月时 EBF 持续时间方面的影响，这是迈向 6 个月时 EBF 的一步。
参与者来自中国西部（重庆）、东部（青岛）、南部（柳州）和中部（马鞍山）的四家妇幼保健院。2018 年 4 月至 2019 年 3 月，通过自我报告问卷对 421 名 3 个月大婴儿的母亲（245 名 EBF 组，176 名 NBF 组）进行了调查。通过是/否问题评估了住院期间婴儿友好实践和母乳喂养的经历。使用二变量和多变量逻辑回归分析了影响 3 个月母乳喂养的社会人口因素。
在 EBF 组中，65.57%的母亲报告至少进行了 7 项婴儿友好实践，而 NBF 组中只有 47.72%的母亲报告进行了 7 项以上。在 EBF 组中，进行婴儿友好实践的母亲明显多于 NBF 组。这些做法包括“产后一小时内进行母乳喂养”（74.29%比 59.09%）、“按需母乳喂养”（86.48%比 75.00%）和“从不使用奶嘴”（46.53%比 31.25%）。调整混杂变量后，我们发现进行少于 7 项婴儿友好实践的母亲母乳喂养的可能性比进行 7 项或更多婴儿友好实践的母亲低 1.7 倍（比值比 [OR] 1.720，95%置信区间 [CI] 1.106，2.667）。此外，不按需母乳喂养的母亲母乳喂养至 3 个月的可能性与不母乳喂养至 3 个月的母亲相同（OR 2.263，95% CI 1.265，4.049），住院期间不母乳喂养的母亲也是如此（OR 4.379，95% CI 1.815，10.563）。
这些来自中国医院的数据表明，更高程度地遵守婴儿友好实践可能对 3 个月时的 EBF 产生积极影响，特别是在促进中国按需母乳喂养和住院期间母乳喂养方面。
