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Factors predicting the practice of breastfeeding in Africa and USA
AuthorApanga, Paschal Awingura
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The benefits of exclusive breastfeeding (EBF) are well documented. However, EBF is often not practiced both in the United States and in low-and middle-income countries (LMICs). It is therefore important to further characterize factors that might lead to increased breastfeeding and the subsequent benefits obtained by breastfeeding. In the first study, we used data on 247,090 mothers with children 5 months old or less from Multiple Indicator Cluster Surveys (MICSs) in 19 African countries to assess whether access to an improved water supply and water-fetching were associated with mothers' practice of EBF using complex survey procedures. While the first study used observational data, the second study analyzed data from a longitudinal cohort of 329 mothers with children 5 months old or less in Mozambique. In the second study, we validated the maternal reported measure of EBF and used it to assess the relationship between time spent water-fetching and EBF, and between a woman’s intent to exclusively breastfeed during pregnancy and EBF practice. We also assessed whether access to an improved water supply moderates the relationship between EBF and diarrhea using multivariable mixed models. While the first two studies took place in Africa, the third study was conducted among 1161 low-income mothers with children 5 months of age or less participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in seven program locations in the United States. In the third study, we assessed the relationship between laws supporting breastfeeding and EBF and assessed whether this association varied by employment status. We also assessed how mother’s exposure to WIC breastfeeding consultation was associated with EBF using multivariable mixed models.In the first and second studies, there was evidence that access to an improved water supply and water-fetching were not associated with EBF; however, many mothers spent a significant amount of time water-fetching in many of the countries. While access to an improved water supply did not modify the relationship between EBF and diarrhea in the second study, a mother’s intention to exclusively breastfeed during pregnancy was associated with EBF following birth. In the third study, infants whose mothers were employed were less likely to be exclusively breastfed, but our effect modification analyses showed that laws supporting breastfeeding at the workplace may promote EBF among employed women. Mothers who received a WIC breastfeeding consultation were more likely to exclusively breastfeed than those who did not receive such a consultation. Our study can be used to understand which factors are associated with EBF, which will be important for policy makers interested in increasing breastfeeding rates. Our study also adds to the evidence that EBF improves child health. Our study also lends support to the WHO’s call to increase the prevalence of EBF globally, and the Sustainable Development Goal (SDG) target 6.1, which promotes universal access to drinking water.