Journal of Paediatrics and Child Health ( IF 1.7 ) Pub Date : 2024-04-04 , DOI: 10.1111/jpc.16525
The Complexity of When and Why Women Stop Breastfeeding in a Culturally Diverse Population
Melov SJ1,2, Elhindi J1, White L3, Donnolley K4, Jones R5, Simmons M5, Pasupathy D1
1 Reproduction and Perinatal Centre, The University of Sydney, Sydney, Australia; 2 Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, Australia; 3 Division of Women's and Children's, Blacktown and Mount Druitt Hospitals, Blacktown, Australia; 4 Consumer Representative, Western Sydney Local Health District, NSW, Australia; 5 Women's and Newborn Health, Westmead Hospital, Westmead, Australia
Email: sarah.melov@health.nsw.gov.au
Background: In March 2020 the Sydney BLISS (Breastfeeding Length Intensity Scoring System) check was introduced into routine antenatal care to improve breastfeeding support. We aimed to identify key reasons for breastfeeding cessation over time to inform targeted education.
Methods: Retrospective cohort study from March 2020 – September 2022 utilising routine data.
Multivariate generalised estimating equations with logistic link function, exchangeable correlation structure, and natural spline modelled the relationship between breastfeeding duration and reason cited for cessation. Marginal estimates over a grid of breastfeeding durations were used to rank the effect of individual reasons at each time point.
Results: A total of 8,372 women met inclusion criteria; 67% were born overseas, the mean age was 33 and 61% were primiparous. The median duration of breastfeeding was 9 months (IQR 4 – 16 months). There was a significant difference in the predominant reason for ceasing breastfeeding over time. The reason with the highest chance (47% 95% CI 44 – 51%) cited as the cause of breastfeeding cessation in the first month was perceived low breast milk supply; this reason persisted in the third month. At six months, the chance of breastfeeding cessation was high for baby lost interest (chance 19%; CI 17 – 21%), perceived low supply (chance 29%; 27 – 32%), and baby's age (chance 18%; CI 16 – 20%). Further differences emerged partitioned by maternal ethnicity (Table 1).
Conclusions: In a large cohort we identified variation over time and by ethnicity for rank of reason to stop breastfeeding. Individualised, culturally appropriate patient education is necessary to optimise support for breastfeeding women and their families.
Table 1: Duration and Ranked Reasons for Ceasing Breastfeeding by Self-Identified Ethnicity
| Ethnicity | Proportion of total cohort (n) | Breastfeeding duration median (IQR) | Predominant Ranked Reasons for Stopping Breastfeeding | ||
|---|---|---|---|---|---|
| 1 Month | 3 Months | 6 Months | |||
| Middle Eastern | 22% (1825) | 7 (3 – 14) | Perceived low supply Attachment Baby lost interest |
Perceived low supply Attachment Baby lost interest |
Perceived low supply Baby's age Baby lost interest |
| Other | 9% (718) | 8 (3 – 14) | Perceived low supply Attachment * |
Perceived low supply * |
Baby's age Perceived low supply Baby lost interest |
| Pacific Islander | 5% (387) | 7 (3 – 14) | Perceived low supply * |
Perceived low supply * |
Perceived low supply Baby's age * |
| South-East Asian | 16% (1320) | 9 (4 – 15) | Perceived low supply Work/study * |
Perceived low supply Work/study Baby's age |
Perceived low supply Baby's age Work/study |
| South Asian | 28% (2384) | 12 (6 – 18) | Perceived low supply * |
Low supply Baby's age * |
Perceived low supply Baby's age * |
| White | 21% (1738) | 8 (4 – 14) | Perceived low supply Attachment * |
Perceived low supply Attachment * |
Perceived low supply * |
| Overall | 100% (8,372) | 9 (4 – 16) | Perceived low supply Attachment * |
Low supply Attachment * |
Low supply Baby lost interest Baby's age |
- * Other reasons not significant
中文翻译：
口服
在文化多元化的人群中，女性何时以及为何停止母乳喂养的复杂性
梅洛夫 SJ 1,2、埃尔欣迪 J 1、怀特 L 3、唐诺利 K 4、琼斯 R 5、西蒙斯 M 5、帕苏帕蒂 D 1
1悉尼大学生殖和围产期中心，澳大利亚悉尼；2澳大利亚韦斯特米德韦斯特米德医院韦斯特米德母婴医学研究所；3澳大利亚布莱克敦布莱克敦和德鲁伊特山医院妇女儿童科；4澳大利亚新南威尔士州西悉尼地方卫生区消费者代表；5澳大利亚韦斯特米德韦斯特米德医院妇女和新生儿健康中心
电子邮件：sarah.melov@health.nsw.gov.au
背景： 2020 年 3 月，悉尼 BLISS（母乳喂养长度强度评分系统）检查被引入常规产前护理中，以改善母乳喂养支持。我们的目的是确定一段时间内停止母乳喂养的关键原因，以便为有针对性的教育提供信息。
方法：利用常规数据进行 2020 年 3 月至 2022 年 9 月的回顾性队列研究。
具有逻辑联系函数、可交换相关结构和自然样条的多元广义估计方程模拟了母乳喂养持续时间和停止原因之间的关系。使用母乳喂养持续时间网格的边际估计来对每个时间点的个别原因的影响进行排名。
结果：共有 8,372 名女性符合纳入标准； 67%在海外出生，平均年龄33岁，61%是初产儿。母乳喂养的中位持续时间为 9 个月（IQR 4 – 16 个月）。随着时间的推移，停止母乳喂养的主要原因存在显着差异。在第一个月内停止母乳喂养的可能性最高的原因（47% 95% CI 44 – 51%）是认为母乳供应量不足；这个理由一直持续到了第三个月。六个月时，由于婴儿失去兴趣（几率 19%；CI 17 – 21%）、感知母乳喂养量不足（几率 29%；27 – 32%）和婴儿年龄（几率 18%；CI），停止母乳喂养的几率很高。 16 – 20%）。根据母亲种族划分，出现了进一步的差异（表 1）。
结论：在一个大型队列中，我们发现停止母乳喂养的原因排名随时间和种族的变化。为了优化对母乳喂养妇女及其家人的支持，需要进行个性化、适合文化的患者教育。
表 1：按自我认定的种族划分的停止母乳喂养的持续时间和原因排名
| 种族 | 占总队列的比例 (n) | 母乳喂养持续时间中位数 (IQR) | 停止母乳喂养的主要原因排名 | ||
|---|---|---|---|---|---|
| 1个月 | 3个月 | 6个月 | |||
| 中东 | 22% (1825) | 7（3 – 14） | 感知供应量低 依恋 宝宝失去了兴趣 |
感知供应量低 依恋 宝宝失去了兴趣 |
感知供应量低 宝宝的年龄 宝宝失去了兴趣 |
| 其他 | 9% (718) | 8 (3 – 14) | 感知供应量低 依恋 * |
感知供应量低 * |
宝宝的年龄 感知供应量低 宝宝失去了兴趣 |
| 太平洋岛民 | 5% (387) | 7（3 – 14） | 感知供应量低 * |
感知供应量低 * |
感知供应量低 宝宝的年龄 * |
| 东南亚 | 16% (1320) | 9（4 – 15） | 感知供应量低 工作/学习 * |
感知供应量低 工作/学习 宝宝的年龄 |
感知供应量低 宝宝的年龄 工作/学习 |
| 南亚 | 28% (2384) | 12（6 – 18） | 感知供应量低 * |
供应不足 宝宝的年龄 * |
感知供应量低 宝宝的年龄 * |
| 白色的 | 21% (1738) | 8 (4 – 14) | 感知供应量低 依恋 * |
感知供应量低 依恋 * |
感知供应量低 * |
| 全面的 | 100% (8,372) | 9 (4 – 16) | 感知供应量低 依恋 * |
供应不足 依恋 * |
供应不足 宝宝失去了兴趣 宝宝的年龄 |
- *其他不重要的原因
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