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Past research suggests that whether pregnancies are wanted, unwanted, or mistimed may influence breastfeeding behavior. The purpose of this chapter is to develop a more precise understanding of this relationship. Specifically, this chapter asks three questions: first, do pregnancy intentions matter most in sustaining breastfeeding for long or for short durations postpartum; second, at what time postpartum are rates of breastfeeding discontinuation most differentiated by pregnancy intentions; and third, how does poverty (measured here by Medicaid receipt) moderate the relationship between pregnancy intentions and breastfeeding duration.

Logistic regression analysis of survey data from a national sample representative of US mothers is used to determine the relationship of pregnancy intentions to whether breastfeeding continues for various durations and through various intervals after birth. Interaction terms between pregnancy intentions and mother’s Medicaid status are used to test for relationships specific to poor or nonpoor mothers between pregnancy intentions and breastfeeding duration.

Results show that pregnancy timing matters most for sustaining breastfeeding for durations past 6 months and that differences in rates of breastfeeding discontinuation between mothers with wanted, unwanted, and mistimed pregnancies are most pronounced in the 3–7 months postpartum period. In addition, findings show that Medicaid recipients (but not nonrecipients) are less likely to exclusively breastfeed for 6 months when their pregnancies are mistimed.

The literature on fundamental causes of health disparities typically suggests that poverty impairs access to resources necessary for effective planning to achieve desirable health outcomes. This study’s results, however, show that planning of pregnancies is more critical for poor mothers to sustain exclusive breastfeeding. Further research is needed to explain this relationship. The results also suggest that policy interventions to help mothers with unplanned pregnancies to sustain breastfeeding should target the period from 3 to 7 months postpartum.

These findings can help shape policies for facilitating the continuation of breastfeeding for durations recommended by health authorities and advance our understanding of the effects of poverty on health behaviors.

This paper aims to investigate breastfeeding and complementary feeding practices among children less than five years old and living in a rice surplus area in Demak Regency, Central Java.

From December 2014 to February 2015, a cross-sectional survey was carried out in Demak, which had a high proportion of undernourished children despite high rice production. In total, 384 mothers having children below five years old from farmer family background were interviewed using a structured questionnaire about sociodemographic parameters and child feeding practices. Food habits were also investigated among these women during two focus group discussions in two selected sub-districts.

Only 10.9 per cent of the children were exclusively breastfed for six months. About 60 per cent of the mothers practiced supplementary feeding in addition to breastfeeding and started complementary feeding too early. Duration of exclusive breastfeeding practice and child’s age at onset of complementary feeding were positively correlated (p = 0.04). The main reasons of supplementary feeding and too early introduction of complementary food were based on the elderly women’s opinions, and the very short duration of maternity leave for employed mothers. Mothers with a low education level had a higher chance of not reaching the optimum score of complementary feeding practices (p = 0.012).

Despite a high level of food security in the project area, inadequate knowledge of young child feeding practices has contributed to sub-optimal breastfeeding practices. Higher educated women were more likely to follow optimal complementary feeding practices. Therefore, promotion of breastfeeding and complementary feeding practices targeting all key actors should be implemented in the study area to prevent undernutrition among infants.

Exclusive breastfeeding (EBF) rates continue to be low in Vietnam. This study aimed to determine the factors predicting 6-month EBF among mothers in Ho Chi Minh City, Vietnam.

A cross-sectional study was conducted with 259 mothers of infants aged between six to nine months at well-baby clinics in Ho Chi Minh City. The questionnaires used for data collection included personal background questionnaire, perceived benefits of breastfeeding scale, breastfeeding self-efficacy scale-short form, perceived barriers to breastfeeding scale and the family support of breastfeeding scale. Descriptive statistics, bivariate and multiple logistic regression were used for data analysis.

About 32% of the Vietnamese mothers practiced 6-month EBF. By increasing one unit of perceived benefits of breastfeeding, perceived self-efficacy in breastfeeding and family support, the mothers' likelihood to give 6-month EBF would increase 19% (AOR = 1.19, 95% CI = 1.08, 1.31), 12% (AOR = 1.12, 95% CI = 1.04, 1.19) and 10% (AOR = 1.10, 95% CI = 1.04, 1.16), while previous breastfeeding experience, maternal age and maternal education could not significantly contribute to the 6-month EBF.

This is the first study in Vietnam using a nursing model, the health promotion model, as a framework to identify factors predicting 6-month EBF. An effective program for promoting EBF could be developed by manipulating and tailoring the predicting factors to fit the Vietnamese mothers' needs through a mother class, lactation clinic or individual approach.

The prevalence of stunting in children under five years old is high (37.9 percent). The health advantage of breast milk as a prevention is recognized. The purpose of this paper is to examine the relationship of early initiation to breastfeeding, wherein a child is breastfed within an hour of birth, as a means of preventing stunted growth in 6–59 month old children in Jambi province, Indonesia.

This paper used data from the 2015 National Nutrition Survey in Jambi province. A total of 2,502 children aged 6–59 months were analyzed by binary logistic regression.

The results showed that as many as 27.5 percent (95% CI: 25.2–29.9) children aged 6–59 months were stunted and 54.1 percent (95% CI: 51.1–57.1) had not been introduced to breastfeeding soon after birth. The analysis showed that delayed initiation to breastfeeding is a significant factor in stunting amongst 6–59 month old children. (p=0.024; AOR=1.3; 95% CI: 1.0–1.6). Other results of the analysis showed a significant association between water source and birth weight issues as causes for stunting.

Research revealed that delayed initiation into breastfeeding results in a 1.3 times higher risk of stunting. Furthermore, early initiation to breastfeeding reduces the risk of consuming polluted river water that is a health risk and cause of stunting.

Throughout human history and around the world, co-sleeping was the context for human evolutionary development. Currently, most of the world’s peoples continue to practice co-sleeping with infants, but there is increasing pressure on families in the West not to co-sleep. Research from anthropology, family studies, medicine, pediatrics, psychology, and public health is reviewed through the lens of a developmental theory to place co-sleeping within a developmental, theoretical context for understanding it. Viewing co-sleeping as a family choice and a normative, human developmental context changes how experts may provide advice and support to families choosing co-sleeping, especially in families making the transition to parenthood. During this transition, many decisions are made by parents “intuitively” (Ball, Hooker, & Kelly, 1999), making understanding the developmental consequences of some of those choices even more important. In Western culture, families are making “intuitive” decisions that research has shown to be beneficial, but families are not receiving complete messages about benefits and risks of co-sleeping. Co-sleeping can be an important choice for families as they make the life-changing transition to parenthood, if individualized messages about safe infant sleep practices (directed toward their individual family circumstances) are shared with them.

The negative effects of gender disparities on nutrition outcomes for women and children are well documented. Gender analyses are often used at the start of projects to capture contextual factors contributing to persisting inequalities and malnutrition but there is a dearth of information about processes for applying findings to program designs and activities at the implementation level. The authors describe a three-phase process used by Helen Keller International (HKI) in 2015–2016 for a nutrition-sensitive program called Family Farms for the Future in rural Cambodia that included: (1) a community-based gender assessment; (2) a workshop to interpret findings from the assessment; and (3) a strategy to incorporate gender-relevant findings into program activities. The gender analysis used qualitative methods involving 32 participatory group activities and 20 individual interviews with men, women, and elders in the program communities. Findings and insights gained from this analysis revealed persistent and different gender disparities and perceptions from each respondent group regarding the reasons for the inequalities. A workshop organized to share the gender analysis findings with program implementers generated ideas and strategies for incorporating and translating findings into program activities. This three-phase process was crucial not only to reveal and understand barriers to socio-economic empowerment of women, but also to obtain buy-in from program implementers and to encourage use of their insights to translate findings into practical strategies and activities to address gender disparities that may influence nutrition and health outcomes of women and children.

The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of a child's life. However, while the national coverage was 61.33%, the coverage in Sukoharjo was 39.33%. Effective intervention is needed to promote the importance of exclusive breastfeeding, and this requires knowledge of the barriers and support structures in place. This study analyzed the supports and barriers of exclusive breastfeeding in Sukoharjo, Central Java, Indonesia.

This qualitative study used in-depth interviews conducted from December 2017 to March 2018. The population consisted of 33 informants (29 mothers with babies over six months of age, a pregnant mother, two midwives working in the community health center and a staff member in the district health department).

There were barriers to and support for exclusive breastfeeding in Sukoharjo, Central Java province, Indonesia. The district already has support systems in place, while the barriers emerge from society, the baby's condition, environmental and other sources. The government has tried to overcome the barriers.

The limitation of this study was that the triangulation method was not utilized. However, the use of various informants strengthened the findings.

The district government, especially the health department, needs to establish a program to evaluate existing exclusive breastfeeding support programs thoroughly. Smarter and more comprehensive interventions may be needed, for example, by integrating various supports into one activity. For researchers, the findings of this study imply that they can conduct experimental community research using the framework of the two aforementioned theories of behavior change. For example, investigation of combining the support of trained peers with the presence of family members such as the grandmothers of the babies. If both types of support are conducted concurrently, it may strengthen support and reduce barriers from either inside or outside the home.

The district government, especially the health department, needs to establish a program to evaluate existing exclusive breastfeeding support programs thoroughly. Smarter and more comprehensive interventions may be needed, for example, by integrating various supports into one activity. For researchers, the findings of this study imply that they can conduct experimental community research using the framework of the two aforementioned theories of behavior change. For example, investigation of combining the support of trained peers with the presence of family members such as the grandmothers of the babies. If both types of support are conducted concurrently, it may strengthen support and reduce barriers from either inside or outside the home.

There are barriers to exclusive breastfeeding in Sukoharjo, but the government has made effective attempts to overcome them. The support systems in place were in line with the theory of planned behavior (TPB) and social cognitive theory (SCT).

This chapter examines how women understand and account for their behaviour concerning the traditional forms of communication that underpin the ideology of motherhood, which has been socially constructed as a critical aspect of womanhood. The participants were selected through purposive sampling where 60 women participated in focus group discussions. The findings revealed that women's breastfeeding knowledge and attitudes, as well as their degree of education, were all connected to their practice of exclusive breastfeeding, while cultural views were also connected to breastfeeding practices. The study recommends that mothers and the public be better educated about the benefits and importance of exclusive breastfeeding.

Ireland has one of the lowest rates of breastfeeding in Europe with exclusive breastfeeding rates of 44 per cent at discharge from hospital. Increased awareness and debate on breastfeeding and its issues is needed. The purpose of this paper is to describe an evaluation of the piloting of a forum theatre production in increasing awareness of breastfeeding.

A mixed methods approach was taken. Research participants were identified through the four organisations in which the play was performed. Approximately 160 people watched a performance of the play. Quantitative data were collected from 110 audience members who completed a postcard survey. Qualitative data were collected from 42 people prior to seeing the play and 47 people after seeing the play, through focus groups and individual interviews.

Over 90 per cent of participants thought the play was a good way of discussing breastfeeding and they thought it was more effective than usual health promotion of giving out leaflets. Qualitative interviews found that the play heightened people's awareness of breastfeeding, highlighted the importance of support and engaged people in discussion and debate around breastfeeding.

The concept of promoting breastfeeding through drama is quite novel and this evaluation shows a potential for using such techniques in health promotion on varied nutrition‐related topics.

The purpose of this study was to explore the experiences of adolescent mothers who wean their babies from breastfeeding before the first six months from the perspective of a psychosocial aspect in the Thai context.

A descriptive qualitative design was applied to this study to obtain meaningful data. The adolescent mothers for the primary study and nine supplementary participants were recruited from the largest university hospital in Bangkok, Thailand. Semi-structured in-depth interviews were conducted with 20 adolescent mothers. Descriptive statistics and content analysis were used for data analysis.

The average breastfeeding duration was 3.1 months while breastfeeding exclusively lasted 1.3 months. More than half of the adolescent mothers encountered breastfeeding problems at hospitalization including sore/cracked nipples (63.6%), one side breastfeeding (27.3%) and exhaustion (9.1%). According to the content analysis, (1) breastfeeding obstacles concealed by the adolescents' dependence and (2) repetitive emotional mistakes encountered were the two main themes that emerged.

The influence of key family members plays a vital role in breastfeeding and psychological outcomes. Therefore, family-adolescent support programs including support from the adolescents' mothers and grandmothers may improve breastfeeding outcomes, yield positive emotions and enhance maternal attachment. Moreover, healthcare professions are important mediators to convince adolescent mothers' key family members to reach an agreement and provide suitable support.