Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates

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Abstract

Introduction

Despite the enormous benefits of breastfeeding, working mothers face more challenges to meet the World Health Organization (WHO) recommendations regarding successful breastfeeding practices. Little research has been done to understand the breastfeeding practices among working mothers in the United Arab Emirates (UAE). Thus, the aim of this study was to investigate the prevalence and factors associated with delayed initiation and cessation of breastfeeding among working mothers with children under the age of two years in Abu Dhabi, the UAE.

Methods

A cross-sectional multicenter study was conducted from March to September 2017. The study included both Emirati and non-Emirati mothers of children below the age of two years. The data were collected from seven government health care centers in Abu Dhabi as well as from the community. Mothers with young children attending the centers during the study days were approached by trained research assistants, who provided oral and written information about the study.

Results

Among the 1610 mother–child pairs with complete data who were included in this study, 606 were working mothers giving an employment rate of 37.6%. The mean (standard deviation) of maternal age and children’s age were 30.9 (5.1) years and 8.6 (6.1) months, respectively. Of the 606 mothers, 217 (35.8%) delayed initiation of breastfeeding, and 359 (59.2%) ceased breastfeeding. In multivariable logistic regression analysis, factors associated with delayed breastfeeding initiation among working mothers were older mother age (adjusted odds ratio [AOR] 1.04, 95% confidence interval [CI]1.01, 1.08), being of non-Arab nationality (AOR 2.24, 95% CI 1.53, 3.27), caesarean section (AOR 2.70, 95% CI 1.84, 3.96), non-rooming-in (AOR 3.85, 95% CI 1.56, 9.51) and mothers with low birth weight children (AOR 2.47, 95% CI 1.23, 4.94). The main factors associated with cessation of breastfeeding were being of non-Arab nationality (AOR 1.59, 95% CI 1.09, 2.31) and mother with high-income rating (AOR 2.79, 95% CI 1.36, 5.75).

Conclusion

The study highlighted the need for urgent actions to improve the working mothers’ conditions in order to promote optimal breastfeeding practices, including both early initiation and continuation of breastfeeding among all mothers in the UAE regardless of employment status. Policies to improve EBF rates among professional working mothers should include maternity leave extension to enable mothers to continue breastfeeding.

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Optimal duration of exclusive breastfeeding

Michael S Kramer, Ritsuko Kakuma (2012)

Although the health benefits of breastfeeding are widely acknowledged, opinions and recommendations are strongly divided on the optimal duration of exclusive breastfeeding. Since 2001, the World Health Organization has recommended exclusive breastfeeding for six months. Much of the recent debate in developed countries has centred on the micronutrient adequacy, as well as the existence and magnitude of health benefits, of this practice. To assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through six months. We searched The Cochrane Library (2011, Issue 6), MEDLINE (1 January 2007 to 14 June 2011), EMBASE (1 January 2007 to 14 June 2011), CINAHL (1 January 2007 to 14 June 2011), BIOSIS (1 January 2007 to 14 June 2011), African Index Medicus (searched 15 June 2011), Index Medicus for the WHO Eastern Mediterranean Region (IMEMR) (searched 15 June 2011), LILACS (Latin American and Caribbean Health Sciences) (searched 15 June 2011). We also contacted experts in the field.The search for the first version of the review in 2000 yielded a total of 2668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. The updated literature review in December 2006 yielded 835 additional unique citations. We selected all internally-controlled clinical trials and observational studies comparing child or maternal health outcomes with exclusive breastfeeding for six or more months versus exclusive breastfeeding for at least three to four months with continued mixed breastfeeding until at least six months. Studies were stratified according to study design (controlled trials versus observational studies), provenance (developing versus developed countries), and timing of compared feeding groups (three to seven months versus later). We independently assessed study quality and extracted data. We identified 23 independent studies meeting the selection criteria: 11 from developing countries (two of which were controlled trials in Honduras) and 12 from developed countries (all observational studies). Definitions of exclusive breastfeeding varied considerably across studies. Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for six months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest differences in risk of undernutrition. In developing-country settings where newborn iron stores may be suboptimal, the evidence suggests that exclusive breastfeeding without iron supplementation through six months may compromise hematologic status. Based on the Belarusian study, six months of exclusive breastfeeding confers no benefit (versus three months of exclusive breastfeeding followed by continued partial breastfeeding through six months) on height, weight, body mass index, dental caries, cognitive ability, or behaviour at 6.5 years of age. Based on studies from Belarus, Iran, and Nigeria, however, infants who continue exclusive breastfeeding for six months or more appear to have a significantly reduced risk of gastrointestinal and (in the Iranian and Nigerian studies) respiratory infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials and from observational studies from Bangladesh and Senegal suggest that exclusive breastfeeding through six months is associated with delayed resumption of menses and, in the Honduran trials, more rapid postpartum weight loss in the mother. Infants who are exclusively breastfed for six months experience less morbidity from gastrointestinal infection than those who are partially breastfed as of three or four months, and no deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea. Although infants should still be managed individually so that insufficient growth or other adverse outcomes are not ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed-country settings.

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The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum

Amy Hobbs, Cynthia Mannion, Sheila W. McDonald … (2016)

Background The caesarean section (c-section) rate in Canada is 27.1 %, well above the 5–15 % of deliveries suggested by the World Health Organization in 2009. Emergency and planned c-sections may adversely affect breastfeeding initiation, milk supply and infant breastfeeding receptivity compared to vaginal deliveries. Our study examined mode of delivery and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum. Methods The All Our Babies study is a prospective pregnancy cohort in Calgary, Alberta, that began in 2008. Participants completed questionnaires at <25 and 34–36 weeks gestation and approximately 4 months postpartum. Demographic, mental health, lifestyle, and health services data were obtained. Women giving birth to singleton infants were included (n = 3021). Breastfeeding rates and difficulties according to mode of birth (vaginal, planned c-section and emergency c-section) were compared using cross-tabulations and chi-square tests. A multivariable logistic regression model was created to examine the association between mode of birth on breastfeeding duration to 12 weeks postpartum. Results More women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding (7.4 % and 4.3 % respectively), when compared to women with vaginal births (3.4 % and 1.8 %, respectively) and emergency c-section (2.7 % and 2.5 %, respectively). Women who delivered by emergency c-section were found to have a higher proportion of breastfeeding difficulties (41 %), and used more resources before (67 %) and after (58 %) leaving the hospital, when compared to vaginal delivery (29 %, 40 %, and 52 %, respectively) or planned c-sections (33 %, 49 %, and 41 %, respectively). Women who delivered with a planned c-section were more likely (OR = 1.61; 95 % CI: 1.14, 2.26; p = 0.014) to discontinue breastfeeding before 12 weeks postpartum compared to those who delivered vaginally, controlling for income, education, parity, preterm birth, maternal physical and mental health, ethnicity and breastfeeding difficulties. Conclusions We found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned c-section. As well, additional supportive care could be made available to lactating women with emergency c-sections, within the first 24 hours post birth and throughout the early postpartum period. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0876-1) contains supplementary material, which is available to authorized users.

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What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies

Ana Betran, Maria Torloni, Jun Zhang … (2015)

In 1985, WHO stated that there was no justification for caesarean section (CS) rates higher than 10–15 % at population-level. While the CS rates worldwide have continued to increase in an unprecedented manner over the subsequent three decades, concern has been raised about the validity of the 1985 landmark statement. We conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. Four electronic databases were searched for ecologic studies published between 2000 and 2014 that analysed the possible association between CS rates and maternal, neonatal or infant mortality or morbidity. Two reviewers performed study selection, data extraction and quality assessment independently. We identified 11,832 unique citations and eight studies were included in the review. Seven studies correlated CS rates with maternal mortality, five with neonatal mortality, four with infant mortality, two with LBW and one with stillbirths. Except for one, all studies were cross-sectional in design and five were global analyses of national-level CS rates versus mortality outcomes. Although the overall quality of the studies was acceptable; only two studies controlled for socio-economic factors and none controlled for clinical or demographic characteristics of the population. In unadjusted analyses, authors found a strong inverse relationship between CS rates and the mortality outcomes so that maternal, neonatal and infant mortality decrease as CS rates increase up to a certain threshold. In the eight studies included in this review, this threshold was at CS rates between 9 and 16 %. However, in the two studies that adjusted for socio-economic factors, this relationship was either weakened or disappeared after controlling for these confounders. CS rates above the threshold of 9–16 % were not associated with decreases in mortality outcomes regardless of adjustments. Our findings could be interpreted to mean that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level. Electronic supplementary material The online version of this article (doi:10.1186/s12978-015-0043-6) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Womens Health

Journal ID (iso-abbrev): Int J Womens Health

Journal ID (publisher-id): ijwh

Journal ID (pmc): intjwh

Title: International Journal of Women's Health

Publisher: Dove

ISSN (Electronic): 1179-1411

Publication date (Electronic): 02 June 2021

Publication date Collection: 2021

Volume: 13

Pages: 539-548

Affiliations

[1 ]Department of Health Sciences, College of Natural and Health Sciences, Zayed University , Abu Dhabi, U.A.E

[2 ]Department of Research, Taami for Agricultural and Animal Production , Khartoum, Sudan

Author notes

Correspondence: Zainab Taha Tel +971-2-5993111 Email Zainab.taha@zu.ac.ae

Author information

Zainab Taha http://orcid.org/0000-0002-3915-3755

Article

Publisher ID: 303041

DOI: 10.2147/IJWH.S303041

PMC ID: 8180278

PubMed ID: 34104003

SO-VID: d1c5895b-8c08-475f-b8f4-9cd52e076735

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 21 January 2021

Date accepted : 04 May 2021

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Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates

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Abstract

Introduction

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Research from Sudan

Most cited references 58

Optimal duration of exclusive breastfeeding

The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum

What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies

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Cited by 10

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