Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia.
Children (Basel). 2018 Jan 03;5(1):
Authors: Azzeh FS, Alazzeh AY, Hijazi HH, Wazzan HY, Jawharji MT, Jazar AS, Filimban AM, Alshamrani AS, Labani MS, Hasanain TA, Obeidat AA
The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother's room (OR: 2.37; 95% CI: 1.66-3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13-2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51-31.4), followed by not rooming-in infants in the mother's room (OR: 2.2; 95% CI: 1.52-3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3-2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04-2.35), and cesarean sections (OR:1.42; 95% CI: 1.02-1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers' awareness and promote BF practice.
PMID: 29301353 [PubMed]
Expressing Human Milk in the NICU: Coping Mechanisms and Challenges Shape the Complex Experience of Closeness and Separation.
Adv Neonatal Care. 2018 Jan 03;:
Authors: Bujold M, Feeley N, Axelin A, Cinquino C
BACKGROUND: Human milk has multiple benefits for human health; however, rates of infants receiving human milk at discharge in Canadian neonatal intensive care units (NICUs) are far below recommendations of the Baby Friendly Hospital Initiative supported by the Canadian Pediatric Association. Mothers of infants requiring NICU care usually need to express their milk, especially mothers of premature infants, since for some time their infant is unable to feed directly at the breast. Expressing human milk for an extended period can be challenging for mothers.
PURPOSE: To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions.
METHODS: In this descriptive qualitative cross-sectional study, 15 mothers whose infants were hospitalized in a level III NICU and who were expressing human milk audio recorded their thoughts and feelings with a smartphone application for 48 hours while they were expressing milk. A thematic content analysis was used to analyze data.
FINDINGS: Expressing human milk for their hospitalized infant was a difficult experience for all mothers, and most described both closeness and separation feelings while expressing milk. Their feelings fluctuated depending on their coping mechanisms, perceived challenges, as well as their location and environment. Mothers were all pursuing their goal of continued milk expression with various levels of motivation.
IMPLICATIONS FOR PRACTICE: NICUs should adopt a family-centered approach to care whereby mothers' care needs related to milk expression are addressed. Nurses can ask open-ended questions to explore how mothers are coping, and they can assist mothers to find effective coping strategies to minimize the challenges related to milk expression to promote mother-infant closeness.
IMPLICATIONS FOR RESEARCH: The impact of environment and location on mothers with hospitalized infants should be explored, as unit designs could be altered to foster closeness.
PMID: 29300195 [PubMed - as supplied by publisher]
Integrating Molecular Subclassification of Medulloblastomas into Routine Clinical Practice: A Simplified Approach.
Brain Pathol. 2016 May;26(3):334-43
Authors: Kaur K, Kakkar A, Kumar A, Mallick S, Julka PK, Gupta D, Suri A, Suri V, Sharma MC, Sarkar C
Medulloblastoma (MB) is composed of four molecular subgroups viz. WNT, SHH, groups 3 and 4, identified using various high-throughput methods. Translation of this molecular data into pathologist-friendly techniques that would be applicable in laboratories all over the world is a major challenge. Ninety-two MBs were analyzed using a panel of 10 IHC markers, real-time PCR for mRNA and miRNA expression, and FISH for MYC amplification. β-catenin, GAB1 and YAP1 were the only IHC markers of utility in classification of MBs into three subgroups viz. WNT (9.8%), SHH (45.6%) and non-WNT/SHH (44.6%). mRNA expression could further classify some non-WNT/SHH tumors into groups 3 and 4. This, however, was dependent on integrity of RNA extracted from FFPE tissue. MYC amplification was seen in 20% of non-WNT/SHH cases and was associated with the worst prognosis. For routine diagnostic practice, we recommend classification of MBs into three subgroups: WNT, SHH and non-WNT/SHH, with supplementation by prognostic markers like MYC for non-WNT/SHH tumors. Using this panel, we propose a new three-tier risk stratification system for MBs. Molecular subgrouping with this limited panel is rapid, economical, works well on FFPE tissue and is reliable as it correlates significantly with clinicopathological parameters and patient survival.
PMID: 26222673 [PubMed - indexed for MEDLINE]
Maternal perceptions of family-centered support and their associations with the mother-nurse relationship in the neonatal intensive care unit.
J Clin Nurs. 2017 Dec 21;:
Authors: Shimizu A, Mori A
AIM AND OBJECTIVES: The aim of this study was to evaluate maternal perceptions of family-centered support with hospitalized preterm infants, and their relationship between mothers and nurses in the neonatal intensive care unit (NICU).
BACKGROUND: Mothers who gave birth to preterm infants tend to suffer more stress, and need individual support based on family-centered care. However, there may be a shortage of support for mothers to obtain parent-crafting skills before bringing their infants home.
DESIGN: This cross-sectional study used path analysis and multiple-group analysis to evaluate a structural equation model of the relationship between maternal perception based on family-centered support in parent-crafting training and the mothers-nurses collaboration.
METHODS: We analyzed data from 98 mothers (valid response proportion, 41.0%) whose infants were hospitalized in the NICU of two types of perinatal centers in Japan. We used two revised standardized questionnaires in Japanese: Measure of Process of Care in the NICU (Neo-MPOC 20), Enabling Practice Scale in the NICU (Neo-EPS), and the author-developed Mother and Infant Questionnaire.
RESULTS: Path analysis revealed that the relationship between mothers and nurses was linked to three factors related to the perinatal centers' support: consideration of parents' feelings, ability to deal with specific needs, and coordination in dealing with situations that interact with provision of parent-friendly visual information. Separate path analyses for each perinatal center showed the same pattern, although the standard coefficients were different.
CONCLUSIONS: Maternal perceptions of family-centered support with hospitalized preterm infants promoted better collaboration between mothers and nurses to obtain parent-crafting skills at two types of perinatal units in Japan.
RELEVANCE TO CLINICAL PRACTICE: Clear visual information materials might promote better maternal understanding of their infants, help in acquisition of parent-crafting skills, and improve mother-nurse collaboration, with the result that mothers are better able to care for their infants autonomously at home. This article is protected by copyright. All rights reserved.
PMID: 29266474 [PubMed - as supplied by publisher]
Catholic social teaching and America's suboptimal breastfeeding rate: Where faith and policy should meet to combat injustice.
Linacre Q. 2017 Nov;84(4):356-366
Authors: Stark GE
Despite the numerous health benefits of breastfeeding, few American women breastfeed for the optimal duration of time. Reasons given for not following national and global institutional breastfeeding recommendations are various and multi-faceted. However, for many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching seeks to protect the poor and the vulnerable by working for social and economic justice, encourages stewardship of the environment, and uplifts the family as the most important unit in society. As such, Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. In response to the crisis in American rates of breastfeeding, American Catholic healthcare institutions should work to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.
Summary: For many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. Therefore, American Catholic healthcare institutions should work particularly hard to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.
PMID: 29255330 [PubMed - in process]
Factors Influencing Engagement and Behavioral Determinants of Infant Feeding in an mHealth Program: Qualitative Evaluation of the Growing Healthy Program.
JMIR Mhealth Uhealth. 2017 Dec 18;5(12):e196
Authors: Litterbach EK, Russell CG, Taki S, Denney-Wilson E, Campbell KJ, Laws RA
BACKGROUND: Infant feeding practices, including breastfeeding and optimal formula feeding practices, can play a role in the prevention of childhood obesity. The ubiquity of smartphone ownership among women of childbearing age provides important opportunities for the delivery of low-cost, broad reach parenting interventions delivered by mobile phone (mHealth or mobile health interventions). Little is known about how parents engage with mHealth programs targeting infant feeding and how such programs might influence infant feeding practices.
OBJECTIVE: The objectives of this study were to explore participant views on (1) factors influencing engagement with the Growing healthy program, an mHealth program targeting healthy infant feeding practices from birth to 9 months of age, and (2) the ways in which the program influenced behavioral determinants of capability, opportunity, and motivation for breastfeeding and optimal formula feeding behaviors.
METHODS: Semistructured, telephone interviews were conducted with a purposeful sample (n=24) of mothers participating in the Growing healthy program. Interviews explored participants' views about engagement with the program and its features, and the ways the program influenced determinants of infant feeding behaviors related to breastfeeding and optimal formula feeding. The interview schedule was informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model.
RESULTS: Participants reported that engagement fluctuated depending on need and the degree to which the program was perceived to fit with existing parenting beliefs and values. Participants identified that the credibility of the program source, the user friendly interface, and tailoring of content and push notifications to baby's age and key transition points promoted engagement, whereas technical glitches were reported to reduce engagement. Participants discussed that the program increased confidence in feeding decisions. For breastfeeding mothers, this was achieved by helping them to overcome doubts about breast milk supply, whereas mothers using formula reported feeling more confident to feed to hunger and satiety cues rather than encouraging infants to finish the bottle. Participants discussed that the program provided around-the-clock, readily accessible, nonjudgmental information and support on infant feeding and helped to reinforce information received by health professionals or encouraged them to seek additional help if needed. Participants reflected that their plans for feeding were typically made before joining the program, limiting the potential for the program to influence this aspect of motivation. Rather, the program provided emotional reassurance to continue with current feeding plans.
CONCLUSIONS: Our findings suggest that engagement with the program was influenced by an interplay between the program features and needs of the user. Participants reported that the program enhanced confidence in feeding decisions by providing a 24/7 accessible, expert, nonjudgmental support for infant feeding that complemented health professional advice. It is likely that interventions need to commence during pregnancy to maximize the impact on breastfeeding intentions and plans.
PMID: 29254908 [PubMed]
Female respondent acceptance of computer-assisted personal interviewing (CAPI) for maternal, newborn and child health coverage surveys in rural Uganda.
Int J Med Inform. 2017 Feb;98:41-46
Authors: Mercader HF, Kabakyenga J, Katuruba DT, Hobbs AJ, Brenner JL
INTRODUCTION: High maternal and child mortality continues in low- and middle-income countries (LMIC). Measurement of maternal, newborn and child health (MNCH) coverage indicators often involves an expensive, complex, and lengthy household data collection process that is especially difficult in less-resourced settings. Computer-assisted personal interviewing (CAPI) has been proposed as a cost-effective and efficient alternative to traditional paper-and-pencil interviewing (PAPI). However, the literature on respondent-level acceptance of CAPI in LMIC has reported mixed outcomes. This is the first study to prospectively examine female respondent acceptance of CAPI and its influencing factors for MNCH data collection in rural Southwest Uganda.
METHODS: Eighteen women aged 15-49 years were randomly selected from 3 rural villages to participate. Each respondent was administered a Women's Questionnaire with half of the survey questions asked using PAPI techniques and the other half using CAPI. Following this PAPI/CAPI exposure, semi-structured focus group discussions (FGDs) assessed respondent attitudes towards PAPI versus CAPI. FGD data analysis involved an immersion/crystallization method (thematic narrative analysis).
RESULTS: The sixteen FGD respondents had a median age of 27 (interquartile range: 24.8, 32.3) years old. The majority (62.5%) had only primary level education. Most respondents (68.8%) owned or regularly used a mobile phone or computer. Few respondents (31.3%) had previously seen but not used a tablet computer. Overall, FGDs revealed CAPI acceptance and the factors influencing CAPI acceptability were 'familiarity', 'data confidentiality and security', 'data accuracy', and 'modernization and development'.
DISCUSSION: Female survey respondents in our rural Southwest Ugandan setting found CAPI to be acceptable. Global health planners and implementers considering CAPI for health coverage survey data collection should accommodate influencing factors during survey planning in order to maximize and facilitate acceptance and support by local stakeholders and community participants. Further research is needed to generate best practices for CAPI implementation and LMIC; higher quality, timely, streamlined and budget-friendly collection of MNCH indicators could help direct and improve programming to save lives of mothers and children.
PMID: 28034411 [PubMed - indexed for MEDLINE]
Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial.
JAMA Pediatr. 2017 Dec 11;:e174523
Authors: Relton C, Strong M, Thomas KJ, Whelan B, Walters SJ, Burrows J, Scott E, Viksveen P, Johnson M, Baston H, Fox-Rushby J, Anokye N, Umney D, Renfrew MJ
Importance: Although breastfeeding has a positive effect on an infant's health and development, the prevalence is low in many communities. The effect of financial incentives to improve breastfeeding prevalence is unknown.
Objective: To assess the effect of an area-level financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks post partum.
Design, Setting, and Participants: The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015 and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. A total of 10 010 mother-infant dyads resident in the 92 study electoral ward areas where the infant's estimated or actual birth date fell between February 18, 2015, and February 17, 2016, were included. Areas were randomized to the incentive plus usual care (n = 46) (5398 mother-infant dyads) or to usual care alone (n = 46) (4612 mother-infant dyads).
Interventions: Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk.
Main Outcomes and Measures: The primary outcome was electoral ward area-level 6- to 8-week breastfeeding period prevalence, as assessed by clinicians at the routine 6- to 8-week postnatal check visit. Secondary outcomes were area-level period prevalence for breastfeeding initiation and for exclusive breastfeeding at 6 to 8 weeks.
Results: In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, -0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, -0.2 to 4.8; P = .07).
Conclusions and Relevance: Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data.
Trial Registration: International Standard Randomized Controlled Trial Registry: ISRCTN44898617.
PMID: 29228160 [PubMed - as supplied by publisher]
Physician and Nurse Perceptions of Gentle Cesarean Birth.
MCN Am J Matern Child Nurs. 2017 Dec 08;:
Authors: Mercier RJ, Durante JC
BACKGROUND: Protocols for neonatal care and mother-baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols.
PURPOSE: To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes.
STUDY DESIGN AND METHODS: A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes.
RESULTS: Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care.
CLINICAL IMPLICATIONS: Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.
PMID: 29227288 [PubMed - as supplied by publisher]
A realist review of one-to-one breastfeeding peer support experiments conducted in developed country settings.
Matern Child Nutr. 2017 Dec 06;:
Authors: Trickey H, Thomson G, Grant A, Sanders J, Mann M, Murphy S, Paranjothy S
The World Health Organisation guidance recommends breastfeeding peer support (BFPS) as part of a strategy to improve breastfeeding rates. In the UK, BFPS is supported by National Institute for Health and Care Excellence guidance and a variety of models are in use. The experimental evidence for BFPS in developed countries is mixed and traditional methods of systematic review are ill-equipped to explore heterogeneity, complexity, and context influences on effectiveness. This review aimed to enhance learning from the experimental evidence base for one-to-one BFPS intervention. Principles of realist review were applied to intervention case studies associated with published experimental studies. The review aimed (a) to explore heterogeneity in theoretical underpinnings and intervention design for one-to-one BFPS intervention; (b) inform design decisions by identifying transferable lessons developed from cross-case comparison of context-mechanism-outcome relationships; and (c) inform evaluation design by identifying context-mechanism-outcome relationships associated with experimental conditions. Findings highlighted poor attention to intervention theory and considerable heterogeneity in BFPS intervention design. Transferable mid-range theories to inform design emerged, which could be grouped into seven categories: (a) congruence with local infant feeding norms, (b) integration with the existing system of health care, (c) overcoming practical and emotional barriers to access, (d) ensuring friendly, competent, and proactive peers, (e) facilitating authentic peer-mother interactions, (f) motivating peers to ensure positive within-intervention amplification, and (g) ensuring positive legacy and maintenance of gains. There is a need to integrate realist principles into evaluation design to improve our understanding of what forms of BFPS work, for whom and under what circumstances.
PMID: 29210171 [PubMed - as supplied by publisher]
Status of Baby Friendly Hospital Initiative in Neonatal Units.
Mymensingh Med J. 2017 Oct;26(4):846-853
Authors: Akhtar K, Khatoon S, Kabir S, Elahi QE, Nahar S, Ahamed F
Neonatal unit is more vulnerable and critical ward than any others. To assure breastfeeding in neonatal unit is one of the ways to reduce child morbidity and mortality. Baby friendly hospital initiative is the best method in hospital setting to assure breastfeeding. This cross-sectional descriptive study was conducted from July 2014 to December 2014 to find out the Status of Baby Friendly Hospital Initiative (BFHI) in neonatal unit of different public hospitals. The study area was consisting of several tertiary level hospitals in Dhaka city. Study was done in those hospital where declared as Baby Friendly Hospital Initiative. Total 137 data was collected from care givers (70) and healthcare providers (67). From hospital data it was found that all children discharged for last month were exclusively breastfed. Written breastfeeding policy was present in all hospitals but out of 67 staffs only 28(41.48%) staffs received training which was not fulfillment of the requirement of Global Criteria of UNICEF/WHO (BFHI External Assessment and Reassessment). In step 5 only 21(31.34%) staffs show or offered help for breastfeeding. In step 6 and 9 there were 100% fulfill the requirements, no teats and pacifier was found, no use of foods or drinks except medications. Nurses were co-operative but due to lack of training and motivation they were not fully aware about the importance of breastfeeding.
PMID: 29208874 [PubMed - in process]
Egy új kutatás alapján meghatározható a csecsemők védelméhez szükséges minimális szoptatási időtartam.
Összegzés: Egy új nemzetközi tanulmány eredménye szerint a legalább két hónapig tartó szoptatás közel felére csökkenti a hirtelen csecsemőhalál szindróma kockázatát.
A tanulmány megállapította, hogy a nem kizárólagosan szoptatott csecsemők is védelmet élveznek a hirtelen csecsemőhalál szindróma (SIDS) ellen. Ez nagyon jó hír azoknak az anyukáknak, akik nem tudják megvalósítani a kizárólagos szoptatást.
"Ennek az eredménynek óriási jelentősége van! Tanulmányunk szerint a legalább két hónapig szoptatott csecsemőknél jelentősen csökken a bölcsőhalál miatti elhalálozás kockázata" - mondta a Kawai Tanabe, a Virginiai Egyetem Orvostudományi Karának kutatója. "A szoptatásnak rengeteg előnye van, és közülük ez kiemelkedő jelentőségű."
Prevalence of breast-feeding and exclusive breast-feeding at 48 h after birth and up to the sixth month in Cyprus: the BrEaST start in life project.
Public Health Nutr. 2017 Nov 27;:1-14
Authors: Economou M, Kolokotroni O, Paphiti-Demetriou I, Kouta C, Lambrinou E, Hadjigeorgiou E, Hadjiona V, Tryfonos F, Philippou E, Middleton N
OBJECTIVE: To assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive breast-feeding (EBF) in Cyprus up to the sixth month.
DESIGN: Cross-sectional and longitudinal descriptive study. BF and EBF were estimated based on mothers' self-reported BF status in line with Step 7 of the WHO/UNICEF Baby-Friendly Hospital Initiative questionnaire and based on 24 h recall.
SETTING: Maternity wards in all public hospitals and twenty-nine (of thirty-five) private maternity clinics nationwide.
SUBJECTS: Consecutive sample of 586 mothers recruited within 48 h from birth, followed up by telephone interview at the first, fourth and sixth month.
RESULTS: Although 84·3 % of mothers initiated BF before discharge, prevalence of BF at the sixth month was 32·4 %, with the highest reduction observed between the first and fourth months. Prevalence of EBF at 48 h was 18·8 % and fell gradually to 5·0 % at the sixth month. Mothers with higher educational attainment or higher family income were more likely to breast-feed until the sixth month. In terms of EBF, an association was observed only with education, which persisted until the sixth month. Other than social gradient, mode of delivery was the strongest determinant of BF initiation, exclusivity and continuation. Mothers who gave birth vaginally were three to four times more likely to initiate BF (OR=3·1; 95 % CI 1·7, 5·4) and EBF (OR=4·3; 95 % CI 2·7, 6·8).
CONCLUSIONS: The low prevalence of BF and EBF in Cyprus, together with the fact that caesarean section rates are currently among the highest in Europe, suggest the need for further research to understand this multidimensional phenomenon and for interdisciplinary policy action to protect, promote and support BF.
PMID: 29173197 [PubMed - as supplied by publisher]