Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers

Authors: Kris Yuet Wan Lok, Dorothy Li Bai, Marie Tarrant

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

Background

In recent years there has been a steady influx of immigrants into Hong Kong from Mainland China, where breastfeeding patterns differ. Studies in other regions have found substantial differences in breastfeeding rates between native-born and immigrant mothers. The purpose of this study was to examine factors associated with breastfeeding initiation in Hong Kong born and Mainland China born mothers living in Hong Kong.

Methods

We used a multi-center cross-sectional study design and recruited 2761 new mothers from the postnatal wards of all eight public hospitals in Hong Kong that offer obstetric services. We assessed breastfeeding status as well as various socio-demographic, maternal and birth characteristics. Chi-square tests and multivariable logistic regression were used to identify the predictors of breastfeeding initiation in Hong Kong born and Mainland China born participants.

Results

80.3 % of Hong Kong and 81.1 % of Mainland Chinese born women initiated breastfeeding. In the fully adjusted models, multiparity (Odds Ratio [OR] 0.53, 95 % CI 0.43–0.66) and maternal smoking (OR 0.29, 95 % CI 0.18–0.45) were strongly associated with failure to initiate breastfeeding in both Hong Kong and Mainland China born participants. In Hong Kong born mothers, participants with lower maternal education and those who had a cesarean section were significantly less likely to breastfeed. For Mainland China born mothers, paternal smoking (OR 0.70, 95 % CI 0.49–0.99) and having a pregnancy-related health problem (OR 0.60, 95 % CI 0.38–0.94) were both additional risk factors for not breastfeeding.

Conclusion

This study has identified predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers. Given the current high breastfeeding initiation rates among both groups, antenatal breastfeeding education and promotion programmes need to specifically intervene with sub-groups of pregnant women at risk for not breastfeeding so that their efforts are more strategic and cost-effective.
Literature
1.
World Health Organization. Global strategy for infant and young child feeding. In: vol. A54/INF.DOC/4. Geneva: World Health Organization; 2003.
2.
American Academy of Pediatrics. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–41.CrossRef
3.
4.
5.
Callen J, Pinelli J. Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review. Birth. 2004;31(4):285–92.PubMedCrossRef
6.
Foo LL, Quek SJS, Ng SA, Lim MT, Deurenberg-Yap M. Breastfeeding prevalence and practices among Singaporean Chinese, Malay and Indian mothers. Health Promot Int. 2005;20(3):229–37.PubMedCrossRef
7.
Li R, Zhao Z, Mokdad A, Barker L, Grummer-Strawn L. Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey. Pediatrics. 2003;111(5 Part 2):1198–201.PubMed
8.
Riva E, Banderali G, Agostoni C, Silano M, Radaelli G, Giovannini M. Factors associated with initiation and duration of breastfeeding in Italy. Acta Paediatr. 1999;88(4):411–5.PubMedCrossRef
9.
Clements MS, Mitchell EA, Wright SP, Esmail A, Jones DR, Ford RPK. Influences on breastfeeding in southeast England. Acta Paediatr. 1997;86(1):51–6.PubMedCrossRef
10.
Scott JA, Aitkin I, Binns CW, Aroni RA. Factors associated with the duration of breastfeeding amongst women in Perth, Australia. Acta Paediatr. 1999;88(4):416–21.PubMedCrossRef
11.
Leung GM, Lam TH, Ho LM, Lau YL. Health consequences of breastfeeding: doctors’ visits and hospitalisations during the first 18 months of life in Hong Kong Chinese infants. Epidemiology. 2005;16(3):328–35.PubMedCrossRef
12.
Tarrant M, Kwok MK, Lam TH, Leung GM, Schooling CM. Breast-feeding and childhood hospitalizations for infections. Epidemiology. 2010;21(6):847–54.PubMedCrossRef
13.
Oddy WH, Kickett-Tucker C, De Maio J, Lawrence D, Cox A, Silburn SR, et al. The association of infant feeding with parent-reported infections and hospitalisations in the West Australian Aboriginal Child Health Survey. Aust N Z J Public Health. 2008;32(3):207–15.PubMedCrossRef
14.
Paricio Talayero JM, Lizan-Garcia M, Otero Puime A, Benlloch Muncharaz MJ, Beseler Soto B, Sanchez-Palomares M, et al. Full breastfeeding and hospitalization as a result of infections in the first year of life. Pediatrics. 2006;118(1):e92–9.PubMedCrossRef
15.
Kramer MS, Guo T, Platt RW, Vanilovich I, Sevkovskaya Z, Dzikovich I, et al. Feeding effects on growth during infancy. J Pediatr. 2004;145(5):600–5.PubMedCrossRef
16.
Feng LP, Chen HL, Shen MY. Breastfeeding and the risk of ovarian cancer: a meta-analysis. J Midwifery Womens Health. 2014;59(4):428–37.PubMedCrossRef
17.
Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER, Clapp RW, et al. Lactation and a reduced risk of premenopausal breast cancer. NEJM. 1994;330(2):81–7.PubMedCrossRef
18.
Khin PP, Cheung SL, Loh T. Support and promotion of breastfeeding. Where are we now? Public Health Epidemiol Bull. 2002;11(3):25–32.
19.
Baby Friendly Hospital Initiative Hong Kong Association. World breastfeeding week 2013: annual summary. Hong Kong: Author; 2013.
20.
McInnes RJ, Love JG, Stone DH. Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women. BMC Public Health. 2001;1:10.CrossRef
21.
Leung GM, Ho LM, Lam TH. Maternal, paternal and environmental tobacco smoking and breast feeding. Paediatr Perinat Epidemiol. 2002;16(3):236–45.PubMedCrossRef
22.
Yang Q, Wen SW, Dubois L, Chen Y, Walker MC, Krewski D. Determinants of breast-feeding and weaning in Alberta, Canada. JOGC. 2004;26(11):975–81.PubMed
23.
Noble L, Hand I, Haynes D, McVeigh T, Kim M, Yoon JJ. Factors influencing initiation of breast-feeding among urban women. Am J Perinatol. 2003;20(8):477–83.PubMedCrossRef
24.
Kogan MD, Singh GK, Dee DL, Belanoff C, Grummer-Strawn LM. Multivariate analysis of state variation in breastfeeding rates in the United States. Am J Public Health. 2008;98(10):1872–80.PubMedPubMedCentralCrossRef
25.
Leung GM, Ho LM, Lam TH. Breastfeeding rates in Hong Kong: a comparison of the 1987 and 1997 birth cohorts. Birth. 2002;29(3):162–8.PubMedCrossRef
26.
Tarrant M, Fong DY, Wu KM, Lee IL, Wong EM, Sham A, et al. Breastfeeding and weaning practices among Hong Kong mothers: a prospective study. BMC Pregnancy Childbirth. 2010;10:27.PubMedPubMedCentralCrossRef
27.
Kwok MK, Schooling CM, Lam TH, Leung GM. Does breastfeeding protect against childhood overweight? Hong Kong’s ‘Children of 1997’ birth cohort. Int J Epidemiol. 2010;39:297–305.PubMedCrossRef
28.
Kennedy KJ. Immigration and Hong Kong: “New immigrants” and ethnic minorities. In: UNESCO-KEDI Regional Policy Seminar 2012 - Education policy: Making in the age of migration in Asia and the Pacific. Bangkok: UNESCO-KEDI; 2012.
29.
30.
31.
Chen S, Binns CW, Zhao Y, Maycock B, Liu Y. Breastfeeding by Chinese mothers in Australia and China: the healthy migrant effect. J Hum Lact. 2013;29(2):246–52.PubMedCrossRef
32.
Chin AC, Myers L, Magnus JH. Race, education, and breastfeeding initiation in Louisiana, 2000–2004. J Hum Lact. 2008;24(2):175–85.PubMedCrossRef
33.
Celi AC, Rich-Edwards JW, Richardson MK, Kleinman KP, Gillman MW. Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation. Arch Pediatr Adolesc Med. 2005;159(3):255–60.PubMedCrossRef
34.
Li R, Ogden C, Ballew C, Gillespie C, Grummer-Strawn L. Prevalence of exclusive breastfeeding among US infants: the Third National Health and Nutrition Examination Survey (Phase II, 1991–1994). Am J Public Health. 2002;92(7):1107–10.PubMedPubMedCentralCrossRef
35.
Yuen CYS, Fong DYT, Lee ILY, Sing C, Siu ES-m, Tarrant M. Prevalence and predictors of maternal seasonal influenza vaccination in Hong Kong. Vaccine. 2013;31(45):5281–8.CrossRef
36.
37.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007;18(6):800–4.CrossRef
38.
Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S. A comparison of goodness-of-fit tests for the logistic regression model. Stat Med. 1997;16(9):965–80.PubMedCrossRef
39.
StataCorp. Stata statistical software: release 13.1. College Station: StataCorp LP; 2013.
40.
Bailey BA, Wright HN. Breastfeeding initiation in a rural sample: predictive factors and the role of smoking. J Hum Lact. 2011;27(1):33–40.PubMedCrossRef
41.
Baxter J, Cooklin AR, Smith J. Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study. Acta Paediatr. 2009;98(8):1274–7.PubMedCrossRef
42.
Baby Friendly Hospital Initiative Hong Kong Association. World breastfeeding week 2010: annual summary. Hong Kong: Author; 2011.
43.
Tarrant RC, Younger KM, Sheridan-Pereira M, White MJ, Kearney JM. The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland. Public Health Nutr. 2010;13(6):760–70.PubMedCrossRef
44.
Cattaneo A, Burmaz T, Arendt M, Nilsson I, Mikiel-Kostyra K, Kondrate I, et al. Protection, promotion and support of breast-feeding in Europe: progress from 2002 to 2007. Public Health Nutr. 2010;13(6):751–9.PubMedCrossRef
45.
Watt S, Sword W, Sheehan D, Foster G, Thabane L, Krueger P, et al. The effect of delivery method on breastfeeding initiation from the The Ontario Mother and Infant Study (TOMIS) III. JOGNN. 2012;41(6):728–37.PubMedCrossRef
46.
Hauck YL, Fenwick J, Dhaliwal SS, Butt J. A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns. Matern Child Health J. 2011;15(2):260–8.PubMedCrossRef
47.
Tarrant M, Lok KYW, Fong DYT, Lee ILY, Sham A, Lam C, et al. Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breastfeeding duration. Public Health Nutr. 2015;18(14):2689–99.PubMedCrossRef
48.
Tarrant M, Dodgson JE, Choi VWK. Becoming a role model: the breastfeeding trajectory of Hong Kong women breastfeeding longer than six months. Int J Nurs Stud. 2004;41(5):535–46.PubMedCrossRef
49.
Tarrant M, Dodgson JE, Tsang SF. Initiating and sustaining breastfeeding in Hong Kong: contextual influences on new mothers’ experiences. Nurs Health Sci. 2002;4(4):189–91.CrossRef
50.
Tarrant M, Dodgson JE, Wu KM. Factors contributing to early breastfeeding cessation among Chinese mothers: an exploratory study. Midwifery. 2014;30(10):1088–95.PubMedCrossRef
51.
Tarrant M, Dodgson JE. Knowledge, attitudes, exposure, and future intentions of Hong Kong University Students toward infant feeding. JOGNN. 2007;36(3):243–54.PubMedCrossRef
52.
Tarrant M, Wu KM, Fong DY, Lee IL, Wong EM, Sham A, et al. Impact of baby-friendly hospital practices on breastfeeding in Hong Kong. Birth. 2011;38(3):238–45.PubMedCrossRef
53.
Parry JE, Ip DK, Chau PY, Wu KM, Tarrant M. Predictors and consequences of in-hospital formula supplementation for healthy breastfeeding newborns. J Hum Lact. 2013;29(4):527–36.PubMedCrossRef
54.
Bai DL, Wu KM, Tarrant M. Association between intrapartum interventions and breastfeeding duration. J Midwifery Womens Health. 2013;58(1):25–32.PubMedCrossRef
55.
Bai DL, Fong DY, Tarrant M. Factors associated with breastfeeding duration and exclusivity in mothers returning to paid employment postpartum. Matern Child Health J. 2015;19(5):990–9.PubMedCrossRef
56.
Scott JA, Binns CW, Graham KI, Oddy WH. Temporal changes in the determinants of breastfeeding initiation. Birth. 2006;33(1):37–45.PubMedCrossRef
57.
Dunn JF, Plomin R, Daniels D. Consistency and change in mothers’ behavior toward young siblings. Child Dev. 1986;57(2):348–56.PubMed
58.
59.
Jacobs BS, Moss HA. Birth order and sex of sibling as determinants of mother-infant interaction. Child Dev. 1976;47(2):315–22.PubMedCrossRef
60.
Lumley J, Oliver S, Waters E. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 1999;2:CD001055.
61.
Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 2012;1248(1):107–23.PubMedCrossRef
62.
Andres RL, Day M-C. Perinatal complications associated with maternal tobacco use. Semin Neonatol. 2000;5(3):231–41.PubMedCrossRef
63.
England LJ, Kendrick JS, Gargiullo PM, Zahniser SC, Hannon WH. Measures of maternal tobacco exposure and infant birth weight at term. Am J Epidemiol. 2001;153(10):954–60.PubMedCrossRef
64.
Fantuzzi G, Aggazzotti G, Righi E, Facchinetti F, Bertucci E, Kanitz S, et al. Preterm delivery and exposure to active and passive smoking during pregnancy: a case–control study from Italy. Paediatr Perinat Epidemiol. 2007;21(3):194–200.PubMedCrossRef
65.
American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776–89.CrossRef
66.
Xu F, Binns C, Yu P, Bai Y. Determinants of breastfeeding initiation in Xinjiang, PR China, 2003–2004. Acta Paediatr. 2007;96(2):257–60.PubMedCrossRef
67.
Chalmers B, Kaczorowski J, Darling E, Heaman M, Fell DB, O’Brien B, et al. Cesarean and vaginal birth in canadian women: a comparison of experiences. Birth. 2010;37(1):44–9.PubMedCrossRef
68.
Nakao Y, Moji K, Honda S, Oishi K. Initiation of breastfeeding within 120 minutes after birth is associated with breastfeeding at four months among Japanese women: a self-administered questionnaire survey. Int Breastfeed J. 2008;3:1.PubMedPubMedCentralCrossRef
69.
Perez-Rios N, Ramos-Valencia G, Ortiz AP. Cesarean delivery as a barrier for breastfeeding initiation: the Puerto Rican experience. J Hum Lact. 2008;24(3):293–302.PubMedCrossRef
70.
Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113–35.PubMedCrossRef
71.
Chung W, Kim H, Nam C-M. Breast-feeding in South Korea: factors influencing its initiation and duration. Public Health Nutr. 2008;11(3):225–9.PubMedCrossRef
72.
Althabe F, Sosa C, Belizan JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth. 2006;33(4):270–7.PubMedCrossRef
73.
Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2010. Natl Vital Stat Rep. 2011;60(2):1–25.PubMed
74.
Tang S, Li X, Wu Z. Rising cesarean delivery rate in primiparous women in urban China: evidence from three nationwide household health surveys. Am J Obstet Gynecol. 2006;195(6):1527–32.PubMedCrossRef
75.
Leung GM, Lam T, Thach TQ, Wan S, Ho L. Rates of cesarean births in Hong Kong: 1987–1999. Birth. 2001;28(3):166–72.PubMedCrossRef
76.
Montgomery A, Hale TW, Academy Of Breastfeeding Medicine Protocol C. ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother. Breastfeed Med. 2006;1(4):271–7.PubMedCrossRef
77.
Smith LJ. Impact of birthing practices on the breastfeeding dyad. J Midwifery Womens Health. 2007;52(6):621–30.PubMedCrossRef
78.
Thompson LA, Zhang S, Black E, Das R, Ryngaert M, Sullivan S, et al. The association of maternal pre-pregnancy body mass index with breastfeeding initiation. Matern Child Health J. 2013;17(10):1842–51.PubMedCrossRef
79.
Merewood A, Brooks D, Bauchner H, MacAuley L, Mehta SD. Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts. Pediatrics. 2006;118(4):e1048–54.PubMedCrossRef
80.
Pilkauskas NV. Breastfeeding initiation and duration in coresident grandparent, mother and infant households. Matern Child Health J. 2014;18(8):1955–63.PubMedPubMedCentralCrossRef
81.
Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr. 1999;70(4):525–35.PubMed
82.
83.
Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet. 1992;339(8788):261–4.PubMedCrossRef
84.
Census and Statistics Department. Thematic household survey report - Report No. 53. Hong Kong: Author; 2013.
85.
Parry J. China’s tainted infant formula sickens nearly 13 000 babies. BMJ. 2008;337.
86.
Wang J. Weaning streak. South China Morning Post. 2013 Aug 19; Sect. C:9.
87.
88.
Hatton C. Baby milk rationing: Chinese fears spark global restrictions. In: BBC News. 2013.
Metadata
Title
Predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers
Authors
Kris Yuet Wan Lok
Dorothy Li Bai
Marie Tarrant
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0719-5

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue

Research article

A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives

Study protocol

QF2011: a protocol to study the effects of the Queensland flood on pregnant women, their pregnancies, and their children's early development

Research article

Gestational weight gain among American Samoan women and its impact on delivery and infant outcomes

Research article

Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh

Research article

Lifestyle and health status in a sample of Swedish women four years after pregnancy: a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus

Research article

Effect of an integrated maternal health intervention on skilled provider’s care for maternal health in remote rural areas of Bangladesh: a pre and post study