Title Breastfeeding and weaning practices among Hong Kongmothers : A prospective study

Background: Breastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infant’s first year of life to determine the factors associated with early cessation. Methods: A cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation. Results: At 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months. Conclusions: Breastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer. Background Breastfeeding provides optimal and complete nutrition for newborn babies. The benefits of breastfeeding to both the infant and the mother have been widely recognized [1] and the health risks associated with infant formula feeding are increasingly documented [2-4]. During infancy, breastfeeding protects against infectious disease [5-7] and long term, breastfeeding is associated with benefits in several areas, such as cardiovascular risk factors [8], intellectual capacity [9,10], and allergy [11,12]. Even in the developed world, breastfeeding offers substantial health benefits to infants and young children [6,13,14]. Both the World Health Organization (WHO) [1] and the American Academy of Pediatrics [5] have recommended exclusive breastfeeding for the first six months of life, with continued breastfeeding up to 12 months of age or longer along with the introduction of solid foods. Women in Hong Kong, like women in many other industrialized countries, are increasingly choosing to breastfeed their infants. Although more than 70% of all new mothers now initiate breastfeeding [15], up from 19% in 1981 [16] and 37% in 1997 [17], Hong Kong still has low breastfeeding rates when compared with other developed countries [18,19]. Despite the recommendation of the Hong Kong Department of Health, which like the WHO [1] recommends exclusive breastfeeding until 6 months of age [20], and active promotion of * Correspondence: tarrantm@hku.hk School of Nursing, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Pokfulam, Hong Kong Tarrant et al. BMC Pregnancy and Childbirth 2010, 10:27 http://www.biomedcentral. com/1471-2393/10/27 © 2010 Tarrant et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. breastfeeding by the Hong Kong Government and various other organizations [15], both the duration of exclusive breastfeeding and the total duration of breastfeeding remain below the WHO recommendations [1,21]. Few Hong Kong women exclusively breastfeed and most stop breastfeeding within the first few months postpartum [22]. A population-based birth cohort study done in 1997 found that only 20.4% and 10.3% of infants were still breastfeeding at 1 month and 3 months of age, respectively [17]. Another large breastfeeding survey showed that from 1997 to 2000, 35-39% of women breastfed for at least 1 month, 22-28% breastfed for 4 months, and 15-19% breastfed for at least 6 months [16]. A longitudinal non-population based study found that about 20% of women continued to breastfeed for 6 months or longer [22]. The high breastfeeding attrition rate in Hong Kong has been attributed to sociocultural variables such as lack of family, community, and workplace support for breastfeeding [22,23]. As in many Western societies, breastfeeding in public is often perceived as embarrassing and cultural values have made formula feeding the norm. While there have been an increasing number of studies on breastfeeding among Hong Kong mothers over the past decade, few studies have described breastfeeding and weaning practices in Hong Kong in any detail. Most larger-scale studies that have been done in Hong Kong are now outdated as they were done when breastfeeding rates were substantially lower than today [17,24,25]. Furthermore, while exclusive breastfeeding rates are known to be low and breastfeeding duration remains short, little research has documented breastfeeding practices over the first year of life and the self-identified reasons for weaning. This longitudinal prospective cohort study of mother-infant pairs provides more up-to-date information on the breastfeeding and weaning practices in Hong Kong and describes the differences in these patterns from those of other developed countries. In addition, this study highlights some possible explanations for the low prevalence of continued breastfeeding in the population, which have significant public health implications.