The changing patterns of infant feeding in Scotland – exclusive or mixed messages?
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Transcript of The changing patterns of infant feeding in Scotland – exclusive or mixed messages?
The changing patterns of infant feeding in Scotland – exclusive or
mixed messages?
‘Tomi Ajetunmobi, Bruce Whyte
Glasgow Centre for Population Health/
ISD Scotland
10th November, 2011
Outline
• Introduction/Background
• Aims and objectives
• Definitions
• Results
• Conclusions
Introduction
• The WHO recommends exclusive breastfeeding for the first 6 months.
• The benefits of breastfeeding to both mother and infant are well established.
• In Scotland, although there have been programs and policies set up to improve and monitor breastfeeding, the proportion of exclusively breastfed infants remains one of the lowest in Europe and has remained relatively stable over the past 10 years.
Background: GCPH Breastfeeding Project
• 2 main aims:– To carry out analysis using a new using linked
dataset in order to investigate breastfeeding trends nationally and locally and to inform future monitoring
– To investigate the unexpected increase in breastfeeding in selected deprived neighbourhoods within Greater Glasgow and Clyde
Overview of data schemes
Predictor Variables Outcome Variables
Geography (NHS Board, CHP, Neighbourhood area, hospital)
Maternal characteristics (e.g. maternal age, marital status, ethnicity, socioeconomic characteristics, deprivation, smoking status)
Pregnancy/Delivery characteristics (e.g. gestation, previous pregnancies, parity, length of stay, mode of delivery, outcome, multiple birth, caesarean section,)
Infant characteristics (e.g. APGAR score, birth weight, congenital anomaly, neonatal/infant admission, length of stay)
Infant feeding – initiation (first feed, feed on hospital discharge)
Infant feeding - duration(feed on hospital discharge, feed at community discharge, feed at first visit, 6 to 8 week review, 8-9 month review)
NRS(GROS)
SMR02
CHSP-PS
SBR/SMR11
SSBID
NRS(GROS) – Births; SMR02 – Maternal hospital records ; CHSP-PS - Child Health Surveillance (pre-school); SBR/SMR11 - Scottish Birth Record/Neonatal and infant health; SSBID - Scottish Still Birth and Infant Death Records
Infant feeding definitions
• Exclusive breastfeeding
• Bottle (Formula) feeding
• Mixed formula and breastfeeding – Complementary/supplementary – Flexible, partial or minimal*
*Morse JM & Harrison MJ (1988) Patterns of mixed feeding. Midwifery 4:19-28
Infant feeding trends
Scotland: Exclusive breastfeeding trends
Scotland: Exclusive breastfeeding trends 2001- 2009 Source: CHSP, NRS/ISD Scotland linked extract
51% 54% 54% 53% 54% 54% 55% 55% 55%
45%45%43% 44% 45% 44% 45% 45% 45%
36%37%37%37%38%38%39%37% 38%
26% 27% 27% 26% 28% 26% 26% 26% 26%
0%
10%
20%
30%
40%
50%
60%
2001 2002 2003 2004 2005 2006 2007 2008 2009
Year of birth
Infa
nts
(%)
Birth Hospital discharge First visit 6 to 8 week review
Scotland: Mixed feeding trends
Scotland: Mixed feeding trends 2001 - 2009Source: CHSP, NRS/ISD Scotland linked extract
3% 4% 4% 4%4%5% 5% 6%
6% 6% 7%8%
9% 9% 9% 9% 9% 9% 9% 10%
3% 3% 3% 3%4% 4% 4%
4%5%5%5% 5%
6%7%
8%9%
0%
2%
4%
6%
8%
10%
12%
2001 2002 2003 2004 2005 2006 2007 2008 2009
Year of birth
Infa
nts
(%)
Birth Hospital discharge First visit 6 to 8 w eek review
Infant feeding amongst first time mothers
Scotland: Mixed feeding trends amongst first-time mothers
Scotland: First-time mothers mixed feeding trends 2001 - 2009Source: CHSP-PS, NRS/ISD Scotland linked extract
0%2%4%6%8%
10%12%
2001 2002 2003 2004 2005 2006 2007 2008 2009
Year of birth
Infa
nts
(%)
Birth Hospital discharge First visit 6 to 8 w eek review
First-time mothers: Infant feeding trends 2001 and 2009
2001 2009Scotland: First time mothers
Infant feeding trends at hospital discharge 2001Source: CHSP-PS, NRS/ISD Scotland linked extract
MIXED3%
BOTTLE50%
BREAST47%
Scotland: First time mothers Infant feeding trends at hospital discharge 2009
Source: CHSP-PS/ISD Scotland linked extract
MIXED7%
BOTTLE45%
BREAST48%
Scotland: First time mothersInfant feeding trends at first visit 2001
Source: CHSP-PS, NRS/ISD Scotland linked extract
BOTTLE56%
BREAST40%
MIXED4%
Scotland: First time mothers Infant feeding trends at first visit 2009
Source: CHSP-PS, NRS/ISD Scotland linked extract
MIXED10%
BOTTLE52%
BREAST38%
First-time mothers: Mixed feeding and maternal age 2001 and 2009
Scotland first time mothers: Mixed feeding at first visit by maternal age2001 and 2009
Source: SMR02, CHSP-PS/ISD Scotland linked extract
2% 3% 4% 5%8% 9%
4%7%
10%13%
14%16%
0%
5%
10%
15%
20%
Less than20years
20 - 24years 25 - 29 years 30 - 34 years 35 - 39 years 40 + years
Maternal age
Infa
nts
(%)
2001 2009
First-time mothers: mixed feeding as a proportion of any breastfeeding by
maternal ageScotland first time mothers: Mixed feeding at first visit as a proportion of any
breastfeeding by maternal age 2001 and 2009 Source: SMR02/CHSP-PS/ISD Scotland linked extract
15%11% 9% 9%
13% 14%
28%
22%19% 20%
22% 24%
0%
5%
10%
15%
20%
25%
30%
Less than20years
20 - 24years 25 - 29 years 30 - 34 years 35 - 39 years 40 + years
Maternal age
Infa
nts
(%)
2001 2009
First-time mothers: mixed feeding as a proportion of any breastfeeding by area
deprivationFirst time mothers: Mixed feeding at first visit as a proportion of any
breastfeeding by area deprivation 2001 and 2009Source: SIMD 2006, NRS, CHSP-PS/ISD Scotland linked extract
9%11% 11% 10%
9%
25%22%
20%18% 18%
0%
5%
10%
15%
20%
25%
30%
SIMD 1_Mostdeprived
SIMD 2 SIMD 3 SIMD 4 SIMD 5_Leastdeprived
SIMD 2006 Quintile
Infa
nts
(%
)
2001 2009
First-time mothers: infant feeding trends by neonatal admission
Scotland first-time mothers: Infant feeding trends at first visit by neonatal admission 2001 - 2009
Source: SMR02, CHSP-PS/ISD Scotland linked extract
53%59%
55%
39%32% 31%
6% 6%9%
0%
10%
20%
30%
40%
50%
60%
70%
Not admitted Admitted for up to 48 hours Admitted for more than 48 hours
Neonatal indicator
Infa
nts
(%
)
BOTTLE BREAST MIXED
Mixed feeding as a proportion of any breastfeeding by neonatal admission
Scotland first-time mothers: Mixed feeding as a proportion of any breastfeeding by neonatal indicator 2001 - 2009
Source: SMR02, CHSP-PS/ISD Scotland linked extract
14%16%
23%
0%
5%
10%
15%
20%
25%
Not admitted Admitted for up to 48 hours Admitted for more than 48 hours
Neonatal indicator
Infa
nts
(%
)
Factors that increased the likelihood of mixed feeding compared to exclusive
breastfeeding at the first visitDemographic – Parents of Non-British origin/birth
– Mothers aged 40 years or older– Mothers of lower socio-economic class– Unemployed fathers– Residence in a more deprived area
Maternity care and health behaviour
– Instrumental delivery or caesarean section– Maternal post-natal hospital stay >2 days – Maternal smoking
Infant health – Infants with ill health/a neonatal event– Small weight for gestational age
In other studies…
Mixed feeding is associated with:
• (Further) reduced milk supply
• Infants separated from mothers due to ill health, work/child care arrangements
• Flexibility/social contexts
• Commencing weaning/early weaning practices
Conclusion • Exclusive breastfeeding rates have remained
relatively static while mixed feeding rates are increasing.
• Mixed fed infants are similar to exclusively breastfed infants. However compared to exclusively breastfed infants mixed feeding is associated with:– Infant ill-health/admission to neonatal ward – Maternal health care/delivery characteristics– Demographic background of parents (e.g. place of
birth, deprivation)
• Further research will be required to understand the patterns of mixed feeding and its influence on infant health.
Acknowledgements• GCPH Breastfeeding project is jointly funded by the
Scottish Centre for Public Health Research and Policy (SCPHRP) and GCPH.
• The project is being managed by Bruce Whyte (GCPH)• With support from an advisory group:
– James Egan (Public Health Programme Manager, GCPH) – Jim Chalmers (Public Health Consultant, ISD Scotland)– Rachel Woods (Public Health Consultant, ISD Scotland)– Diane Stockton (Public Health Specialist, ISD Scotland)– Judith Tait (Child Health Information Team Leader, ISD Scotland)– Linda Wolfson (Infant Feeding Advisor, NHS GG&C),– Jill Muirie (Public Health Advisor, NHS Health Scotland)– Ruth Campbell (Consultant Dietitian, NHS Ayrshire & Arran)– Helen Yewdell (Scottish Government)– David Tappin (Senior Clinical Lecturer, PEACH unit, Royal Hospital for
Sick Children, Glasgow)
Thank you!