Evaluating regional differences in breast-feeding in French maternity units: a multi-level approach

Abstract

Objectives: To study how individual and regional characteristics might explain regional variations in breast-feeding rates in maternity units and to identify outlier regions with very low or high breast-feeding rates. Design: Individual characteristics (mother and infant) were collected during hospital stay. All newborns fed entirely or partly on breast milk were considered breast-fed. Regional characteristics were extracted from census data. Statistical analysis included multi-level models and estimation of empirical Bayes residuals to identify outlier regions. Setting: All births in all administrative regions in France in 2003. Subjects: A national representative sample of 13 186 live births. Results: Breast-feeding rates in maternity units varied from 43 % to 80 % across regions. Differences in the distribution of individual characteristics accounted for 55 % of these variations. We identified two groups of regions with the lowest and highest breast-feeding rates, after adjusting for individual-level characteristics. In addition to maternal occupation and nationality, the social characteristics of regions, particularly the population's educational level and the percentage of non-French residents, were significantly associated with breast-feeding rates. Conclusions: Social characteristics at both the individual and regional levels influence breast-feeding rates in maternity units. Promotion policies should be directed at specific regions, groups within the community and categories of mothers to reduce the gaps and increase the overall breast-feeding rate.

Factors Associated with Breastfeeding Initiation: A Comparison between France and French-Speaking Canada

“…That is, higher levels of education, being of immigrant status and not smoking during pregnancy increased the odds of breastfeeding initiation with the cohort infant. These findings are largely consistent with the literature suggesting the stability of these determinants over the past few decades [17,29,40]. Of interest, the effect of maternal education at the university level differed between the cohorts.…”

“…According to national census data, the rates of infants who were ever breastfed in France were among the lowest across European and North American countries, reported as less than 70% [8,14]. National breastfeeding initiation statistics collected in 1998, 2003, and 2010 were estimated at 52.5%, 62.6%, and 68.7% respectively [15–16], with notable differences between regions [17]. By 2011, data from the French Longitudinal Study of Children (ELFE), a population-based sample comprised of ~18, 000 families, revealed a promising rise to 70.5% of infants who were ever breastfed [18].…”

Severe physical violence between intimate partners during pregnancy: a risk factor for early cessation of exclusive breast-feeding

“…Likewise, the proposition that reduced maternal selfconfidence and self-esteem is sometimes in the path between SPVP and EBF seems quite tenable. This hypothesis is strengthened by connecting previous findings pointing out that low confidence and feelings of worthlessness are consistent with the long-term psychological consequences of SPVP victimization (38,39) , and with other studies indicating that the psychosocial wellbeing of women during pregnancy is an important protective factor for early weaning (5,(40)(41)(42)(43)(44)(45)(46)(47) . The importance of maternal self-esteem as a mediator of the relationship between SPVP and EBF is also reasonable when comparing the gradual effects of introducing the dimensions in the multivariate model.…”

Combining breastfeeding and work: findings from the Epifane population-based birth cohort

“…Though they were less likely to return to work within the child's first year, women born outside of France were more likely to combine ABF and work, regardless of other co-variates. Birthplace abroad was previously highlighted as a prominent BF determinant in developed countries [42]: community norms and dissemination across generations may account for such findings. Thus, ABF behavior of foreign women who return to work *Covariate kept in the final multivariate model, since removing it modified the OR of "Workers" by more than 10%.…”