Influence of the COVID-19 pandemic on breastfeeding support for healthy mothers and the association between compliance with WHO recommendations for breastfeeding support and exclusive breastfeeding in Japan

Abstract

Background Professional breastfeeding support contributes to maternal and child health. However, the influence of the current coronavirus disease 2019 (COVID-19) pandemic on breastfeeding support has not been carefully examined. Therefore, we assessed maternal breastfeeding intention and professional breastfeeding support before and during the pandemic. We further examined the association of compliance with World Health Organization (WHO) recommendations for professional breastfeeding support with exclusive breastfeeding during the pandemic. Methods This cross-sectional, internet-based, questionnaire study analyzed data from 484 healthy women with live singleton births between 15 October 2019 and 25 October 2020 in Japan. A delivery before 5 March 2020 was classified as a before-pandemic delivery (n = 135), and a delivery after 6 March 2020 was a during-pandemic delivery (n = 349). Among the ten breastfeeding support steps recommended by the WHO, we assessed the five steps that are measurable by maternal self-report and would likely exhibit variability. Receipt of a free formula sample or invitation to a free sample campaign by the time of survey was also asked. Infant feeding status at the time of the survey was measured among women with infants younger than 5 months, which was a subgroup of mothers who delivered during the pandemic. Mothers were asked what was given to infants during the 24 h before the survey and when nothing other than breast milk was given, the status was classified as exclusive breastfeeding. Results While 82.2% of women with a delivery before the pandemic intended to breastfeed, the rate was 75.6% during the pandemic (p = 0.120). The average number of breastfeeding support steps received was 3.24 before the pandemic but it was 3.01 during the pandemic (p = 0.069). In particular, rooming-in was less frequent (39.3% before vs. 27.8% during the pandemic, p = 0.014). Among mothers with infants younger than 5 months who had a delivery during the pandemic (n = 189), only 37.0% (n = 70) reported exclusively breastfeeding during the 24 h before completing the survey. Multiple logistic regression analysis indicated that receiving support for all five steps was positively associated with exclusive breastfeeding during the 24 h before the survey (adjusted odds ratio 4.51; 95% CI [1.50–13.61]). Receipt of a free formula sample or invitation to a free sample campaign was negatively associated with exclusive breastfeeding (adjusted odds ratio 0.43; 95% CI [0.19–0.98]). Other factors related to non-exclusive breastfeeding were older maternal age, lower education level, primiparity, and no breastfeeding intention. Conclusions The pandemic weakened breastfeeding support for healthy women in Japan; however, support practice that adhered to WHO recommendations appeared to be effective during the pandemic.

Challenging the utility of 24-hour recall of exclusive breast feeding in Japan

“…Recall bias and social-desirability bias are among the various possible sources of error, and the AUCs could have been affected by ‘imperfect gold standard bias’, which can raise or lower sensitivity and specificity 25 27. In addition, this study was conducted in Japan, where the vast majority of mothers intend and initiate breast feeding,28 although only a small proportion of mother–infant pairs receive appropriate in-hospital breastfeeding support 29. Moreover, the mother and the newborn usually stay in a hospital for approximately 5 days in Japan.…”

“… 25 27 In addition, this study was conducted in Japan, where the vast majority of mothers intend and initiate breast feeding, 28 although only a small proportion of mother–infant pairs receive appropriate in-hospital breastfeeding support. 29 Moreover, the mother and the newborn usually stay in a hospital for approximately 5 days in Japan. Those Japan-specific intentions and practices might have highlighted the effect of the provision of in-hospital breastfeeding support on exclusive breast feeding from birth.…”

Factors Related to Exclusive Breastfeeding During The COVID-19 Pandemic: Literature Review

“…Older mothers, lower education levels, and overly tiring work situations can make it difficult for mothers to receive correct information regarding exclusive breastfeeding during the Covid 19 pandemic. 10,15 While most factors related to exclusive breastfeeding are husband and family support, the success of exclusive breastfeeding during a pandemic cannot be separated from the husband's support for breastfeeding mothers. The husband's support is a dominant component of successful exclusive breastfeeding.…”

“…In addition, the mother's age, education level, gravida, and intention to breastfeed are also significant. 8 9,[11][12][13][14][15]18 , two studies used a mix method design (Agrina et al, 2022; Nuampa et al, 2022) 10,17 , and one study used a cohort design (Behesti et al, 2022) 16 .…”

Sudden Infant Death Syndrome, Pulmonary Edema, and Sodium Toxicity: A Grounded Theory

“…Research is needed to update statistics on current cow milk consumption in early infancy. Moreover, regarding the COVID-19 pandemic, “health professionals are crucial to successful breastfeeding, but the pandemic could indirectly affect breastfeeding support” [ 72 ].…”