Women’s experiences of infant feeding support: Findings from a cross-sectional survey in Victoria,Australia

ObjectiveTo evaluate new mothers’ experiences of infant feeding support.DesignA postal survey developed for this study was sent to all new mothers in ten local government areas in Victoria, Australia when their baby was six months of age. Questions explored infant feeding methods, feeding support services, and experiences of infant feeding support. This survey made up one component of the Supporting breastfeeding In Local Communities (SILC) cluster randomised controlled trial.Findings997/4127 women (24%) completed the survey between 15 April 2013 and 31 July 2013. Women received infant feeding support from multiple sources, including professionals, family members, and peers. Overall, 88% reported receiving adequate infant feeding support. Women who reported not receiving adequate infant feeding support were less likely to be giving any breast milk at six months compared to those reporting adequate support (OR = 0.59; 95% CI 0.40, 0.88). Adjusting for breastfeeding intention and parity did not alter the association (Adj. OR = 0.60; 95% CI 0.40, 0.90). Women were most satisfied when they received accessible, available, consistent professional infant feeding support provided in a non-judgemental and reassuring way. Women were dissatisfied when there were barriers restricting access to support, or when they received conflicting advice or support that made them feel guilty, pressured or judged.Key conclusionsRegardless of infant feeding method, women wanted accessible, non-judgemental support. Given that receiving adequate support was associated with more breast milk feeding at six months, care providers should ensure accessible infant feeding support is available to all new mothers.     

Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia

Optimal feeding practices can establish lifelong, transgenerational and global health benefits. Migration and cultural factors impact infant feeding practices and the support mothers receive for optimal infant feeding. This qualitative study explored support for infant feeding among Arabic and Chinese speaking migrant mothers in Australia.Semi-structured focus groups were conducted in language with 24 Arabic and 22 Chinese-Mandarin speaking migrant mothers with children under five years of age. Individual interviews were conducted in English with 20 health professionals working with Arabic or Chinese speaking migrant families. Data were thematically analysed using the framework method.Traditional family networks and trusted bi-cultural doctors were influential infant feeding supports for mothers. Health professionals perceived maternal and child health services to be poorly understood, and some mothers who accessed services felt they were not always culturally sensitive. Mothers sought additional information and support through online sources and peers. Both mothers and health professionals recognised the challenges of managing conflicting infant feeding advice and seeking best-practice support.The findings of this study highlight opportunities for health professionals to better support migrant mothers’ infant feeding practices, for example through engaging families and working with doctors. There is a need for greater cultural sensitivity within maternal and child health services and culturally relevant programs to support healthy infant feeding practices among migrant communities.     

Mothers’ attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa

BackgroundIn American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration.Aims(1) To examine American Samoan mothers’ feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding.MethodsEighteen semi-structured interviews were conducted with American Samoan mothers at 16–32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data.FindingsIntention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous “back-up option” where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design.ConclusionThis study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.     

Diversity and change in Cambodian households, 1998–2006

Extant ethnographic studies suggest that the nuclear family has been the predominant living arrangement in Cambodia, and the country’s rapid socioeconomic transformation since the early 1990s may have accentuated that dominance. To examine these claims, we analyse here household structure in Cambodia between 1998 and 2006, based on data from the 1998 Census, two nationally-representative surveys (2000 and 2005), and a continuing demographic surveillance system (from 2000 on). Our analysis confirms the large prevalence of nuclear families, but not an unequivocal trend toward their increasing prevalence. First, nuclear families are less prevalent in urban than in rural areas, and nationwide, they appear to have receded slightly between 2000 and 2005. We find that increases in the prevalence of extended households correspond to periods of faster economic growth, and interpret these contrasted trends as signs of tensions during this transitional period in Cambodia. While the nuclear family may still be the cultural norm, a high degree of pragmatism is also evident in the acceptance of other living arrangements, albeit temporary, as required by economic opportunities and housing shortage in urban areas.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

宁波市农村空巢家庭老年人生活状况调查分析

文章根据宁波市农村老年人生活1％抽样调查的数据。重点对宁波市农村空巢家庭中夫妇户与孤老户的特点进行了归纳,并在此基础上对二者在经济保障、健康保健、生活照料、社会支持等特殊需求方面的差异进一步剖析．最后根据不同的需求提出了相应的对策建议。     

[An analysis of regional differential mortality].]

Regional differences in mortality and life expectancy in China are explored, and the socioeconomic, cultural, and educational factors affecting such differences are considered using data from the 1982 census. The author notes that mortality, particularly infant mortality, is highest in economically underdeveloped areas, and female infant mortality is high in both rural and urban areas. It is also observed that female life expectancy is 3.26 years longer than for males in urban areas, and 1.38 years longer in rural areas.     

社会救助视角下农村家庭养老服务津贴政策构想

为救助困难家庭的老人、提升老人的养老质量,政府已为部分困难老人购买社会养老服务。然而受制于各地经济社会发展水平,在广大的农村地区、甚至部分城镇地区,社会化服务发展水平较低、服务人员和队伍不足,绝大多数家庭尚未享受到政府购买服务,困难老人仍然依靠传统的家庭养老服务。基于与政府购买社会养老服务政策相匹配的理念,文章通过梳理国内外家庭养老服务相关实践发现对提供服务的家庭予以部分经济补贴是可行之路,实际调研中也发现当下农村地区困难老人面临的养老责任扯皮推诿、服务水平低等问题多为经济不足诱发。针对农村地区为老人提供家庭养老服务的困难家庭,本文从目标、原则、管理体制等几个方面为其构建农村家庭养老服务津贴政策。     

The Cost of Disability in China

We describe the degree to which household income is negatively associated with the prevalence of different types of disability (i.e., medical impairments) in China using data from the 2006 Second National Survey of Disabled Persons. We then calculate the extra costs of disability across different types of households and show how these costs differ by the type and severity of disability in both urban and rural areas. Finally, we use nationally representative panel data on persons with disabilities from 2007 to 2009 to examine the degree to which social security is reaching persons with different types and severity of disabilities in both urban and rural areas. We conclude that although the amount and coverage of social security for households with disabilities is increasing rapidly, it is still not enough to offset the income differential between households with and without disabled persons, especially when we account for the extra costs of disability.     

户籍类型与城乡居民医疗服务利用 ——基于Andersen模型的经验分析

本文利用中国社会科学院经济研究所2018年城乡居民入户调查数据,从户籍改革角度分析户口类型改变对城乡居民医疗服务利用的影响。研究发现:与户口类型未发生改变的城乡居民相比,户口类型发生过改变(农转非)的城乡居民门急诊服务利用的可能性更高,住院医疗服务支出水平更低。从户籍改革与参保类型交互效应看,相对于户口类型未发生过改变的居民医保参保人群,户口类型发生改变(农转非)会显著提高居民医保参保人群门急诊服务利用,同时降低其住院服务利用。进一步采用PSM方法进行稳健性检验,户籍改革对提高城乡居民门急诊服务利用,降低住院医疗服务利用的结论依然成立。此外,本文还发现,直接结算提高了城乡居民门急诊和住院的就诊概率;健康自评状况越差,门急诊和住院医疗服务利用可能性越高,门急诊医疗支出、住院医疗支出和跨省异地就医支出也越高。本文认为,相对于推行基层分级诊疗制度,以户籍改革推动农村居民自由流入医疗资源更丰富的城镇地区,改革基层卫生院制度,以及改变基层医疗服务提供激励机制,可能更有助于改善农村居民健康状况。     

Household structure and labor force participation of black,hispanic, and white mothers

This paper investigates whether the inclusion of nonnuclear adults in a household facilitates the labor force participation of single and married mothers. Results based on a sample of extended and nuclear households show that the extension mechanism facilitates the labor market entry of married mothers, but not of single mothers. Interactions between extended structure, ethnicity, and poverty, however, suggest a complex relationship. For extended family households, the gender and employment characteristics of nonnuclear adults affected the labor force participation of single mothers, but the number of nonnuclear members was inversely associated with the market activity of married mothers. Policy implications are discussed in the final section.     

Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers’ perspectives

BackgroundAlmost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed.AimTo explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices.MethodsA critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers’ narratives.FindingsAnalysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers’ differing views and positions on infant feeding practices and their influence on breastfeeding.ConclusionThis study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers’ influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.     

Aboriginal women in rural Australia; a small study of infant feeding behaviour

BackgroundAboriginal women in rural areas have lower rates of breastfeeding than Australian averages. The reasons for this are poorly understood. Aboriginal people experience higher morbidity and increased rates of chronic disease throughout the life cycle. The protective effects of sustained breastfeeding could benefit rural Aboriginal communities.ObjectiveTo explore the factors impacting upon infant feeding choices in a rural Aboriginal Community.MethodsSemi-structured interviews were conducted with eight Aboriginal rural dwelling first time mothers. These women received a continuity of midwife and Aboriginal Health Worker model of care. Interviews were also undertaken with five Aboriginal Health Workers and two Aboriginal community breastfeeding champions. The analysis was integrated with a conventional literature review and was further developed and illustrated with historical literature. Indigenist methodology guided the study design, analysis and the dissemination of results.ResultsThree key themes were identified. These were “I’m doing the best thing for…” which encompasses the motivations underpinning infant feeding decisions; “this is what I know…” which explores individual and community knowledge regarding infant feeding; and “a safe place to feed” identifying the barriers that negative societal messages pose for women as they make infant feeding decisions. It appears loss of family and community breastfeeding knowledge resulting from colonisation still influences the Aboriginal women of today.DiscussionAboriginal women value and trust knowledge which is passed to them from extended family members and women within their Community. Cultural, historical and socioeconomic factors all strongly influence the infant feeding decisions of individuals in this study.ConclusionsEfforts to normalise breastfeeding in the culture of rural dwelling Aboriginal women and their supporting community appear to be necessary and may promote breastfeeding more effectively than optimal professional care of individuals can do.     

Latin American Households in Comparative Perspective

Comparative family sociology has had little to say about the Latin American family or household despite it links to a European colonial culture mixed with a distinct set of indigenous and historical circumstances. In this paper tentative judgements are put forward about the similarities and differences between the Western and Latin American household by examining four of its dimensions: the household's relative complexity, the separate residence of conjugal units, the incidence of households headed by women, and the incidence of household members being unrelated to the head. Data come from the World Fertility Survey household files gathered during the middle 1970s in six countries: Mexico, Costa Rica, Panama, the Dominican Republic, Colombia and Peru. We find that household complexity in the six countries is intermediate between that of the West and East. Many of the households are extended laterally instead of vertically, because conjugal couples tend to reside in separate households, but often live with unmarried relatives as well. In addition, a high level of marital instability results in a significant proportion of households headed by women, many of them containing members of the extended family. Finally, whereas the circulation of young unmarried people of both sexes was common in rural areas in the West, being an unrelated individual in another's household is most common in urban areas among females between 15 and 19 years old.     

Socioeconomic Differences According to Family Arrangements in Chile

Family changes have accelerated in Chile in the last decades. Impressively, the proportion of children born outside of marriage has reached over 60%, at the same time that marriage has declined and cohabitation has increased. These changes are regularly considered indicators of a second demographic transition. This study describes the socioeconomic differences that currently exist in Chile between first-time mothers living in different family arrangements, and it asks to what extent these differences are the result of long term disadvantages passed on from the families the respondents grew up in. The data comes from a postpartum survey implemented in Santiago (N = 686 women). The results show large differences in the socioeconomic wellbeing of women in different family arrangements. Women in nuclear marriages stand far apart from any other group in terms of educational attainment, income and participation in the labor force. Cohabiters and married women in extended households enjoy a level of socioeconomic wellbeing that is similar, but not as high as that of married women in nuclear households. Cohabiters in extended households, visiting, and single mothers look alike, and are the most vulnerable women in the sample. The link between the current scenario and the family where the respondents grew up is strong. Under these circumstances, it is hard to interpret the recent demographic changes in Chilean families as a prototypical case of the SDT. The trend the country is following resembles closer the dichotomous trajectory the U.S. has followed.     

不同地域女性自杀死亡率差异的经济原因分析——基于城乡差距的视角

自杀是一个值得重视和研究的特殊社会问题,中国自杀现象的基本特征：女性高于男性,农村高于城市。本文基于我国城乡差异的视角,分析我国社会转型时期城乡女性自杀死亡率差异的经济原因。最后从缩小城乡差距,改善农村妇女经济地位的角度提出相应的预防措施。     

The Family Context of Cohabitation and Single Motherhood in Latin America

The dramatic shift from marriage to cohabitation during the last four decades in most Latin American countries, even among the upper social strata, begs the question as to the living arrangements of cohabiting couples and single mothers. The new “Family Interrelationships Variables” in the IPUMS samples of Latin American censuses facilitated the construction of an enlarged LIPRO typology. LIPRO classifies individuals with respect to the types of households in which they are living. The results indicate that cohabiting women and single mothers aged 25 to 29 are frequently found in their parental households or in other extended or composite households. However, there are large variations depending on country and education. For instance, cohabitation is mainly in nuclear households, as in Europe, in Puerto Rico, Costa Rica, Brazil, and Argentina. It occurs mainly in the context of extended households in Peru, Bolivia, Colombia, Venezuela, Panama, and Cuba. Mexico and Chile occupy intermediate positions. In all instances co‐residence of cohabiting couples with other kin drops significantly upon the transition to parenthood, at which point there are no longer any differences between cohabiting and married couples. Single mothers, however, continue to co‐reside in extended or composite households to a larger extent, and this holds particularly for the better‐educated among them. This analysis illustrates that cohabitation of the traditional type and of the “Second Demographic Transition” type are found alongside each other, with one being more important than the other depending on country and on educational level or social class within each country.     

社会支持对农村老年女性孤独感的影响研究

利用2009年陕西省农村老年女性生活福利状况调查数据,定量分析了社会支持对农村老年女性孤独感的影响。孤独感已成为影响农村老年女性生活质量的重要的健康问题,社会支持对农村老年女性孤独感具有显著的负向影响,社会交往面广、代际情感支持丰富和日常生活照料周到是降低农村老年女性孤独感、促进老年女性身心健康、安度晚年的重要因素。研究结果为政府制定旨在改善农村老年女性群体心理福利的相关政策、进行有效的政策干预提供理论和现实依据。     

人力资本、社会资本与工作转换①--基于城乡大学毕业生的比较研究

城乡大学毕业生在工作转换上的差异,一直以来广受关注却缺乏实证考察。研究表明：当前大学毕业生发生工作转换的比例并不高,城乡两类大学毕业生在工作转换上也不存在显著差异。总体而言,人力资本有利于大学毕业生的稳定就业,而工作年限与社会资本则会增加其工作转换的可能性。但更为细致的分析发现,与城镇家庭出生者相比,来自农村的大学毕业生的人力资本与社会资本均呈明显的劣势,且对其工作转换的影响较弱,他们工作转换后的回报也甚微,这意味着城乡差异与资本累积的不平等仍然存在。     

An analysis of the size of the family household and family structure in China]

Since 1949, great social and economic changes have taken place in China. The entire economic structure and social relations are no longer the way they used to be. These changes have also had a strong impact on the size of family households and family structure. Major changes are summarized as follows: (1) The size of the present family household has been greatly reduced from its earlier size. The main reason for this reduction in size is the change of the social system. Under the new social system, the natural population growth rate and family structure have shown the greatest change from the past. (2) The major change in family structure is that small families have replaced the traditional large families. Under the large family system, several generations may stay together as one household, and brothers do not divide the large family even after they are married. Under the small family system, a household is normally limited to the parents and their children. With the gradual disappearance of large families, small families are increasing rapidly. Some households with three generations living together are still in existence, and the young and the old may support each other in their daily life. Both in cities and in rural areas, the traditional custom of respecting one's old parents still exists. There must be a value and necessity for the existence of this particular kind of family structure.