Paradox found (again): Infant mortality among the Mexican-origin population in the united states

Recent research suggests that the favorable mortality outcomes for the Mexican immigrant population in the United States may largely be attributable to selective out-migration among Mexican immigrants, resulting in artificially low recorded death rates for the Mexican-origin population. In this paper we calculate detailed age-specific infant mortality rates by maternal race/ethnicity and nativity for two important reasons: (1) it is extremely unlikely that women of Mexican origin would migrate to Mexico with newborn babies, especially if the infants were only afew hours or afew days old; and (2) more than 50% of all infant deaths in the United States occur during the first week of life, when the chances of out-migration are very small. We use concatenated data from the U.S. linked birth and infant death cohort files from 1995 to 2000, which provides us with over 20 million births and more than 150,000 infant deaths to analyze. Our results clearly show that first-hour, first-day, and first-week mortality rates among infants born in the United States to Mexican immigrant women are about 10% lower than those experienced by infants of non-Hispanic, white U.S.-born women. It is extremely unlikely that such favorable rates are artificially caused by the out-migration of Mexican-origin women and infants, as we demonstrate with a simulation exercise. Further, infants born to U.S.-born Mexican American women exhibit rates of mortality that are statistically equal to those of non-Hispanic white women during the first weeks of life and fare considerably better than infants born to non-Hispanic black women, with whom they share similar socioeconomic profiles. These patterns are all consistent with the definition of the epidemiologic paradox as originally proposed by Markides and Coreil (1986).     

The impact of breast feeding patterns on the biometric analysis of infant mortality

A major assumption of the biometric analysis of infant mortality as developed by Bourgeois-Pichat is that the age structure of infant deaths after the first month of life is virtually constant across time and cultures. Reanalysis of results from studies which compare the mortality of infants according to the type of feeding indicated that the relationship between mortality and age within the first year of life followed different patterns for breast fed and artificially fed infants. Historical data for populations with different breast feeding customs reveal similar differences in the age pattern of infant mortality. In populations where breast feeding was uncommon or of very short duration, infant mortality rises particularly steeply during the early months of the first year of life. The age structure of infant mortality in less developed countries where breast feeding is decreasing rapidly may be similarly affected. When substantial deviations from the linear relationship are evident, particular caution is required in applying the biometric technique, since in such situations the estimated endogenous mortality is very much affected by the particular set of data points within the first year of life which are chosen for the basis of the estimates.     

Prospective study of birth interval dynamics in rural Bangladesh

Abstract A group of 209 married, fecund women in rural Bangladesh were studied prospectively for 24 months from 1969 to 1971 to define some of the biological and sociological factors relating to fertility performance. These women were selected from a larger study population of 112,000 that had been followed with a daily house-to-house vital registration programme since 1966. The selected women were interviewed bi-weekly and were asked questions about menstruation, pregnancy, lactation, husband's occupational absences, and monthly urine tests for pregnancy were taken. The results for 193 non-contracepting women revealed that the seasonal pattern of births previously observed in this population could be associated with a corresponding seasonal pattern of conceptions and that this was due to a seasonal trend in fecundability. The highest conception rates were in the coolest months of the year. Post-partum lactational amenorrhoea was very prolonged, averaging 17 months for women with a surviving child. The appearance of the first post-partum menstrual flow (onset of ovulation) also had a seasonal trend which could not be adequately explained. The median waiting time to conception, once menstruation had resumed was eight months. This interval was influenced by seasonal fluctuations, as well as by the age of women and by husbands' absences. The foetal wastage rate was 15·0 per 100 conceptions, with 62 per cent of the foetal losses occurring during the second month of gestation. Overall, the average birth interval was 33 months, with the prolonged lactational amenorrhoea accounting for almost 45 per cent of this interval. From the Department of Population Dynamics, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland 21205.     

Contraceptive overlap with post-partum anovularity

Abstract Contraceptive use in the early post-partum months is, for the majority of women, without any direct protective value because, whilst not ovulating, they are not exposed to the risk of pregnancy. This does not, of course, imply that contraception should be delayed until signs of the resumption of ovulation appear, as for many women the first sign of such resumption is pregnancy. There are, besides, logistic and psychological reasons which make early post-partum contraception advisable. It does, however, demand that any calculation of the demographic effects of contraceptive use should make due allowance for this null period of use.     

Contraceptive overlap with post-partum anovularity

Contraceptive use in the early post-partum months is, for the majority of women, without any direct protective value because, whilst not ovulating, they are not exposed to the risk of pregnancy. This does not, of course, imply that contraception should be delayed until signs of the resumption of ovulation appear, as for many women the first sign of such resumption is pregnancy. There are, besides, logistic and psychological reasons which make early post-partum contraception advisable. It does, however, demand that any calculation of the demographic effects of contraceptive use should make due allowance for this null period of use.     

Prospective study of birth interval dynamics in rural Bangladesh

A group of 209 married, fecund women in rural Bangladesh were studied prospectively for 24 months from 1969 to 1971 to define some of the biological and sociological factors relating to fertility performance. These women were selected from a larger study population of 112,000 that had been followed with a daily house-to-house vital registration programme since 1966. The selected women were interviewed bi-weekly and were asked questions about menstruation, pregnancy, lactation, husband's occupational absences, and monthly urine tests for pregnancy were taken. The results for 193 non-contracepting women revealed that the seasonal pattern of births previously observed in this population could be associated with a corresponding seasonal pattern of conceptions and that this was due to a seasonal trend in fecundability. The highest conception rates were in the coolest months of the year. Post-partum lactational amenorrhoea was very prolonged, averaging 17 months for women with a surviving child. The appearance of the first post-partum menstrual flow (onset of ovulation) also had a seasonal trend which could not be adequately explained. The median waiting time to conception, once menstruation had resumed was eight months. This interval was influenced by seasonal fluctuations, as well as by the age of women and by husbands' absences. The foetal wastage rate was 15·0 per 100 conceptions, with 62 per cent of the foetal losses occurring during the second month of gestation. Overall, the average birth interval was 33 months, with the prolonged lactational amenorrhoea accounting for almost 45 per cent of this interval.      

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.     

Changing the risky beliefs of post-partum women about therapeutic sun-exposure

BackgroundMany post-partum women hold risky beliefs about perceived therapeutic benefits of sun-exposure in the post-partum period and infancy.QuestionCan a maternity hospital based educational intervention reduce the prevalence of such beliefs among post-partum women?MethodsIn this outcome evaluation of an interventional study, two groups of healthy post-partum women (hospital inpatients) were interviewed, 1–4 days following delivery. The first cross-section (106 women) was recruited prior to in-services for maternity staff; the second (203 women) was recruited after completion of the in-services. Data were compared between the groups.FindingsMore pre-intervention than post-intervention women reported they would expose their baby to sunlight to treat suspected jaundice (28.8% vs 13.3%; p < 0.001) or help his/her skin adapt to the sun (10.5% vs 2.5%; p = 0.003); or use sunlight to manage breastfeeding-associated sore/cracked nipples (7.6% vs 2%; p = 0.026).ConclusionThis simple, effective educational intervention could be implemented in programmes for parents, health professionals and students.     

Association between expressed breast milk feeding and breastfeeding duration in Hong Kong mothers

BackgroundExpressed breast milk feeding has increased substantially in the past two decades. Once used primarily for preterm infants, feeding expressed breast milk is now more common in mothers giving birth to healthy term infants. However, the effect of expressed breast milk feeding on breastfeeding duration is unclear.ObjectivesTo assess the association between breast milk expression practices and breastfeeding duration in women giving birth to healthy infants.MethodsFrom 2017 to 2018, we recruited 821 new mothers from two public hospitals in Hong Kong. Participants were followed up at 1.5, 3, and 6 months postpartum or until they stopped breastfeeding. The proportion, type, and mode of all milk feeding were assessed at each follow-up.ResultsAt 1.5 months postpartum, 47.9%, 37.7%, and 14.4% of participants were feeding by direct breastfeeding only, mixed-mode feeding, and expressed breast milk only, respectively. Participants feeding expressed breast milk only were more likely to be supplementing with infant formula. When compared with participants who provided only direct breastfeeding, participants who gave only expressed breast milk at 1.5 months had 57% lower odds of breastfeeding continuation at three months postpartum. After stratification by infant formula supplementation, expressed breast milk feeding only at 1.5 months was associated with an increased risk of breastfeeding cessation in participants supplementing with infant formula (adjusted hazard ratio [aHR] = 1.86, 95% CI = 1.17–2.95).ConclusionIn the first six months postpartum, giving only expressed breast milk is associated with early breastfeeding cessation, especially in participants who are also supplementing with infant formula.     

The effect of child mortality experience on subsequent fertility: in Pakistan and Bangladesh

Summary This paper presents an empirical analysis of the effects, behavioural and biological, of child mortality experience on subsequent fertility in two South Asian Islamic nations. Data for the investigation came from retrospective pregnancy histories of 2,910 currently married women interviewed in the Pakistan National Impact Survey (1968-69) and from longitudinal vital registration data (1966-2070) of 5,236 women residing in a rural area of Bangladesh collected by the Cholera Research Laboratory. The aim of this study was to assess the importance of the child-replacement motivational response to child death experience after biological effects have been controlled adequately. A common approach employed previously has been to examine cumulative fertility according to child death experience. In Pakistan and Bangladesh, a consistently positive relationship was demonstrated between the number of children ever born and the number of child deaths. This method, however, did not exclude the inverse relationship, the influence of fertility on mortality, nor did it dissect out behavioural from biological effects. Utilizing a measure of subsequent fertility, live-birth-to-live-birth intervals, the study further illustrated another common pitfall. Since the risk of infant death, which leads to shorter birth intervals, is associated with the mother's reproductive history, women with child mortality experience are more likely to experience shorter intervals because of the biological effect of subsequent infant death. Behavioural influences may, therefore, be observed by considering only those birth intervals in which the first-born child survives to the end of the interval. With these limitations controlled, very few, if any, behavioural influences were noted in the Pakistan and Bangladesh data. Median birth intervals in Pakistan varied between 35-43 and 41-42 months, increasing with parity. Within each parity group, no consistent difference was observed between women with and without previous child loss. In Bangladesh, the median birth interval for all women with a surviving infant was 37-2 months. This was shortened to 24-31 months by an infant death. When intervals with infant deaths were excluded, little or no behavioural influence was detected among women of the same parity, but with varying levels of previous child loss. Even without behavioural effects, elimination of infant mortality in Bangladesh would reduce fertility by prolonging the average period of post-partum sterility. In the Bangladesh setting, however, the size of the effect was only about four per cent. This modest effect, more-over, was counterbalanced by an overall increase of net reproduction by seven per cent due to better survivorship of infants.     

Dynamics of contraceptive use and breastfeeding during the post-partum period in Peru and Indonesia

This paper examines the interaction between contraceptive use and breastfeeding in relation to resumption of intercourse and duration of amenorrhea post-partum. We used data from the month-by-month calendar of reproductive events from Demographic and Health Surveys (DHS) in Peru and Indonesia. The analyses show that breastfeeding women were less likely than non-breastfeeding women to have resumed sexual intercourse in the early months post-partum in both countries. In Peru, but not in Indonesia, breastfeeding women had a significantly lower odds than non-breastfeeding women of adopting contraception. Although the likelihood of contraceptive adoption was highest in the month women resumed menstruation in both countries, about ten per cent of subsequent pregnancies occurred to women before they resumed menses. These results emphasize the importance of integrating breastfeeding counselling and family planning services in programmes serving post-partum women, as a means of enabling those who wish to space their next birth to avoid exposure to the risk of a pregnancy that may precede the return of menses.     

Lactation and fertility in Rural Bangladesh

Summary Analysis of data from various phases of a study of post-partum amenorrhoea in Bangladesh illustrated good aggregate consistency of response on menstrual status, but less individual consistency on duration of post-partum amenorrhoea. Using life table techniques, the median duration of amenorrhoea was calculated as 19.9 months for women with births between February and September 1974. There were substantial seasonal variations in duration, with the median decreasing from 21.5 months for women with February births to 16.9 months for those with September births. By contrast, the median duration of post-partum amenorrhoea varies by only two months for women in the lowest and highest quartiles of weight and weight for height. The seasonal pattern was similar for all weight groups.     

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.     

Prevalence and risk factors for postnatal depression in Sabah,Malaysia: A cohort study

BackgroundPostnatal depression can have serious consequences for both the mother and infant. However, epidemiological data required to implement appropriate early prevention are still lacking in Malaysia.AimTo investigate the prevalence of postnatal depression within six months postpartum and associated risk factors among women in Sabah, Malaysia.MethodsA prospective cohort study of 2072 women was conducted in Sabah during 2009–2010. Participants were recruited at 36–38 weeks of gestation and followed up at 1, 3 and 6 months postpartum. The presence of depressive symptoms was assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale. Logistic regression analyses were performed to ascertain risk factors associated with postnatal depression.FindingsOverall, 14.3% of mothers (95% confidence interval (CI) 12.5–16.2%) had experienced depression within the first six months postpartum. Women depressed during pregnancy (odds ratio (OR) 3.71, 95% CI 2.46–5.60) and those with consistent worries about the newborn (OR 1.68, 95% CI 1.16–2.42) were more likely to suffer from depression after childbirth. Women whose husband assisted with infant care (OR 0.43, 95% CI 0.20–0.97) and mothers who were satisfied with their marital relationship (OR 0.27, 95% CI 0.09–0.81) appeared to incur a reduced risk of postnatal depression.ConclusionA substantial proportion of mothers suffered from postnatal depression in Sabah, Malaysia. Screening and intervention programmes targeting vulnerable subgroups of women during antenatal and early postpartum periods are recommended to deal with the problem.     

India's National Family Health Survey provides new information on maternal and child health and AIDS awareness

Teams surveyed a sample of 88,562 households, drawn from 99% of the population of India in 24 states plus the National Capital Territory of Delhi, between April 1992 and September 1993 to collect a basic set of information on all 500,492 household members, with more details on the 89,777 women in the households who had ever been married and were aged 13-49 years. This National Family Health Survey (NFHS) collected information from the women on a range of health topics including child immunization, women's knowledge of AIDS, services and facilities use during pregnancy and childbirth, infant feeding and treatment for diarrhea, and infant, child, and maternal mortality. Levels of infant and child mortality declined in India, but 8% of all children still die before their first birthday and 11% die before reaching age 5. As for maternal mortality, there are an estimated 420 maternal deaths per 100,000 live births annually. That rate implies that at least 100,000 Indian women die each year due to causes related to pregnancy and childbirth. Survey results indicate the need to strengthen vaccination programs and teach women about proper infant feeding practices. They also highlight the need to increase antenatal care and other medical services. In all of these areas, the NFHS results indicate wide variation among India's regions and states. Furthermore, a general lack of AIDS awareness suggests that the government's AIDS awareness campaign, relying primarily upon electronic media, has not yet reached the majority of India's population.     

Population planning in Asia in the 1970s

Analysis of data from various phases of a study of post-partum amenorrhoea in Bangladesh illustrated good aggregate consistency of response on menstrual status, but less individual consistency on duration of post-partum amenorrhoea. Using life table techniques, the median duration of amenorrhoea was calculated as 19.9 months for women with births between February and September 1974. There were substantial seasonal variations in duration, with the median decreasing from 21.5 months for women with February births to 16.9 months for those with September births. By contrast, the median duration of post-partum amenorrhoea varies by only two months for women in the lowest and highest quartiles of weight and weight for height. The seasonal pattern was similar for all weight groups.     

A study of environmental and behavioral factors affecting pregnancy outcome in an Italian community

This study sought to identify environmental factors (socioeconomic conditions, work conditions, service availability, and so on) and behavioral factors (preventive health behaviors, pre- and postnatal care, and so on) which might be related to pregnancy outcome (childbirth, still birth, infant death, abortion). For this purpose high risk families (all families where an infant death or still birth had occurred in the last five years, a total of 253 cases) were compared with a random sample of the families where a normal child was born and survived during the same period (a sample of 239 cases). The results contain data on: (a) socioeconomic and demographic characteristics of study and control cases (residence, housing conditions, marital status or parents, work activity, and educational level): (b) the health status of the mother, prior and during pregnancy; (c) preventive health behavior such as prenatal care, nutrition, and use of drugs, tobacco, and alcohol; (d) working condition of the mother during pregnancy, type of work, work-related environmental risks, leave from work, and transportation; and (e) postnatal care and breast feeding patterns. The findings are discussed in terms of the present and future educational and service needs of the population.This study was made possible by the financial assistance of the World Health Organization, Division of Family Health. Dr. Figa-Talamanca is affiliated with the Institute of General Physiology, University of Rome, 00100 Rome, Italy.     

Influences of household structure and composition on breast-feeding

Researchers applied longitudinal data on 2884 women who were at least 6 months pregnant between May 1983-April 1984 and living in the Cebu metropolitan area, the Philippines to examine assumptions which may explain the association between lower breast feeding levels and dwindling social support for mothers who breast feed in urban areas. Extended family households were much more common in urban areas than rural areas (46.3% vs. 27.5%). This finding did not support the 3rd assumption of falling extended family patterns with urbanization. Further as the levels of complexity and extension of the household rose so did infant care support regardless of location. For example, the number of hours of help with infant care for mothers in nuclear families in urban areas was 1.23 which climbed from 2.53 for horizontal extended families to 2.9 for vertical extended families and to 3.09 for horizontal and vertical extended families. This result supported the 2nd assumption of much more social support in extended families than nuclear families. Yet social support did not translate into promotion of breast feeding--the 1st assumption. Mothers in horizontally extended families had a lower likelihood of breast feeding than those in nuclear families. Further only adult female relatives of the same generation as the mother has a negative influence on breast feeding in urban mothers, but not rural mothers. In fact, female children of at least 7 years old, female servants, and yayas all negatively affect breast feeding in urban mothers, but not rural mothers. In rural households, young female relatives (at least 7 years old) significantly increased the probability of breast feeding whereas young male relatives decreased the probability.     

Craving closeness: a grounded theory analysis of women's experiences of mothering in the Special Care Nursery

AIM: The aim of the study was to increase knowledge and understanding of how women begin their roles as mothers when their infant is in the neonatal nursery. BACKGROUND: Research is limited into how women experience mothering in contexts such as the neonatal nursery. Consequently many nurses and midwives remain inadequately informed of parents' experiences which we know may have long-term family outcomes. METHOD: This paper presents the overarching synthesis of a grounded theory analysis of data collected from 28 Australian women whose infants were in Special Care Nurseries. It draws together a number of previous publications that have described in detail the categories derived from the analysis that explain the actions, interactions and reactions women engage in as they seek to 'connect' with their infant. Data collection consisted of two in-depth interviews conducted with women, 333h of taped cot side recordings, field notes and interview data collected from 20 nursery staff, 19 of whom were midwives. FINDINGS: Six major categories were identified that, when combined, explained the intense emotional, cognitive and worry 'work' women undertook with both their infants and the nursery staff in an effort to learn how to mother in the nursery. Four explained how women worked to get to know and connect with their infants. The first three were labelled 'just existing', 'striving to be the baby's mother' and 'trying to establish competence'. The fourth, 'learning and playing the game', overlays the first three and represents the reality of having to undertake these already difficult and unexpected activities of mothering in the nursery. Two categories 'becoming connected' and 'struggling to mother' were identified as the consequences of women's actions and interactions. A significant finding of the study was the impact of the interactions between nurses and mothers' mothering. The nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. CONCLUSIONS: It becomes clear that the intense work women undertake as mothers in the nursery is focused on not only the infant, which might have been expected, but also the nursery staff. It is driven by their desire to develop or re-establish some sense of competence in the eyes of the nurse and to achieve control over the situation. Achieving physical closeness with the baby was a major strategy through which women not only learned about and gained intimate knowledge of their infant, but also demonstrated authority and ownership. It appears that reorientating the delivery of services from the infant to the mother-infant dyad would improve the care women and families receive during their nursery experience.     

Fertility and mortality in Finland since 1750

Summary In this paper the development of fertility and mortality in Finland, and their interrelations with each other and with economic factors is discussed. An analysis by individual years shows that rises and falls in mortality and fertility rates did not always coincide with poor and good harvests. Fertility in Finland decreased slightly at the turn of the eighteenth and nineteenth centuries, but fell sharply over the period 1876-1925. This fall corresponded closely to changes in the death rate, especially for infants, and appears to justify the conclusion that the changes were connected. These population shifts have been called the first and second demographic transitions, of which the latter was the more dramatic. Factors tending to reduce mortality among infants and in other age groups during the second demographic transition are obvious; those underlying the first demographic transition are less clear. In this connection, the importance of breast feeding and campaigns designed to favour the practice are stressed. These helped to reduce infant mortality and were one of the main reasons for the first demographic transition. Finnish material also suggests that some kind of family planning existed during the pre-industrial period; it is only by making this assumption that the various figures can be made compatible.