As recommended by WHO and UNICEF, it is better to exclusively breastfeed infants at least for 6 months postpartum, and breast milk has been identified as the ideal food that benefits the healthy growth and development of children [1, 8]. Therefore, many of the policies formulated by our government to a certain extent play an important role in promoting breastfeeding. In our study, the rate of exclusive breastfeeding for six months reached 29.4% and was higher than that of a large national representative survey conducted by Tang Kun et.ac in 2018, with the rate of 15.4% .
As shown by other studies, women with a high monthly family income were more likely to have lower exclusive breastfeeding rates . In our study, the relationship between monthly family income and exclusive breastfeeding was not statistically significant. However, the group with a monthly family income >¥10,000 had the lowest level of exclusive breast-feeding. As previously explained , the reason may be that higher-income families can afford to purchase milk formula. However, the <¥5,000 group had the second-lowest rate among the four groups, indicating that the economic advantage may not be the reason. Our results showed that women with a higher education level more readily fed the infants with milk formula, which was similar to other findings [12, 14]
The women with a higher education level generally have more busy work lives and a higher family income . Therefore, we also speculated that women with a high monthly family income or high education level were likely to go back to work early and must take more time for their work, and this may be the reason for the lower exclusive breastfeeding rate among these women.
In our study, more than ten percent of women had taken medicine during the lactation period, and only 12.7% of these mothers were exclusively breastfeeding. In fact, we found that some mothers did not need to stop feeding breast milk because some medications are safe for lactation, such as cephalosporin, macrolides and NSAIDs (non-steroidal anti-inflammatory drugs) (data not shown). These mothers may have been worried about transmitting illness or drugs to their babies. They decided to stop breastfeeding their children based on their own experience or were even suggested by doctors to stop. Until now, there have been limited data investigating the misjudgements about whether to stop breastfeeding with the usage of drugs during location. We think this would be an interesting and meaningful research topic.
Interestingly, we found that approximately one-third of the mothers in our research asked a babysitter for help in raising their infants. However, these mothers were more likely to give formula milk to children, and only 23.0% of these infants were exclusively breastfed, which was less than of the prevalence among the infants without a babysitter. In China, infants who are cared for by babysitters tend to have more time with their babysitters, even in the first month and at night. As reported, the support from others, such as a mother-in-law or babysitter, did not affect exclusive breastfeeding or breastfeeding initiation . We know that these infants had less time to bond with their mothers. Therefore, it was difficult for mothers to promote or sustain breast milk secretion.
As previously reported [9-11], several factors could cause lactating mothers to give up exclusive breastfeeding, such as perceived insufficient breast milk, infant illness, and painful nipples. In our study, we were also interested in the possible influencing factors. As we know, mothers can encounter various difficulties and discontinue exclusive breastfeeding at different age stages in the first six months. Therefore, we divided the six months into four stages to survey the main reasons in different stages. As the data show, perceived insufficient breast milk is the most common reason in all four stages, and more than half of mothers claimed to have this situation. Interestingly, less than 50% of infants were confirmed by doctors to receive insufficient intake of breast milk. This finding indicated that many mothers could not distinguish perception from reality, which was similar to other studies [16, 17]. In our investigation, we found that even under the Chinese standard maternity leave of 98 days, “returning to work” was the third reason for some mothers to give up exclusive breastfeeding. Thus, other than appealing for extended maternity leave, guiding mothers on how to express, transport and conserve breast milk to maintain breast milk secretion after returning to work is important. In addition, some laws to guarantee lactating women to have a time and place to express breast milk during working hours should be passed.
More than 40% of infants (n=280) were supplemented with solid food before 6 months of age, as shown in Table 7; solid food was a notable reason for giving up exclusive breastfeeding. Moreover, our survey showed that a small portion of mothers provided water to infants in every age group. According to the WHO recommendations, it is better to provide complementary food or water after six months of age. Therefore, it is necessary to provide knowledge about breastfeeding in different ways.