To determine if exclusive breast-feeding counselling modifies the association of experience of any lifetime or specific forms of domestic violence (DV) on duration of exclusive breast-feeding (EBF).

In the MINIMat trial pregnant women were randomized to receive either usual health messages (UHM) or usual health messages with breast-feeding counselling (BFC) in eight visits. During pregnancy (30 weeks), lifetime experience of any or specific forms of DV was measured. Infant feeding practice information was collected from 0 to 6 months at 15 d intervals.

Matlab, Bangladesh.

Pregnant and postpartum women (n 3186) and their infants.

Among women in the UHM group, those who had experienced any lifetime DV exclusively breast-fed for a shorter duration than women who did not experience any lifetime DV (P=0·02). There was no difference, however, in duration of EBF among women in the BFC group based on their experience of any lifetime DV exposure (P=0·48). Using Cox regression analysis, there was an interaction of exposure to any lifetime DV, sexual violence and controlling behaviour, and counselling group with duration of breast-feeding at or before 6 months (P-interaction≤0·08). Among the UHM group, experience of any lifetime DV, sexual violence or controlling behaviour was associated with fewer days of EBF (P<0·05). In contrast, among the BFC group, experience of DV was not associated with duration of EBF.

The experience of DV compromises EBF and the support of breast-feeding counselling programmes could assist this vulnerable group towards better infant feeding practices.

To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya.

A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facility-based semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months.

Kibera slum, Nairobi.

A total of 360 HIV-negative women, 34–36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group.

Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23·6 % in HBICG, 9·2 % in FBSICG and 5·6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk = 4·01; 95 % CI 2·30, 7·01; P = 0·001). There was no significant difference between EBF rates in FBSICG and CG.

EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF.

To assess breast-feeding promotion in maternity hospitals and breast-feeding prevalences during the first year of life in mother–infant pairs in Germany.

Cross-sectional assessment of breast-feeding practices in a random sample of German maternity hospitals by use of a postal questionnaire. Follow-up of mother–infant pairs recruited in the participating hospitals to assess breast-feeding prevalences and infant feeding practices by use of a telephone interview 14 days after birth and food-frequency questionnaires mailed at the end of the 2nd, 4th, 6th, 9th and 12th month of life. Use of indicators for breast-feeding proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Nation-wide survey.

One hundred and seventy-seven maternity hospitals, 1717 mother–infant pairs.

There were wide variations in breast-feeding promotion in hospitals as evaluated by the practice of the '10 Steps to Successful Breastfeeding' given by WHO and UNICEF for certification as a ‘Babyfriendly Hospital’. Some steps (3, 4, 8) were practised in about 90% of the hospitals, others (steps 7, 9) in only 10%. Prevalences for exclusive (total) breast-feeding as defined by WHO were: 73% (86%) at discharge, 60% (85%) at 14 days, 42% (70%) at 2 months, 33% (59%) at 4 months, 10% (48%) at 6 months, <1% (26%) at 9 months and 0 (13%) at 12 months.

By use of indicators proposed by WHO and UNICEF, a differentiated insight into the breast-feeding situation in Germany has become possible. Moderate levels of breast-feeding promotion in hospitals resulted in almost satisfactory early breast-feeding prevalences but were not effective for long-term breast-feeding success in most mothers.

To examine statistical models that have been used to predict the cessation of breast–feeding.

In nutritional epidemiology, a knowledge of risk factors that lead to breast-feeding cessation is essential to promote optimal infant health by increasing or sustaining breast–feeding rates. However, a number of methodological issues complicate the measurement of such risk factors. It is important when building multivariate models that variables entered into the model are not intervening variables, factors on the causal pathway or surrogate outcomes. Inclusion of these types of variable can lead to inaccurate models and biased results. A factor often cited to predict breast–feeding is ‘intention to breast–feed’ prior to the birth of the infant, although this factor is directly on the causal decision–making pathway. Another factor often cited is the age of introduction of formula feeding, which is actually part of the outcome variable because formula feeding defines the difference between full, complementary and no breast-feeding. Rather than include these as risk factors in multivariate models, factors removed from the causal pathway such as influences of educational practices, including advice to complementary feed, and beliefs and attitudes of families and health-care practitioners should be measured.

The accurate quantification of modifiable risk factors is essential for designing public health education campaigns that are effective in sustaining or increasing breast–feeding duration.