Breastfeeding in Taiwan : an investigation into the prevalence of breast and formula feeding and the factors influencing the balance between them

Objective: This study aimed to build an understanding of the factors, determinants and correlates of breastfeeding of women giving birth in hospital in Taiwan. The qualitative phase of this study explored the women's experience and attitudes around childbirth, during hospital stay and after discharge. It also explored women's attitudes and experience of the Chinese traditional postpartum practice "tso yueh tzu" to frame a better understanding of women's early postpartum life. The survey aimed to investigate women's infant feeding behaviour at discharge, 1 and 3 months postpartum. It also quantified the magnitude of the factors identified by the qualitative method as associated with breastfeeding. Method: There were qualitative and quantitative phases of this study. The qualitative phase had three separate stages of interviews. The first stage (stage A) used semi-structured interviews based on a topic list for a group of women before discharge, and at 1 & 3 months after birth. Stage A recruited a convenience sample of women selected on the nurses' account on their intention to breastfeed. The second stage (stage B) used unstructured interview recruiting women who had breastfed for more than 3 months by snowball sampling. The last stage (stage C) also used unstructured interview approaching women with purposed sampling intending to recruit women with wide variety of age and background. All interviews were tape recorded and transcribed to the original language. The narratives were analysed based on grounded theory. The quantitative phase employed a structured survey conducted before discharge (face-to-face) and at 3 months (telephone) postpartum on women gave birth in two hospitals in north Taiwan. The data was entered and analysed by STATA 8.0. Results: The quantitative phase revealed that childbirth was quite medicalised and some intrapartum interventions (e.g. episiotomy) caused considerable discomfort after birth, and disenabled women from the initiation of breastfeeding. During hospitalisation, inappropriate practices like mother baby separation and supplemental feeds jeopardised the establishment of breastfeeding. After returning home, some women regained their autonomy and managed to breastfeed more. Husbands and mothers-in-law played influential roles. While husbands' support was said to be important to encourage breastfeed, mothers-in-law generally had a negative influence. The working place was not supportive to breastfeeding and women who breastfed after returning to work found it difficult and exhausting. As to the traditional postpartum practice, according to the older women, the "tso yueh tzu" practice was to encourage breastfeeding, while young women reported that the tradition had made breastfeeding difficult. The survey showed that the formula feeding rates were 36.9% and 54.40/0; mixed feeding rates were 55.9% and 37.1 %; exclusive breast feeding rates were 7.1 % and 8.5% at discharge - and 3 months respectively. This study found that older, more educated women and women who lived independently were more likely to breastfeed at discharge and 3 months. Overall, husband's attitude was a significarit factor encouraging breastfeeding, and women who lived with in-laws had much less chance to breastfeed both at discharge and 3 months. The mother-in-Iaw's attitude and provision of information both had strong influence in favour of formula feeding. After adjusting for age, education, living with in-laws, and previous feeding experience, women with caesarean section had less breastfeeding at discharge, but no significant difference at 3 months; women formed their infant feeding intention late were more in favour of formula feeding at discharge and 3 month. Interventions including antenatal education, intrapartum epidural, early skin contact and room-in had no significant influence after adjusting for socio-demographic and intrapartum factors. Breastfeeding women tended to seek for information from the Internet. Conclusion: In this study, we found that women's immediate social networks appeared to be more influential on infant feeding than the health care system. The current breastfeeding promotion. programmes in Taiwan has strong health service orientation that may be undermined by this fact. The environment at home and in the working place also played important roles. Women who had strong intentions to breastfeed had to persevere to continue breastfeeding if the environment was not favourable. Programmes targeting husbands and mothers-in-law can be of public health significance