Factors affecting Chinese mothers' choices of infant feeding methods in Hong Kong

Background: Human milk is the best food for the human infant. However, Hong Kong breastfeeding initiation and duration rates are far from satisfactory when compared with the WHO goal of exclusive breastfeeding for 6 months. The various factors that may contribute to infant feeding choices from the mother’s perspective are not well understood. Objectives: This study aims to 1) identify factors affecting infant feeding choices of primiparous and multiparous Chinese mothers in Hong Kong, 2) determine the congruence of mothers’ antenatal planned infant feeding method to the actual infant feeding method, 3) identify factors influencing mother’s actual feeding method. Methods: A prospective longitudinal, correlational study was conducted in three interdependent phases using the Theory of Planned Behaviour (TPB) as the framework. A stratified cluster sample of 670 pregnant women in their last ten weeks of pregnancy was recruited from three public antenatal outpatient clinics in Hong Kong. The mothers were continued to follow-up, with 384 (61.5%) mothers completing the data sets until their infant was six months of age. Data were collected for exclusive breastfeeding, mixed breast and formula feeding and exclusive formula feeding. Following appropriate bivariate analyses, linear regression was used to determine the factors affecting mothers’ planned feeding methods. Logistic regression was used to determine predictors of actual infant feeding practices. Findings: Among the 384 mothers, 190 (49%) mothers planned to exclusively breastfeed their infant after delivery. Only 105 (27%) were exclusively breastfeeding at the infant’s birth and 31 (8%) exclusively breast fed their infant for 6 months. Multiple factors influenced the relationship between mothers’ planned feeding methods and actual feeding methods. Antenatal intention and success in past breastfeeding experience for all infant feeding methods were stronger predictors for mothers’ actual feeding methods. In addition, factors that positively influenced mothers to use exclusive breastfeeding from date of birth to 1St month of infant’s age was arrangement in teaching infant feeding skill during hospitalization (OR = 2.103) while the negative influencing factors were formula feeding allows freedom (OR = 0.996), more than one child (OR = 0.062) and provision of information from relative(s) 0r friend(s) (OR = 0.485). Factors that positively influenced mothers to use exclusive breastfeeding from 3rd month to 6th month of infant’s age were feeding skill and knowledge (OR = 1.011), monthly family income less than HK$10,000 (OR = 4.841) while the negative influencing factors were influenced by relative(s) and friend(s) (OR = 0.960), employment situation (OR = 0.985), information from artificial feeding information (OR = 0.981), monthly family income between HK$10,001 to 20,000 (OR = 0.137) and fixed infant feeding schedule during hospitalization (OR = 0.262). Conclusion: This study confirms the strength of the relationship between maternal antenatal planned infant feeding method and their actual feeding behaviour. It also identifies past breastfeeding experience and several important influences on Hong Kong mothers’ planned and actual infant feeding method. The factors identified provide insight and evidence for the development of breastfeeding promotion strategies. The effectiveness of clinical practice could be optimized to increase the initiation and maintenance of breastfeeding with the Chinese mothers in Hong Kong. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration