A population-based study of exclusive breastfeeding in Icelandic women: is there a relationship with depressive symptoms and parenting stress?

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Abstract

This study investigated whether postpartum depressive symptoms and parenting stress are related to exclusive breastfeeding in mothers at 2–3 months postpartum. Data were collected from 734 Icelandic mothers postpartum. Parenting stress, depressive symptoms, feeding methods and demographical data were assessed by self-administered questionnaires. A high level of maternal education increased the likelihood of exclusive breastfeeding whereas lower maternal education, high levels of depressive symptoms, twins and single motherhood reduced the likelihood of exclusive breastfeeding. It is concluded that depressive symptoms are related to lower levels of exclusive breastfeeding and that exclusive breastfeeding becomes more likely with higher level of maternal education.

Section snippets

Introduction and literature review

Exclusive breastfeeding (EBF) is defined as the feeding of breast milk only, and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines (WHO/UNICEF, 1991). The World Health Organization has recently recommended EBF for of the first 6 months of life to obtain optimal health and well being of the infant and this policy has been adopted in Iceland (WHO, 2001; Icelandic Nutrition Council, 2003). In the Nordic countries, including

Aim and context of the study

The current study was a part of a larger national study on maternal distress and infant difficulties carried out between 1992 and 1996 in Iceland and parts of the study have been published elsewhere (Thome and Alder, 1999; Thome, 1996, Thome, 2000, Thome, 2003). The data have partly been reported in a study of depressive symptoms and their relationship with parenting stress and infant's difficulty in the population of Icelandic women and infants (Thome, 2000). The aim of this paper is to report

Sample and demographics

The final sample consisted of 734 women, which approximates a response rate of 70%. The age and residence distribution of the respondents did not differ from that of the general population of childbearing women in Iceland (Table 1).

Maternal education level was distributed as follows: EL 1 (n=305 or 41.7%), EL 2 (n=287 or 39.2%) and EL 3 (n=140 or 19.1%). The range of education level varied significantly by residence as follows: EL 1 (lowest 34.1% in the capital city—highest 58.8% in villages),

Discussion

The 56% rate of EBF between the 2nd and 3rd postpartum month in the Icelandic population found in this study is 13% lower than reported previously in a multicentre study (Atladottir and Thorsdottir, 2000). The findings of varying rates of EBF between the two studies can be explained in two ways: First, there were large variations of EBF rates between electoral districts in this study and also differences in sample characteristics related to different presentation of the rural population in the

Conclusions and recommendations

It is concluded that the factors reducing the likelihood of EBF are low maternal education level, having twins, single motherhood and depressive symptoms. It is recommended that health professionals who are promoting EBF and shape breastfeeding policies should consider the adversely impacting factors in relation to the strength of maternal education level and offer help with management of depressive symptoms to distressed mothers. Mothers of twins should receive special attention. It is of

Acknowledgements

The study was supported by a grant from the University of Iceland Research Fund. The authors thank Bergthora Kristinsdottir, project manager, Faculty of Nursing, University of Iceland, for critically reading the draft.

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