IJE Advance Access originally published online on August 18, 2005
International Journal of Epidemiology 2005 34(6):1378-1386; doi:10.1093/ije/dyi162
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The contribution of parental and community ethnicity to breastfeeding practices: evidence from the Millennium Cohort Study
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
* Corresponding author. E-mail: l.griffiths{at}ich.ucl.ac.uk
 |
Abstract |
|---|
 Top Abstract MethodsResultsDiscussionConclusionReferences |
|---|
Background The association of ethnic and social factors at the individual and community level with inequalities in starting, and continuing, to breastfeed remains unclear. We explored these factors using data from the Millennium Cohort Study.
Methods We obtained data for 11 286 natural mothers [8207 (85%) white] of singleton infants, living in England at age 9 months. Breastfeeding mothers were defined as the proportion of all mothers who reported: putting their baby to the breast at least once and giving any breastmilk (initiation); and having started, continuing for at least 1 month (continuation).
Results In England, 72% of all mothers started breastfeeding, and of these 70% continued for at least 1 month. White mothers were the least likely to start breastfeeding (70%), as were multiparous mothers (69%), younger mothers, those with no academic qualifications (51%), in routine occupations (59%), or living in disadvantaged communities (60%). For white mothers, having a partner of a different ethnic group was independently and positively associated with breastfeeding initiation and continuation to 1 month [adjusted rate ratios (95% CI): 1.14 (1.07–1.21) and 1.09 (1.03–1.16), respectively]. White lone mothers were more likely to initiate breastfeeding if they lived in high ethnic minority communities [adjusted rate ratio (95% CI): 1.42 (1.15–1.76)] rather than disadvantaged areas. For all mothers, maternal age at first motherhood was positively associated with breastfeeding [adjusted rate ratio (95% CI): 1.06 (1.04–1.08) per 5 year increase].
Conclusions Significant inequalities in breastfeeding practices remain within the UK. White women are less likely to breastfeed and, for these women, partner and community ethnicity have an important relation to starting and continuing to breastfeed. Our findings suggest that public health strategies to increase breastfeeding need to be focussed on mothers who are young at first motherhood and address support offered by partners and the communities in which women live. Measures to evaluate the effectiveness of these strategies over time and between places should take account of changes in ethnic composition of the child-bearing population.
Keywords Breast feeding, socioeconomic factors, ethnic groups, cohort studies
Accepted 21 July 2005
Breastfeeding rates within the UK are amongst the lowest in Europe, with the highest rates reported in some of the Central Asian republics (such as Uzbekistan and Kyrgyzstan) and in Scandinavia.1 As part of a commitment to reduce mortality and health inequalities of babies and children, government targets to increase breastfeeding rates have been set in all countries of the UK. National and local initiatives have been implemented throughout the UK to increase both initiation and duration of breastfeeding2–4: for example, in England the objective is to increase breastfeeding initiation by 2% each year, with a focus on women from disadvantaged groups.5 This was reinforced subsequently in the recently published Children's National Service Framework.6
Information about breastfeeding practices in the UK comes mainly from the quinquennial Infant Feeding Surveys7 and, in Scotland, from routine data sources.8 The importance of maternal ethnicity was highlighted in the most recent survey carried out in 2000, when information on feeding practices was obtained for 9492 women, of whom 619 (6.5%) were from ethnic minority groups. White mothers were less likely to start breastfeeding than mothers from ethnic minority groups, confirming observations from an earlier survey of Asian families living in England.9 By contrast, ethnic minority groups in the US are less likely to breastfeed,10,11 suggesting alternative social circumstances, beliefs about, and influences on infant feeding. Social and family support, especially from partners, is recognized as influential in the adoption and maintenance of breastfeeding.12–14 There is some evidence that social support for breastfeeding initiation varies by ethnic group: black Americans, Mexican Americans, and Anglo-Americans have reported that support from a close friend, the mother's mother, or the male partner are, respectively, the most important sources.15 Public health interventions aimed at influencing breastfeeding behaviour16,17 need to reflect the important contributions of these ethnic and social factors. However, their relative contributions at the individual and community level remain unclear.
The Millennium Cohort Study was set up to examine the social, economic, and health-related circumstances of the new century's babies and their families, and was designed to ensure adequate representation of families living in socially disadvantaged communities and/or those of high ethnic minority prevalence.18 We analysed data from the first contact with this cohort, when the children were aged 9 months, to examine the association of ethnic and social factors at the individual and community level with breastfeeding practices.
|
Methods |
|---|
|
TopAbstractMethodsResultsDiscussionConclusionReferences |
|---|
Study population
The population for the Millennium Cohort Study was stratified by UK country and in order to adequately represent children from disadvantaged and minority ethnic backgrounds there was also stratification at the electoral ward level. Within England, wards (as existent in 1998) were categorized as ‘ethnic’, ‘advantaged’, or ‘disadvantaged’ according to the 1991 census data. Ethnic wards were defined as those with an ethnic minority indicator of
30%. Disadvantaged wards were ‘non-ethnic’ wards, which fell into the upper quartile (i.e. the poorest 25% of wards) of the ward-based Child Poverty Index (CPI). Advantaged wards were ‘non-ethnic’ wards, which did not fall into the upper quartile of the CPI. For Wales, Scotland, and Northern Ireland there were just two strata: ‘disadvantaged’ and ‘advantaged’ wards. The overall response rate for the study was 72%; details on the characteristics of the non-responders are published elsewhere.19 The cohort comprises 18 819 children (including 246 sets of twins and 10 sets of triplets), from 18 553 households, and living in the UK at age 9 months. Mothers and their partners were interviewed when their child was 9 months old and information was obtained on a large number of factors, including infant feeding practices, parity, parental age, socioeconomic status, ethnicity, and academic qualifications.20 In this report, we examine data obtained from 18 150 women who were natural mothers of singleton infants (7479 first live born), 11 286 of whom lived in England.
Outcome measures
In the Millennium cohort, 6116 (38%) of infants were fully breastfed (Table 1) for at least 1 month, 608 (4%) for at least 4 months, and 208 (1%) for at least 6 months. Although, the recommended optimum duration of breastfeeding is 6 months,21 shorter periods are reported to be associated with health benefits.22,23 We examined breastfeeding initiation, as well as measures of breastfeeding duration and prevalence (Table 1) as any breastfeeding to: at least 1 month (4.35 weeks), a time when many women gave up; 4 months (17.4 weeks), given the 1994 UK government recommendation that infants should be breastfed for at least this duration (this recommendation was still current at birth of the cohort children); and 6 months (26.1 weeks) of age, based on the subsequent 2001 World Health Organization recommendation of exclusive breastfeeding for 6 months.
|
Explanatory variables
Explanatory variables considered in this analysis included: community level indicators of social advantage, disadvantage, and ethnic composition, i.e. ward type as defined in the population stratification of electoral wards; ethnicity of the mother and partner—categorized in accordance with guidelines from the Office for National Statistics.24 White women were further categorized as either ‘white’, defined as Caucasian women of either British or Irish origin as opposed to being from other European or other countries, or ‘other-white’, 68% of whom were from other European countries. The ethnicity of the mother's partner, 99.6% of whom were natural fathers of the cohort child, was categorized according to whether or not they were ‘white’. Where information on self-reported paternal ethnic group was not available (n = 679), we inferred it from the infant's ethnicity, which the mother reported; however, this could not be inferred for the partners of women who were not white (n = 497). Maternal socioeconomic status was classified according to the National Statistics Socio-economic Classification,25 and maternal education as the highest academic qualification attained. Analyses also considered lone mother status (as reported at 9 months) and reproductive history, including maternal age at first live birth, maternal age at cohort child's birth, and parity.
Statistical methods
Breastfeeding initiation, duration, and prevalence were compared as proportions for each UK country using chi-squared tests, and Kaplan–Meier plots were used to show the proportion of mothers breastfeeding in weeks since birth. Subsequent analyses, which incorporated ward type, were restricted to England, as other UK countries lacked electoral wards of high ethnic composition. Poisson regression was used to calculate rate ratios as a measure of relative risks26 according to individual and community factors, and logistic regression for probability plots. In the multivariable analyses, we used a combination of forward and backward selection to select the variables that were significantly associated with the specific breastfeeding outcome measure considered. Variables identified to be significant (P 
0.05) were retained in the model. The results of subgroup analyses are reported only where the relevant whole-group interaction term was significant. All analyses were conducted using STATA 8.2 (Stata Corporation, TX), using sample weights and SVY commands to allow for the cluster sampling design effect (clustered by electoral ward n = 398), thus producing results that are generalizable to the UK, and to obtain robust standard errors for the Poisson regression. As weights calculated to account for non-response bias19 had very little effect on the rate ratios and their confidence intervals, they were not combined with the sample weights in this study.
|
Results |
|---|
|
TopAbstractMethodsResultsDiscussionConclusionReferences |
|---|
Overall in the UK, 70% of mothers initiated breastfeeding; this was highest in England (72%) and lowest in Northern Ireland (51%) (Table 2).
|
Of those who initiated breastfeeding, 67% continued to breastfeed for at least 1 month, 38% for 4 months, and 33% for 6 months. Thus in the cohort as a whole, 45, 26, and 22% of all infants were still breastfed to at least 1, 4, and 6 months, respectively. Our figures are comparable with those of the Infant Feeding Survey 2000, with slight variations owing to different definitions of 1 month (calendar vs 4 weeks). These country patterns were similar when analysed for white mothers only, with white mothers in Northern Ireland having the steepest decline in breastfeeding in the first month after birth (Figure 1). The median time for discontinuing breastfeeding was 14 weeks in Scotland, 13 weeks in England, 10 weeks in Wales, and 6 weeks in Northern Ireland.
|
Of the 11 286 women living in England, 4413 (39%) and 2354 (21%) lived in disadvantaged and ethnic wards, respectively, 8207 (85%) were white, 3941 (34%) were in semi-routine occupations with a further 1504 (7%) either long-term unemployed or never employed, 2260 (14%) had no academic qualifications, and 1804 (13%) were lone mothers. Mothers living in ethnic wards were also substantially disadvantaged: they were more likely to be lone mothers than those in advantaged, but not in disadvantaged, wards (20% vs 8 and 22%, respectively); to have no academic qualifications (39% vs 8% in advantaged wards and 22% in disadvantaged wards); and to be long-term unemployed or never employed (39% vs 2% in advantaged wards and 11% in disadvantaged wards). Median (inter-quartile range) age at first motherhood and at birth of the cohort child were 25 (20–29) years and 29 (24–33) years, respectively, and 4595 (43%) cohort babies were first born.
There was significant variation in community and individual factors between mothers who started to breastfeed and those who did not (Table 3). After adjustment for factors found to be significant in univariable analyses, mothers living in advantaged or ethnic wards, those with managerial and professional occupations, educated to degree level or above, who were non-lone mothers or primiparous were more likely to start breastfeeding. Inclusion of maternal ethnic group and socioeconomic status in the adjusted model resulted in a marked attenuation in the association between ward type and breastfeeding initiation. Similarly, the effect of socioeconomic status was attenuated by adjusting for lone mother status, and the effect of highest academic qualification by adjusting for socioeconomic status. Maternal age at first motherhood (rather than age at birth of the cohort baby) was associated with breastfeeding, with an adjusted rate ratio of 1.06 (95% CI 1.04–1.08) per 5 year increase in maternal age.
|
Marked differences in breastfeeding initiation were seen between mothers from different ethnic groups, and these became stronger after adjustment for all other factors suggesting the robustness of this finding: white women were less likely to breastfeed than women from all other ethnic groups, including the ‘other-white’ group (Table 3). This was particularly marked among younger mothers (Figure 2).
|
We investigated these differences further by categorizing mothers according to whether or not they were of ‘white’ origin, and limited further analyses to white women only. When we repeated the analysis for this group, the resulting adjusted rate ratios for the white mothers were similar to those presented in Table 3 for social class, parity, and maternal age but the effects of maternal education, lone mother status, and area of residence were more marked [e.g. adjusted rate ratio (95% CI) for ethnic ward: 1.15 (1.04–1.26)].
In order to investigate the apparent beneficial effect of living in an ethnic ward on breastfeeding we explored the influence of partner's ethnicity in a subgroup analysis of white mothers only. Among these mothers, 17% living in ethnic wards had a partner of a different ethnicity, compared with 3% in advantaged and 4% in disadvantaged wards. White mothers with a partner of a different ethnicity were 14% more likely to breastfeed than those with a white partner [crude and adjusted rate ratios (95% CI): 1.18 (1.19–1.24) and 1.14 (1.07–1.21), respectively]. Adding an interaction term revealed that the adjusted partner effect was significantly higher in the disadvantaged wards [1.28 (1.12–1.46)] than the ethnic [1.13 (0.95–1.35)] or advantaged wards [1.04 (0.99–1.10)]. However, after accounting for the ethnic group of the partner, area of residence remained a significant factor only for mothers within advantaged wards [adjusted rate ratio (95% CI); advantaged ward: 1.12 (1.08–1.17)], and was now only of borderline significance for those living in ethnic wards [1.09 (1.0–1.19)], compared with those living in disadvantaged wards.
We also examined the influence of partner ethnicity in a subgroup analysis of the non-white mothers only. Non-white mothers with a white partner (n = 242) were more likely to breastfeed than those with a non-white partner (n = 1807) [crude rate ratio (95% CI): 1.08 (1.02–1.13)], although this was no longer significant in the fully adjusted model [adjusted rate ratio (95% CI): 1.0 (0.9–1.0) (P = 0.538)] after adjustment for academic qualifications and socioeconomic status.
We then investigated the ward effect for lone white mothers. After allowing for maternal characteristics associated with breastfeeding initiation, lone mothers living in either advantaged or ethnic areas were more likely to start breastfeeding than those in disadvantaged areas [crude and adjusted rate ratios (95% CI), respectively; advantaged ward: 1.61 (1.38–1.87) and 1.31 (1.13–1.53); ethnic ward: 1.37 (1.12–1.68) and 1.42 (1.15–1.76)]. The influence of area of residence was more marked than that seen for white mothers with partners.
These results indicate that the increased rate of initiation in ethnic wards was partly owing to the fact that mothers are more likely to have a partner of another ethnicity, and partly owing to the fact that lone mothers are more likely to start breastfeeding if resident in ethnic wards. Investigating this further by examining interaction terms between ward type and other factors we found that other measures of social disadvantage were also influenced by ward of residence; thus, women without educational qualifications were significantly more likely to start breastfeeding if they lived in an ethnic or advantaged, rather than a disadvantaged, ward. Similarly, younger and first time mothers were more likely to start breastfeeding if they lived in an advantaged ward.
Continuation of breastfeeding
Other-white and white mothers were the most (83%) and least (66%) likely, respectively, to continue breastfeeding for at least 1 month. In multivariable analyses for white women only, younger and first time mothers, as well as those in semi-routine and routine occupations or with no academic qualifications, were least likely to continue breastfeeding for at least 1 month (Table 4). Lone mothers were also less likely to continue breastfeeding (Figure 3), although, this was of borderline significance in the fully adjusted model (Table 4; P = 0.097).
|
|
Finally, we examined the influence of partner's ethnic group, and for lone mothers, of residence in an ethnic ward, on continuation. White mothers with a partner of a different ethnic group were significantly more likely to breastfeed for at least 1 month than those with a white partner [adjusted rate ratio (95% CI): 1.09 (1.03–1.16)]. There were no significant differences according to ward of residence for lone mothers [adjusted rate ratios with disadvantage ward as baseline (95% CI); advantaged ward: 1.04 (0.85–1.28); ethnic ward: 0.92 (0.69–1.23)].
Non-white mothers with a partner of a different ethnic group were more likely to breastfeed for at least 1 month than those with a non-white partner [crude rate ratio (95% CI): 1.14 (1.05–1.24)], although, this was only of borderline significance in the fully adjusted model [adjusted rate ratio (95% CI): 1.06 (1.0–1.1) (P = 0.092)].
|
Discussion |
|---|
|
TopAbstractMethodsResultsDiscussionConclusionReferences |
|---|
We have shown that infants born to white women are among the most disadvantaged in the UK with respect to breastfeeding practices. This is most evident among mothers with no academic qualifications, in routine occupations, and living in disadvantaged communities. Mothers who are young at first motherhood are also less likely to start breastfeeding. A particular strength of our study is the opportunity afforded within the Millennium cohort to examine the influence of ethnic and social characteristics of mothers, their partners, and the communities in which they live. We have found that while white women are least likely to start and continue to breastfeed, they are more likely to do so if their partner is of a different ethnic group to their own. Non-white mothers with white partners were also more likely to continue breastfeeding, although having a partner of a different ethnic group was not significantly associated with starting to breastfeed.
Although a number of studies have highlighted the importance of paternal attitudes to, and support for breastfeeding,13,14 this is the first study to our knowledge to have examined the influence of paternal ethnicity in a nationally representative sample of mothers living in the UK. We have, in addition, been able to examine the influence of community ethnicity and have found that lone white mothers are more likely to start but not continue to breastfeed if they live in communities of high ethnic minority prevalence, that is, among women who are more likely to breastfeed. To our knowledge, this observation is novel and lends support to suggestions that peer influences are an important consideration for some women in their decisions to start breastfeeding.27
Our findings are consistent with previously reported observations of significant inequalities in breastfeeding practices within and between different UK countries.7 These findings have important implications for the health of children since breastfeeding is generally acknowledged to confer protection against later respiratory and gastrointestinal illness, and other adverse health outcomes.22,23 While information on breastfeeding practices was collected from mothers retrospectively, when their babies were 9 months, maternal recall of breastfeeding initiation and duration has been shown to be reliable and valid.28 Furthermore, our breastfeeding figures, and patterns by UK country, are comparable with those of the Infant Feeding Survey 2000, which also collected data prospectively when babies were aged 8–9 months.7 We were unable to examine the influence of intention to breastfeed since no information is available regarding maternal intentions to breastfeed at antenatal booking, a factor found to be an important predictor of breastfeeding in other studies.29
Hoddinott and Pill30 noted the social embarrassment of breastfeeding in front of family and friends reported by some white women living in East London interviewed in their study. They proposed that ‘embodied knowledge’ of breastfeeding may help to increase the confidence and commitment to breastfeed among women who have witnessed breastfeeding among family and friends and consider it to be part of normal everyday life. Indian, Pakistani, and Bangladeshi mothers in the Infant Feeding Survey in Asian families9 reported that they would have breastfed for longer if their baby had been born in the mother's country of birth; this may be explained by cultural influences and maternal, and paternal, social exposure to, and therefore greater knowledge about, breastfeeding.
This existing literature supports our findings that the cultural traditions of women within England who are not white can positively influence breastfeeding practices at a community level; this is in contrast to research findings from the US where most research suggests that more white women start breastfeeding than ethnic minorities,10,11 perhaps explained by different cultural factors within immigrant communities in the US. Existing research supports the influence of social support on breastfeeding practices,15 and we have shown here that partnerships of mixed ethnicity can also have a positive influence, especially for white women. Further research is needed to explore differences in breastfeeding practices among mothers of different ethnic groups and the support provided by their partners.
Health sector initiatives, health education, training of health professionals, media campaigns, and multi-faceted interventions are all initiatives that enable women to start breastfeeding.27 Furthermore, there is an increasing body of evidence to support interventions to promote breastfeeding through peer counsellors and ‘antenatal apprenticeships’,12,16,27,31 which increase maternal knowledge, confidence, and the commitment needed to breastfeed. It is possible that peer support programmes might be particularly helpful for lone mothers but this has not been formally examined within existing trials of peer support.12 Our finding that maternal age, particularly at first motherhood, is an important factor for starting to breastfeed, suggests that young mothers of first borns may also benefit from targeted support to initiate breastfeeding. Qualitative work has provided important insights into factors affecting mothers' feeding intentions,30,32 but, to our knowledge, there has been little specific examination of decisions about breastfeeding, especially by lone mothers.
Our observations also suggest that the ethnic composition of the antenatal population should be taken into account when comparing breastfeeding rates within and between different areas of the UK, and routine data systems have been established to determine initiation rates.8 Changes in breastfeeding within local areas over time, or between areas, are likely to be influenced by concurrent demographic changes in the ethnic composition of the antenatal population. In the Millennium Cohort study, ‘other-white’ women were largely from other European countries and this population is likely to increase in the future. It will be important to distinguish the effects of demographic change from those of health service interventions,33 which are known to be effective in increasing breastfeeding initiation and duration.34,35
|
Conclusion |
|---|
|
TopAbstractMethodsResultsDiscussionConclusionReferences |
|---|
We have confirmed that significant inequalities in breastfeeding practices remain within the UK. White women are less likely to breastfeed and our findings suggest that, for these women, partner and community ethnicity have an important relation to starting and continuing to breastfeed. This has important implications for public health interventions to increase breastfeeding rates, and also for the interpretation of data to measure the effectiveness of such interventions over time and between places.
KEY MESSAGES
|
|
Acknowledgments |
|---|
We would like to thank all the Millennium Cohort Study families for their cooperation, and the Millennium Cohort Study team at the Centre for Longitudinal Studies, Institute of Education, University of London. The Millennium Cohort Study is funded by grants to Professor Heather Joshi, director of the study from the ESRC and a consortium of government funders. LJG is supported by a grant from the International Centre for Child Studies; RT and CD are funded by HEFCE. Research at the Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust benefits from R&D funding received from the NHS Executive.
|
Notes |
|---|
Other members of the Millennium Cohort Study Child Health Group: Catherine Peckham, Catherine Law, Neville Butler, Suzanne Bartington, Suzanne Walton, Tim Cole, Helen Bedford and Lamiya Samad 
|
References |
|---|
|
TopAbstractMethodsResultsDiscussionConclusionReferences |
|---|
1 Fleischer Michaelsen K, Weaver L, Branca F, Robertson A. Health and nutritional status and feeding practices. In: Fleischer Michaelsen K, Weaver L, Branca F, Robertson A (eds). Feeding and Nutrition of Infants and Young Children: Guidelines for the WHO European Region, with Emphasis on the former Soviet Countries. Copenhagen: World Health Organization, 2003: pp. 10–37.
2 Management Executive Letter. Local Breastfeeding Targets. Edinburgh: Scottish Office, 1994.
3 Department of Health & Social Service. Breastfeeding Strategy for Northern Ireland. Belfast: DHSS, 2004.
4 The National Assembly for Wales. Investing in a Better Start: Promoting Breastfeeding in Wales. Cardiff: National Assembly for Wales, 2001.
5 Department of Health. Improvement, Expansion and Reform: The Next 3 Years. Priorities and Planning Framework 2003–2006. London: Department of Health, 2002.
6 Department of Health and Department for Education and Skills. National Service Framework for Children, Young People and Maternity Services. London: The Stationery Office, 2004.
7 Hamlyn B, Brooker S, Oleinikova K, Wands S. Infant Feeding 2000. A Survey Conducted on Behalf of the Department of Health, the Scottish Executive, the National Assembly of Wales and the Department of Health Social Services and Public Safety in Northern Ireland. London: The Stationery Office, 2002.
8 Tappin DM, Mackenzie JM, Brown AJ, Girdwood RW, Britten J, Broadfoot M. Comparison of breastfeeding rates in Scotland in 1990–1 and 1997–8. BMJ 2001;322:1335–36.
9 Thomas M, Avery V. Infant Feeding in Asian Families. London: The Stationery Office, 1997.
10 Li R, Grummer-Strawn L. Racial and ethnic disparities in breastfeeding among United States infants: Third National Health and Nutrition Examination Survey, 1988–1994. Birth 2002;29:251–57.[CrossRef][Web of Science][Medline]
11 Forste R, Weiss J, Lippincott E. The decision to breastfeed in the United States: does race matter? Pediatrics 2001;108:291–96.
12 Sikorski J, Renfrew MJ, Pindoria S, Wade A. Support for breastfeeding mothers: a systematic review. Paediatr Perinat Epidemiol 2003;17:407–17.[CrossRef][Web of Science][Medline]
13 Wolfberg AJ, Michels KB, Shields W, O'Campo P, Bronner Y, Bienstock J. Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. Am J Obstet Gynecol 2004;191:708–12.[CrossRef][Web of Science][Medline]
14 Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery 2002;18:87–101.[CrossRef][Web of Science][Medline]
15 Baranowski T, Bee DE, Rassin DK et al. Social support, social influence, ethnicity and the breastfeeding decision. Soc Sci Med 1983;17:1599–611.[CrossRef][Web of Science][Medline]
16 Hoddinott P, Pill R, Hood K. Identifying which women will stop breast feeding before three months in primary care: a pragmatic study. Br J Gen Pract 2000;50:888–91.[Web of Science][Medline]
17 Ingram J, Johnson D, Hamid N. South Asian grandmothers' influence on breast feeding in Bristol. Midwifery 2003;19:318–27.[CrossRef][Web of Science][Medline]
18 Smith K, Joshi H. The Millennium Cohort Study. Popul Trends 2002;30–34.
19 Plewis, I. Millennium Cohort Study: Technical Report on Sampling. London: Institute of Education, University of London, 2004.
20 UK Data Archive. Available at: http://www.data-archive.ac.uk, 2004.
21 Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002;CD003517.
22 Howie PW, Forsyth JS, Ogston SA, Clark A, du V Florey C. Protective effect of breastfeeding against infection. BMJ 1990;300:11–16.
23 Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998;316:21–25.
24 Office for National Statistics. Ethnic Group Statistics: A Guide for the Collection and Classification of Ethnicity Data. London: Her Majesty's Stationery Office, 2003.
25 Rose D, Pevalin D. A Researcher's Guide to the National Statistics Socio-economic Classification. London: Sage Publications, 2003.
26 Zou G. A Modified Poisson Regression Approach to Prospective Studies with Binary Data. Am J Epidemiol 2004;159:702–6.
27 Protheroe L, Dyson L, Renfrew MJ, Bull J, Mulvihill C. The Effectiveness of Interventions to Promote the Initiation of Breastfeeding. London: Health Development Agency, 2003.
28 Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev 2005;63:103–10.[CrossRef][Web of Science][Medline]
29 Britten J, Tappin DM, Elton RA. Monitoring breastfeeding rates and setting local targets: the Glasgow experience. Health Bull (Edinb) 2001;59:29–36.[Medline]
30 Hoddinott P, Pill R. Qualitative study of decisions about infant feeding among women in east end of London. BMJ 1999; 318:30–34.
31 Scott JA, Binns CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Breastfeed Rev 1999;7:5–16.[Medline]
32 Hoddinott P, Pill R. A qualitative study of women's views about how health professionals communicate about infant feeding. Health Expect 2000;3:224–33.[CrossRef][Medline]
33 Woolridge M. The Baby Friendly Hospital Initiative UK. Mod Midwife 1994;4:32–33.[Medline]
34 Kramer MS, Chalmers B, Hodnett ED et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001;285:413–20.
35 Broadfoot M, Britten J, Tappin DM, MacKenzie JM. The Baby Friendly Hospital Initiative and breast feeding rates in Scotland. Arch Dis Child Fetal Neonatal Ed 2005;90:F114–16.
36 Labbok M. What is the definition breastfeeding? Breastfeeding Abstracts 2000;19:19–21.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. S. Hawkins, K. Lamb, T. J Cole, C. Law, and the Millennium Cohort Study Child Health Group Influence of moving to the UK on maternal health behaviours: prospective cohort study BMJ, May 10, 2008; 336(7652): 1052 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Noble, I. L. Hand, and A. Noble Breastfeeding, Hospitalizations, and the Role of Ethnicity Pediatrics, August 1, 2007; 120(2): 452 - 453. [Full Text] [PDF]
|
|
|
|
|
|
Y. J. Kelly, R. G. Watt, and J. Y. Nazroo Racial/Ethnic Differences in Breastfeeding Initiation and Continuation in the United Kingdom and Comparison With Findings in the United States Pediatrics, November 1, 2006; 118(5): e1428 - e1435. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Bartington, L. J Griffiths, A R. Tate, C. Dezateux, and the Millennium Cohort Study Child Health Group Are breastfeeding rates higher among mothers delivering in Baby Friendly accredited maternity units in the UK? Int. J. Epidemiol., October 1, 2006; 35(5): 1178 - 1186. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||