Emerging trends in breastfeeding practices in Singaporean Chinese women: findings from a population-based study.
BACKGROUND
This study records the prevalence and patterns of breastfeeding in Singaporean Chinese mothers who gave birth between 2000 and 2008.


METHODS
The Strabismus, Amblyopia and Refractive Error in Singaporean Children (STARS) study is a population-based survey conducted in South-Western Singapore. Disproportionate random sampling by 6-month age groups of Chinese children born from 2000 to 2008 was performed. The mothers (n = 3009) completed a standard questionnaire which recorded the initiation, content, method and duration of breastfeeding. World Health Organization (WHO) definitions for feeding content were used: Replacement (exclusive commercial formula or any liquid or solid/semi-solid food, excluding breast milk), Complementary (breast milk, solid/semi-solid foods, and any non-human liquid), and Exclusive (breast milk only, without additional food, drink or water). STARS-specific definitions for feeding method were used: Expressed (breast milk only fed via bottle, with no additional food or non-human liquid), Combination (breast milk and non-breast milk, fed via bottle and breast), and Direct (breast milk only fed via breast).


RESULTS
Breastfeeding initiation (overall prevalence 77.0%) and duration increased over time, and were independently associated with higher maternal education: in 2000 and 2001, 68.6% of mothers initiated breastfeeding and 12.9% breast fed for <or=6 months, versus 82.0% and 26.7%, respectively, from 2006 to 2008; 47.4% of primary-school-educated women initiated breastfeeding, and 11.1% fed for >or=6 months, vs 90.9% and 35.3%, respectively, of university-educated women (P <0.001). Expressed, Combination and Complementary feeding also increased, while Replacement feeding decreased (P <0.001). There was no difference in breastfeeding patterns by the child's gender.


CONCLUSIONS
In a population-based sample of Singaporean Chinese mothers giving birth from 2000 to 2008, breastfeeding initiation and duration increased over time and were independently associated with higher maternal education. This increase was associated with increased milk expression and complementary feeding. Thus awareness of breastfeeding benefits is rising in Singapore, but future health policies may need to target less-educated mothers.
Hornbeak
Dana M
DM
Duke-National University of Singapore Graduate Medical School, Singapore.
Dirani
Mohamed
M
Sham
Wai Kit
WK
Li
Jialiang
J
Young
Terri L
TL
Wong
Tien Yin
TY
Chong
Yap Seng
YS
Saw
Seang Mei
SM
D001942:Breast Feeding / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009035:Mothers; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires