title: Awareness, intention, and needs regarding breastfeeding: findings from first-time mothers in Shanghai, China.
abstract: OBJECTIVE
  Despite efforts, a decline in breastfeeding rates has been documented in China recently. This study explored the awareness of the World Health Organization (WHO) guidelines for breastfeeding and intention to breastfeed among first-time mothers and identified the gap between mothers' needs and perinatal care provision regarding breastfeeding promotion.
  
  
  METHODS
  In total, 653 women at 5-22 gestational weeks were recruited from four community health centers in Shanghai, China. They completed a self-administered questionnaire at recruitment. Two focus group discussions were held among third-trimester pregnant women who had received prenatal education. Twenty-four in-depth interviews were conducted among postpartum mothers.
  
  
  RESULTS
  During early pregnancy, a substantial proportion of mothers were not aware of the nutritional value of breastmilk (40%) or the value of exclusive breastfeeding for 6 months (80%) or any breastfeeding for 24 months (98%). The awareness of the WHO guidelines for breastfeeding was associated with intention to breastfeed (adjusted odds ratio [OR] 2.67, 95% confidence interval [CI] 1.88, 3.78) or intention to breastfeed exclusively (adjusted OR 3.31, 95% CI 1.81, 6.06). In late pregnancy and postpartum, most mothers were still not fully aware of the breastfeeding recommendations and nutritional value of breastmilk. Limited communications with healthcare providers and lack of support for dealing with breastfeeding difficulties were reported.
  
  
  CONCLUSIONS
  Low awareness of the WHO breastfeeding guidelines was found among first-time mothers in Shanghai. Awareness of breastfeeding guidelines was independently associated with mothers' intention to breastfeed and intention to breastfeed exclusively. The health benefits of breastfeeding and the recommended duration of breastfeeding should be emphasized in prenatal education programs.
authors.affiliation: School of Public Health, Fudan University, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
authors.forename: Mu
authors.initials: M
authors.lastname: Li
authors.forename: Dongling
authors.initials: D
authors.lastname: Yang
authors.forename: Li Ming
authors.initials: LM
authors.lastname: Wen
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hunter
authors.forename: Gengsheng
authors.initials: G
authors.lastname: He
authors.forename: Xu
authors.initials: X
authors.lastname: Qian
mesh_terms: D000328:Adult; D001942:Breast Feeding; D002681:China; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D009035:Mothers; D010353:Patient Education as Topic; D011247:Pregnancy; D011295:Prenatal Care; D015397:Program Evaluation