title: A comparison of maternal attitudes to breastfeeding in public and the association with breastfeeding duration in four European countries: results of a cohort study.
abstract: BACKGROUND
  There is wide variation in the duration of breastfeeding across Europe which may in part be due to the between-country differences in mothers' and societal attitudes towards breastfeeding in public. The objective of this study was to quantify and compare the maternal attitudes to, and practice of, breastfeeding in public in four European centers and investigate the association with duration of breastfeeding.
  
  
  METHODS
  Participants (n = 389) were mothers recruited from maternity wards of hospitals in Glasgow (Scotland), Stockholm (Sweden), Granada (Spain), and Reggio-Emilia (Italy).
  
  
  RESULTS
  Among those who had breastfed, Scottish (adjOR 0.25 [95% CI 0.12-0.50]) and Italian mothers (adjOR 0.30 [95% CI 0.14-0.63]) were significantly less likely than Swedish mothers to have ever breastfed in public. Mothers who had a negative attitude toward breastfeeding in public were less likely to have ever breastfed in public (adjOR 0.05 [95% CI 0.02-0.17]), and those who had never breastfed in public were in turn more likely to discontinue breastfeeding earlier.
  
  
  CONCLUSIONS
  Perceived social norms may exert a stronger influence on breastfeeding outcomes than a woman's breastfeeding attitudes and knowledge. Differences between European countries in the duration of breastfeeding may be explained in part by differences in societal attitudes to breastfeeding in public.
authors.affiliation: School of Public Health, Curtin University, Perth, Australia.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Scott
authors.forename: Yin Ying
authors.initials: YY
authors.lastname: Kwok
authors.forename: Kate
authors.initials: K
authors.lastname: Synnott
authors.forename: Joe
authors.initials: J
authors.lastname: Bogue
authors.forename: Sergio
authors.initials: S
authors.lastname: Amarri
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Norin
authors.forename: Angel
authors.initials: A
authors.lastname: Gil
authors.forename: Christine A
authors.initials: CA
authors.lastname: Edwards
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D009035:Mothers / Q000523:psychology*; D016016:Proportional Hazards Models; D066262:Social Norms; D013997:Time Factors; D014886:Weaning
keywords: Iowa infant feeding attitude scale; breastfeeding duration; breastfeeding in public; maternal attitudes