title: Determinants of Breastfeeding Practices and Success in a Multi-Ethnic Asian Population.
abstract: BACKGROUND
  Many countries in Asia report low breastfeeding rates and the risk factors for early weaning are not well studied. We assessed the prevalence, duration, and mode of breastfeeding (direct or expressed) among mothers of three Asian ethnic groups.
  
  
  METHODS
  Participants were 1,030 Singaporean women recruited during early pregnancy. Data collected included early breastfeeding experiences, breastfeeding duration, and mode of breastfeeding. Full breastfeeding was defined as the intake of breast milk, with or without water. Cox regression models were used to identify factors associated with discontinuation of any and full breastfeeding. Logistic regression analyses assessed the association of ethnicity with mode of breastfeeding.
  
  
  RESULTS
  At 6 months postpartum, the prevalence of any breastfeeding was 46 percent for Chinese mothers, 22 percent for Malay mothers, and 41 percent for Indian mothers; prevalence of full breastfeeding was 11, 2, and 5 percent, respectively. More Chinese mothers fed their infants expressed breast milk, instead of directly breastfeeding them, compared with the other two ethnic groups. Duration of any and full breastfeeding were positively associated with breastfeeding a few hours after birth, higher maternal age and education, and negatively associated with irregular breastfeeding frequency and being shown how to breastfeed. Adjusting for maternal education, breastfeeding duration was similar in the three ethnic groups, but ethnicity remained a significant predictor of mode of breastfeeding.
  
  
  CONCLUSIONS
  The low rates and duration of breastfeeding in this population may be improved with breastfeeding education and support, especially in mothers with lower education. Further work is needed to understand the cultural differences in mode of feeding and its implications for maternal and infant health.
authors.affiliation: Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), National University Health System (NUHS), Singapore.
authors.forename: Wei Wei
authors.initials: WW
authors.lastname: Pang
authors.affiliation: Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore.
authors.forename: Izzuddin M
authors.initials: IM
authors.lastname: Aris
authors.affiliation: Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), National University Health System (NUHS), Singapore.
authors.forename: Doris
authors.initials: D
authors.lastname: Fok
authors.affiliation: Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore.
authors.forename: Shu-E
authors.initials: SE
authors.lastname: Soh
authors.affiliation: Department of Neonatology, KK Women's and Children's Hospital (KKH), Singapore.
authors.forename: Mei Chien
authors.initials: MC
authors.lastname: Chua
authors.affiliation: Department of Child Development, KKH, Singapore.
authors.forename: Sok Bee
authors.initials: SB
authors.lastname: Lim
authors.affiliation: Saw Swee Hock School of Public Health, Tahir Foundation Building, NUS, Singapore.
authors.forename: Seang-Mei
authors.initials: SM
authors.lastname: Saw
authors.affiliation: Department of Maternal Fetal Medicine, KKH, Singapore.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kwek
authors.affiliation: Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore.|Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.affiliation: Medical Research Council Lifecourse Epidemiology Unit, Southampton, England.|NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, England.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: Saw Swee Hock School of Public Health, Tahir Foundation Building, NUS, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, NUS, NUHS, Singapore.
authors.forename: Rob M
authors.initials: RM
authors.lastname: van Dam
authors.affiliation: Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), National University Health System (NUHS), Singapore.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.affiliation: Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), National University Health System (NUHS), Singapore.|Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore.
authors.forename: Yap-Seng
authors.initials: YS
authors.lastname: Chong
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D061186:Breast Milk Expression / Q000706:statistics & numerical data*; D002681:China / Q000208:ethnology; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D007231:Infant, Newborn; D016015:Logistic Models; D008296:Malaysia / Q000208:ethnology; D008423:Maternal Age; D010298:Parity; D015995:Prevalence; D016016:Proportional Hazards Models; D012846:Singapore; D014886:Weaning; D055815:Young Adult
keywords: Asian; breastfeeding duration; ethnicity; mode of breastfeeding