Neuropeptide Y: A stressful review.

Stress is defined as an adverse condition that disturbs the homeostasis of the body and activates adaptation responses. Among the many pathways and mediators involved, neuropeptide Y (NPY) stands out due to its unique stress-relieving, anxiolytic and neuroprotective properties. Stress exposure alters the biosynthesis of NPY in distinct brain regions, the magnitude and direction of this effect varying with the duration and type of stress. NPY is expressed in particular neurons of the brainstem, hypothalamus and limbic system, which explains why NPY has an impact on stress-related changes in emotional-affective behaviour and feeding as well as on stress coping. The biological actions of NPY in mammals are mediated by the Y1, Y2, Y4 and Y5 receptors, Y1 receptor stimulation being anxiolytic whereas Y2 receptor activation is anxiogenic. Emerging evidence attributes NPY a role in stress resilience, the ability to cope with stress. Thus there is a negative correlation between stress-induced behavioural disruption and cerebral NPY expression in animal models of post-traumatic stress disorder. Exogenous NPY prevents the negative consequences of stress, and polymorphisms of the NPY gene are predictive of impaired stress processing and increased risk of neuropsychiatric diseases. Stress is also a factor contributing to, and resulting from, neurodegenerative diseases such as Alzheimer's, Parkinson's and Huntington's disease, in which NPY appears to play an important neuroprotective role. This review summarizes the evidence for an implication of NPY in stress-related and neurodegenerative pathologies and addresses the cerebral NPY system as a therapeutic target.

Impoundment effects in the population of Auchenipterus osteomystax (Siluriformes: Auchenipteridae): a Neotropical reservoir case

New impoundments provide opportunities to check whether species that present enough feeding flexibility in natural conditions may take advantage of this situation and, without reproductive restriction, can occupy the most conspicuous habitat in a large reservoir (open areas) and present higher success in the colonization of the new environment. We examined variations in the abundance and feeding of A. osteomystax in two environments, one natural (Sinha Mariana floodplain lake) and one dammed (Manso Reservoir), during two periods: the first year after the filling phase and three years later. Our goal was to evaluate the occupation of the new hábitat (Manso Reservoir), by this species, as well as to test the hypothesis that in the reservoir, unlike the natural environment, there are remarkable changes in diet between the periods. Fish were sampled monthly in the floodplain lake and in the reservoir during two annual periods using gillnets. To evaluate the differences in abundance of A. osteomystax we employed the Kruskal -Wallis test, and the diet analysis was carried out using frequency of occurrence and volumetric methods. Temporal differences in the diet were tested by Kruskal-Wallis test using the scores from a detrended correspondence analysis. A. osteomystax was significantly more abundant in the floodplain lake, where the captures were higher than in the reservoir in almost all months analyzed, and significant variations in abundance between the two periods were not recorded in either the reservoir or the floodplain lake. The diet variation between the two periods, which had a time lag of three years between them, was much less pronounced in the natural environment, where the resource availability is essentially regulated by seasonality. Thus, our hypothesis was accepted; that is, the interannual variations in the diet of A. osteomystax are more relevant in an artificial environment than in a natural one. Rev. Biol. Trop. 60 (2): 699-708. Epub 2012 June 01.

Los embalses nuevos ofrecen la oportunidad de comprobar si especies que presentan suficiente flexibilidad en la alimentación en condiciones naturales pueden aprovechar esta situación y, sin restricciones de reproducción, ocupar la mayor parte del hábitat visible en un gran embalse (espacios abiertos), además, presentar un alto éxito en la colonización del nuevo entorno. Asimismo, examinamos variaciones en la abundancia y alimentación de A. osteomystax, en dos ambientes, uno natural (Sinha Mariana floodplain lake) y otro alterado (Embalse Manso), durante dos periodos: el primer ano después de la fase de llenado y tres años más tarde. Nuestro objetivo fue evaluar la ocupación del nuevo hábitat (Embalse Manso) por esta especie, así como probar la hipótesis de que en el embalse, a diferencia del ambiente natural, se producen cambios notables en la dieta entre los periodos. Los peces fueron muestreados mensualmente en el lago de la planicie de inundación y en el embalse durante dos periodos anuales con redes de enmalle. Para evaluar las diferencias en la abundancia de A. osteomystax empleamos la prueba de Kruskal-Wallis, y el análisis de la dieta se llevo a cabo con el uso de la frecuencia de ocurrencia y métodos volumétricos. Las diferencias temporales en la dieta fueron probadas con Kruskal-Wallis, se usaron los resultados a partir de un análisis de correspondencia sin tendencia. A. osteomystax fue significativamente más abundante en el lago de la llanura de inundación, donde las capturas fueron más altas, que en el embalse en casi todos los meses analizados, y no se registraron variaciones significativas en la abundancia entre los dos periodos tanto en el embalse como en el lago de inundación. La variación en la dieta entre los dos periodos, en los cuales habia un desfase de tres anos entre ellos, fue mucho menos pronunciada en el entorno natural, donde la disponibilidad de recursos es esencialmente regulada por la estacionalidad. Por lo tanto, nuestra hipótesis fue aceptada, es decir, las variaciones interanuales en la dieta de A. osteomystax son más relevantes en un ambiente artificial que en uno natural.

Breast feeding practices in a teaching hospital of Calcutta before and after the adoption of BFHI (Baby Friendly Hospital Initiative).

A comparative study has been made on two groups of 102 mothers each who delivered children in the postnatal ward of obstetrics and gynaecology department of Calcutta National Medical College before and after the introduction of BFHI (Baby Friendly Hospital Initiative). The study revealed that only 14.3% of the babies who were delivered normally were given their first breast feed in time, the ideal time of half an hour, while not a single baby delivered by caesarean section were given their breast feed within the stipulated time period of 4-6 hours. However, there has been a significant overall reduction in the time gap between the birth and the first breast feed in all types of delivery. BFHI has also made significant reduction of prelacteal feeds and in-between feeds in the newborns especially those delivered normally. The fact that babies of first order and those delivered by caesarean section are lagging behind as far as exclusive breast feeding is concerned has been highlighted in the study.

PIP: The Baby Friendly Hospital Initiative spells out 10 steps to promote exclusive breast feeding as soon after delivery as possible. In 1995, the Chittaranjan Hospital of Calcutta (India) National Medical College adopted this initiative. This study compared infant feeding practices identified in a survey of 102 mothers who delivered 6 months before the policy change and another 102 women who delivered 6 months after the change. The proportion of infants with normal deliveries who were breast-fed within 30 minutes of birth--the recommended interval--increased from 1.5% in 1994 to 14.3% in 1995. Multiparous women began breast feeding significantly earlier than primiparae. In both time periods, no infants delivered by cesarean section were breast-fed within the recommended 4-6 hour interval. The incidence of prelacteal feeds declined from 100% to 33.3% between the two studies. In addition, the incidence of supplementary feeds in breast-fed babies dropped from 46% to 19.6%. Although hospital staff received training in conjunction with adoption of the Baby Friendly Hospital Initiative, only 54% of mothers reported that they were encouraged to exclusively breast feed by hospital personnel, primarily by doctors. These findings confirm the positive impact of the initiative on breast feeding practices, but also suggest a need for more intensive staff training and special attention to first-time mothers and those with surgical deliveries.

The effect of changes in population characteristics on breastfeeding trends in fifteen developing countries.

BACKGROUND: Extended breastfeeding is known to benefit the health of children in developing countries and despite widespread expectations of a decline in breastfeeding in these countries, it has been demonstrated that the incidence and duration of breastfeeding are in fact increasing many countries. METHODS: In this paper, trends in breastfeeding duration are examined in 15 developing countries, using data from two comparable surveys for each country, the World Fertility Survey (conducted in the late 1970s) and the Demographic and Health Survey (conducted in the late 1980s). Multivariate regression models are used to examine differentials in breastfeeding behaviour across population subgroups in these countries for each time period, and these differentials are used to determine the extent to which the observed trends are due to changes in population characteristics and to what extent behaviour has changed within population subgroups. RESULTS: Results show that changes in the characteristics of the population have almost universally pushed breastfeeding durations in the downward direction. On the other hand, trends within population subgroups have been positive in all but two of the 15 countries examined. CONCLUSIONS: Changes in population characteristics can be expected to continue for most developing countries, exerting a downward pressure on breastfeeding. Policies that promote breastfeeding are needed to counter these changes, especially in the most vulnerable population subgroups.

Changes in breastfeeding initiation and duration in Peru, 1977-1986.

Both breastfeeding initiation and duration increased in Peru during 1977-86. Although one would have expected that the average incidence and duration of breastfeeding would have declined as a result of changes in population characteristics, the potential for an overall decline was more than overcome by changes in behavior. A net increase in initiation and duration is shown for all subgroups of interest. The largest absolute increases are documented for children who, in 1977, were the least likely to be breastfed and who were breastfed for the shortest durations.

PIP: Demographers compared current-status data on 3560 surviving singleton live births born to ever married women in Peru (1977-1978 World Fertility Survey) with 816 such births (1986 Demographic and Health Surveys) to examine changes in breast feeding behavior. More women were educated (secondary or higher, 35.9% vs. 21.2%), employed outside of the home (60.7% vs. 46.5%), and used contraceptives (34% vs. 20.8%) in 1986 than in 1977. Yet, mean duration of breast feeding and percent of ever breast fed children increased (14.3-17.1 months and 91.7-95.8%). The largest absolute significant increases occurred among women who, in 1977, were the least likely to breast feed and to breast feed for the shortest durations (urban women, highly educated women, professional women, and modern contraceptive users). These findings indicate that reductions in breast feeding incidence and duration are not necessarily inevitable as a society undergoes modernization. Between the two surveys, Peru's Ministry of Health had breast feeding promotion campaigns that stressed breast feeding during diarrheal episodes. They postulated that these campaigns were successful because the population already had adequate access to health care providers and to the mass media. Another possible factor contributing to the improvements in breast feeding patterns was the severe economic crisis in the early 1980s. Poor and uneducated women may have turned to breast milk as a substitute for other infant foods. These two possibilities raise some concerns. If the economy improves, the poor and uneducated may reduce breast feeding, but, if the breast feeding promotion campaigns indeed had the most impact, continuation of these campaigns would offset any declines and have a lasting impact on breast feeding behavior.

The epidemiology of breast-feeding in Mexico: rural vs. urban areas.

This article summarizes published and unpublished data on breast-feeding in Mexico collected between 1958 and 1987. These data suggest that Mexican rates of initiation of breast-feeding (78-83%) are among the lowest found in developing countries, that the median duration of breast-feeding in 1987 was virtually the same as it had been in 1976, and that about half of all Mexican infants are not breast-fed beyond six months of age. A finding that the duration of breast-feeding was shortest in urban areas has important policy implications, since 72% of the population lives in urban zones.

PIP: Nutritionists collected published and unpublished data from 1966-1990 on incidence or duration of breast feeding to summarize them and to determine breast feeding trends in Mexico. National surveys between 1976-1987 showed that 78-83% of mothers began breast feeding which was highest in rural areas (89%). 1973-1987 community surveys in urban Mexico revealed that breast feeding initiation rates varied from 54-94%. In addition, women in metropolitan areas (Mexico City, Guadalajara, and Monterrey) had lower rates of breast feeding initiation and shorter average breast feeding duration than in smaller urban areas. 1960-1988 community surveys in rural areas demonstrated that these rates ranged from 73-99%. Medial duration of breast feeding stood at 8.7 months in 1976 and 8.6 months in 1987. Further mean duration ranged from 6-12 months in 1976 and 7-14 months in 1987. Duration was consistently higher in rural areas than urban and metropolitan areas. Only 6 of the 19 studies ever reported on exclusive breast feeding which led the nutritionists to conclude that breast feeding mothers may also have supplemented with breast milk substitutes. Despite indications of some improvement in breast feeding in 10 years, Mexico still has 1 of the worst breast feeding initiation rates in the developing world. Besides about 50% of all infants in Mexico do not receive breast milk after 6 months. Since 72% of the population lives in urban areas including 39% in metropolitan areas and breast feeding rates were lowest in these areas, public health policy makers should address these trends. Studies specifically looking at incidence and duration of breast feeding in Mexico are needed.

Breastfeeding.

PIP: Standards for research and study design which allow the study of health effects of breastfeeding and its role in controlling fertility have been developed. Better designed studies and evaluations of breastfeeding promotion programs guide health policy makers to promote and protect breastfeeding. Currently, most breastfeeding surveys do not provide many details. They do not address bottle feeding, night feeding, supplementation patterns, and frequency of feeding. International standards deem exclusive breastfeeding adequate for 4-6 months, but the evidence is not clear whether that means mothers should start supplementing at the end of 3 months or at the end of 6 months. The median time for faltering in exclusively fed infants in Jordan was 6 months. 25% grew adequately for 9 months, yet 20% began to falter at 4 months. Breast milk protects against diarrhea (especially cholera and shigellosis) and respiratory infections. Exclusive breastfeeding provides the most protection against infection; partial breastfeeding also provides more protection than not breastfeeding at all. Heating appears to destroy the protective factors. Breastfeeding also plays a key role in regulating fertility. It significantly delays ovulation in postpartum women. Introduction of supplementary food causes a fall in suckling frequency and duration. Moreover in 98% of lactating women, 1st ovulation followed the introduction of supplementary foods. Thus health workers should advise lactating women to begin contraception, such as IUDs or progestin-only oral contraceptives, after 6 months, since breastfeeding protects them from pregnancy during the 1st 6 months postpartum. In developing countries, there has been a trend away from breastfeeding especially for mothers who stay at home whereas, in developed countries, the opposite is true.^ieng

[A study on the proximate determinants of fertility decline in China].

To study the biological and behavioral process of the recent drastic fertility decline in China, the authors reviewed relating factors (proximate determinants) and applied the Bongaarts model to the population of China for the years 1971 and 1981, during which the fertility rate dropped most rapidly and substantial population control policies were performed. By application of the model, the decrease of TFR of 2.78 between 1971 and 1981 was estimated to be contributed by widespread of contraception (68%), later marriage (49%), and increase of induced abortion (28%), through shortening of the length of postpartum breastfeeding showed negative effects (-32%), on the assumption that local data could be substituted for some national data. Compared with other countries, China was characterized by coexistence of strong fertility-inhibiting effects of nonmarriage, contraception, induced abortion, and relatively strong fertility-inhibiting effects of breastfeeding. It strongly suggested that the fertility transition in China was realized by powerful population policies in the context of insufficient socioeconomic development to lead to the transition.

New IPPF statement on breastfeeding, fertility and post-partum contraception.

PIP: The International Planned Parenthood Federation International Medical Advisory Panel drew up the following statement in November, 1989. Breastfeeding is good for the infant. Antibodies passed to it from the mother protect it from infection. Patterns of breastfeeding are changing. Therefore, the risk of pregnancy is increased. Postpartum amenorrhea plays a major role in natural fertility regulation. Studies from around the world show a positive correlation between the length of breastfeeding and the length of lactational amenorrhea. Amenorrhea lasts longer in those who breastfeed more often at night and during the day. There is controversy over the effect of nutrition on postpartum infertility. Pregnancy and the puerperium are a good time for counseling on maternal nutrition, child spacing, breastfeeding, and contraceptive methods. Counseling nursing mothers about potential fertility during lactation should be based on local information. All women should be advised to fully breastfeed. Family planning programs should cooperate with maternity services in providing counseling and education for postpartum women who need contraception, for providing referral services, for producing educational resources, and in training health personnel. Postpartum contraception should be included in the training of traditional birth attendants. Women who do not breastfeed can select any contraceptive method. Mothers who nurse must not hurt success of lactation or the infant's health. Nonhormonal contraception should be the 1st choice for lactating women. IUDs do not harm infant growth or lactation. Postpartum insertions are appropriate, though care must be taken. Female sterilization can be conveniently done at this time. Barrier methods are reliable when used regularly. The failure rate should be lower when used after delivery. Progestagen-only contraception consists of progestagen-only pills, injectables, and Norplant. These do not affect quality and quantity of breast milk or length of lactation. They are suitable for those who do not wish nonhormonal methods. There are possible consequences, however, of the transfer of the steroid to breast milk. Hormonal methods should not be used earlier than 6 weeks postpartum. High and low dose oral contraceptives adversely affect the quality and quantity of breast milk. They also reduce duration of lactation. They should be withheld until 6 weeks after delivery, or until the infant is weaned--whichever comes first. The efficacy or periodic abstinence in nursing women requires further analysis.^ieng

Breast-feeding trends, patterns and policies in Thailand.

PIP: The decline in the duration of breast feeding (BF) in Thailand evident during the 1970s has largely come to a standstill in the 1980s. In addition, the proportion initiating BF was high throughout the period, and has recently increased to the point where, at a national level, it is now close to universal. These changes in BF trends coincide with a variety of efforts, primarily undertaken or coordinated by the Ministry of Public Health, to promote BF and discourage the use of breast milk substitutes. While substantial socioeconomic differentials still exist with respect to the duration of BF, initiation is common even among the groups that breastfeed their babies for the shortest period of time. Breast fed children are commonly given supplemental food or liquids at very early ages. Thus, the duration of full BF is for shorter than of overall BF. Attempts to promote BF by the Ministry of Public Health began in 1979. Several seminars were held with administrators and health professionals. Guidelines were established to implement a program promoting BF. BF promotion was incorporated into the Fifth National Economic and Social Development Plan (for 1982-86) as well as the Sixth Plan (for 1987-91). Month-long promotion programs were started by the Division of Nutrition at the Ministry of Public Health in 1982. These programs were aimed at district, village, and provincial levels and use of the media (newspapers, television, magazines, and public address systems). Posters and leaflets are circulated in the Government health care system. BF is encouraged during the 1st year of life. Steps are being taken to control the marketing of breast milk substitutes. The infant formula industry prohibited mass media promotion of BF. Other promotional techniques were substituted for this. Seminars for health professionals on the promotion of BF in maternity wards began in 1986. Policies and practices in maternity wards are changing as a result. 51% of births in Thailand born in the 5 years before 1987 were delivered in hospitals; 11% in health stations, and most of the remainder at home. Children delivered in hospitals are breastfed those delivered at home.^ieng

Breast-feeding patterns and correlates in Shaanxi, China.

PIP: This study shows a significant change in the breastfeeding (BF) pattern by parity and sex after the transition from a natural fertility regime to a controlled fertility regime in Shaanxi, a less-developed, inland province of China. BF has increased in Shaanxi although the age at which supplemental food is given has declined. The rapid increase in the length of subsequent birth intervals has been partly responsible for the increase in the duration of BF for the high order child. However, BF may also have been used to prevent additional births under the controlled fertility regime. The duration of BF increases significantly with parity, especially if the child is a son. Theses findings are based on the 1985 In-depth Fertility Survey (phase I) called data by the State Statistical Bureau on Shaanxi province. It also shows the change in BF practice after the introduction of the "one child" policy. Infant mortality is high in Shaanxi. BF is very important for child survival and birth spacing. The In-depth Fertility Survey used a stratified, multistage, self-weighing sample. A complete reproductive history and detailed background information were gathered on 4084 ever-married women under age 50 in Shaanxi. Overall response rate was 93.4%. The infant mortality rate decreased from over 100/1000 before 1062 to about 36/1000 in the early 80s. The whole sample consists of 11438 live births. During 1979-83, there were 2055 liver births recorded by the survey, 988 females and 1067 males, giving a sex ration of 108 at birth. The sex ratio at birth increases with birth order, from 99.1 parity (N=880) to 134.7 for parity 4 or above (N=277). BF is almost universal; the proportion never breast fed being only 3.7%. Many children are being weaned at ages that are multiples of 6 months. About 35% are 1st order births. The number of births goes down fast alert parity 2, but there are a few (about 7% births of parity 5 or above). The dependent variables are the duration of BF and the duration of unsupplemented BF which can be censored by either the death of the child or the date of the survey. Therefore, there is a proportion of children whose duration of BF is unknown.^ieng

Urbanization and breastfeeding in the Philippines.

Differences in extent and duration of breastfeeding between rural and urban areas in the Phillippines increased between 1973 and 1983.

PIP: Although urbanization has been seen as responsible for a decline in and duration of breast feeding, nonetheless urban women with at least 10 years of education in the Philippines showed an increase in duration and rate of breast feeding. The results of Popkin et al.'s analysis of survey data from the 1973 and 1983 National Demographic Survey of the Philippines are reported. The multicluster stratified sampling technique produced a sample size of 3573 ever-married mothers with children 3 years in 1973 and 5376 in 1983. The measures for the analysis were % ever breast fed by place of residence, education and place of residence were not cross-classified. Multiple decrement lifetable procedures were used to calculate the likelihood for breast feeding a each month of the child's age. Median age was used for duration in order to reduce the effect of heaping. The findings show that there was a 5.4% decline in breast feeding by 1983, which was greatest in Manila at 9.4%, but urban areas in general showed a greater decline than rural areas. The median duration showed no change. The significance of this study is that poorly educated urban women show declines in breast feeding and the infants are at risk of poor health outcomes. The rates of ever breast fed compared with other nations are lower: 80% of poor urban infants and 94% of rural poor infants, with a 1 month rate of 69% for urban infants and 94% for rural infants, and at 6 months a 36% difference between urban and rural rates. Ethiopia, Nigeria, and Guatemala indicate breast-feeding rates at 6 months vs. ever breast fed of 81% vs. 100%, 97% vs. 100%, and 70% vs. 97%, respectively.

Breast feeding practices in Qatar.

PIP: Medical staff at the neonatal outpatient clinic of the Women's Hospital in Doha, Qatar randomly distributed a questionnaire about breast feeding and socioeconomic characteristics to 340 women (53.5% Qataris and 46.5% other Arabic speaking women) from February-August 1988. Only 32% of the mothers exclusively breast fed at birth. This low incidence could be due to excessive advertising by formula manufacturers and the increasing purchasing power of the Qataris. 5l5% used both breast milk and formula. 13% only bottle fed their infants. 50% of the mothers from the below average income group (5000 Qatar Riyals) breast fed their infants, while only 12% of those from the high income group (10,000 Qatar Riyals) did. Further, 55% of the mothers with less than secondary school education exclusively breast fed whereas 25% of those with secondary school and above breast fed. This result confirmed the downward trend for breast feeding in Qatar as identified in the early 1980s. Even though most mothers decided themselves not to breast feed, 31% reported that their physician suggested feeding formula to their infants. The longer infants stayed in the neonatal intensive care unit the less likely their mothers would breast feed them. For example, 72% were breast fed if discharged 1 week after admission while none were breast fed if discharged 3 weeks after admission. The leading reasons for bottle feeding included that the infant was still hungry (634%), night feeding (12%), mother worked (11%), and maternal diseases (5%). Regardless of the reasons for the downward trend in breast feeding in Qatar, public health professionals and health practitioners must begin direct and specific health education efforts about the benefits of breast feeding.^ieng

Ecological breastfeeding and child spacing.

Until the 2nd and 3rd decades of this century, breastfeeding was essential for infant survival. In that period, spacing of children was generally about 2 years. Later, improved modified cow's milk preparations became commercially available and were well tolerated by most infants. As a result, near cessation of ecological breastfeeding occurred toward the middle of the century. The decline in ecological breastfeeding was associated with early postpartum ovulation and shortened child-spacing of about 1 year. The endocrinology of breastfeeding is now known in considerable detail. Prolactin is secreted promptly in response to nipple stimulation and is a reliable marker of the endocrine alterations occurring postpartum. Success of lactation in suppression of ovulation was found to occur when infants sucked frequently and when only small amounts of selected foods were introduced gradually after the infants were about 6 months of age.

PIP: Ecological breastfeeding can have a favorable effect on child spacing because of the natural suppression of ovulation associated with lactation, but breastfeeding alone cannot be depended upon for birth control. Ecological breastfeeding consists of feeding only human milk for about 6 months, suckling on demand day and night, no pacifiers, gradual introduction of small amounts of selected foods at about 6 months, and continuation of nursing as the primary food for about 1 year or longer. The rapid decline in ecological breastfeeding that occurred over the 1930-60 period resulted in early postpartum ovulation and in shortened child-spacing of about 1 year. Since 1950 there has been evidence by serial postpartum basal temperature recordings and by histological examination of endometrial biopsies that breastfeeding suppresses ovulation. Nursing women maintain a higher prolactin level and lower gonadal hormone or gonadotropin level postpartum than do non-nursing women. Fertility can return prior to the renewal of menstruation, but women who slowly reduce the frequency of breastfeeds by gradually introducing only small servings of other foods over a period of months are likely to have 1 or 2 infertile menstrual cycles. In general, nonbreastfeeding mothers have postpartum amenorrhea for only a few weeks, but truly lactating mothers experience amenorrhea for about 9-18 months, depending primarily on how often the infant suckles.

Infant-feeding practices in Western Australia and Tasmania: a joint survey, 1984-1985.

A joint survey of infant-feeding practices that was carried out in Western Australia and Tasmania in 1984-1985 showed a continuing trend back to breast-feeding in both States. In Western Australia and Tasmania, 86% and 81% of mothers, respectively, were breast-feeding their babies on hospital discharge. Forty-five per cent of all mothers were still breast-feeding at six months. The social rank of the family had a significant effect on both the prevalence of breast-feeding and on the length of lactation: more mothers in the higher social groups breast-fed their infants, and for longer periods than did mothers of lower social groups. Few infants were introduced to solid foods before three months of age; however, solid and non-milk foods were introduced earlier to infants who were fed artificially than those who were breast-fed.

PIP: A survey of infant feeding practices in Western Australia and Tasmania carried out in 1984-85 confirms a trend toward a return to breastfeeding in both of these Australian states. Data from child health records on 911 infants from Western Australia and 460 infants in Tasmania were analyzed to a assess trends in infant feeding practices. At the time of discharge from the hospital, 84% of West Australian mothers and 77% of Tasmanian mothers were fully breastfeeding their infants. Breast milk continued to be the only source of milk for drinking at the age of 12 months for 11% of West Australian and 12% of Tasmanian infants. More mothers from the higher social groups breastfed their infants on discharge from the hospital than did mothers from lower social groups, and more of the higher socioeconomic status mothers continued to breastfeed throughout the 1st year of life. All mothers from the highest social group (A) in both states breastfed for at least 6 weeks, and 35% of such mothers in Western Australia and 50% in Tasmania were still breastfeeding at 12 months. In contrast, 65% of the West Australian and 50% of the Tasmanian mothers in the lowest socioeconomic strata (D) breastfed for 6 weeks, and only 9% of these mothers in Western Australia and 10% in Tasmania were still breastfeeding at 12 months. Few infants surveyed were introduced to solid foods before 3 months of age; however, solid and non-milk foods were introduced earlier to infants who were fed artificially than to those who were breastfed. Data from previous surveys indicate that the nadir of breastfeeding in Australia was reached in 1970. Since that time, women from the higher social groups have comprised the vanguard of the movement back to breastfeeding.

Continuing fertility transitions in a plural society: ethnic trends and differentials in Peninsular Malaysia.

PIP: Fertility in Peninsular Malaysia has declined continuously from the late 1950s, reaching a total fertility rate of 3735 in 1983. All ethnic groups in Malaysia have contributed to this modern demographic transition but the rate of change has been most rapid for Chinese and Indians, Malay fertility having reached a plateau in the early 1980s. The effect of age structure, marital patterns and marital fertility (by parity) on the fertility declines for each ethnic community are analyzed. There has been a tendency, in each ethnic group, for the age distribution within the group of reproductive-age women to grow younger, reflecting the entry into the younger reproductive ages of the large birth cohorts of the 1950s and early 1960s. The effect of this on crude birth rates is hard to determine, because rising age at marriage and increasing use of contraception meant that fertility was increasingly concentrated in the more central reproductive ages. By the 1990s, the earlier declines in fertility will bring about a decline in the proportion of the total population made up of females in the main reproductive ages. After that point, further declines in fertility will be reflected in a sharper decline in the crude birth rate and hence the rate of population increase. Between 1947 and 1980, the age at marriage changed dramatically for females of all ethnic groups. The transition to higher age at marriage for Chinese was completed earlier, and since 1970 has risen by only a year. For Malays and Indians, the rise began later, proceeded faster and continued right up to 1980 when the medium ages at 1st marriage were Malays 22, Indians 23, Chinese 24 years. In 1980, Malay women on average were marrying 5 years later, and Indian women 6 years later than had their mothers' generation in 1947. The proportion never-married among Malay and Indian women aged 20-24 rose from 1/10 to 1/2 over this period; relatively greater changes are evident at ages 25-29. Other factors are the almost complete shift from parent-arranged to self-arranged marriages. Family size desired has decreased for all groups and the decline in breastfeeding has been offset by the sharp increase in the practice of contraception. Continuation of these trends would lead to replacement-level fertility for Malaysian Chinese and Indians by the year 2000. Malay fertility is likely to continue to decline but at a more moderate pace.^ieng

Breastfeeding Act will aid working mothers. Commonwealth of the Northern Mariana Islands.

PIP: Although survey data suggest that the vast majority of women in the Commonwealth of the Northern Mariana Islands are aware that breastfeeding is the optimal form of infant nutrition, by the time of the 6-week postpartum visit, 31% of mothers have stopped breastfeeding exclusively and 26% are resorting to bottle-feeding alone. This pattern has been attributed to the fact that 40% of all women in the Northern Mariana Islands work outside the home, and the majority of these women are government employees who receive only 2 weeks of paid maternity leave. Nurses and physicians are in agreement that 2 weeks is not sufficient time to establish breastfeeding. To remedy this situation, a Family Act has been drafted that includes the following provisions: 1) 30 days of paid maternity leave; 2) 5 days of paid paternity leave; 3) 30 additional days of maternity leave without pay for pregnancy-related illnesses; 4) 30 additional days of parental leave for the care of a child with a serious health condition; 5) 1-hour breastfeeding breaks at work for 1 year; 6) permission for parents to use sick leave to accompany a child to the physician; and 7) job protection while pregnant or breastfeeding. The status of the act is still pending due to the loss of documents caused by typhoon Kim. However, the act has the support of groups such as Catholic Social Services, the Women's Affairs Commission, and members of the Civil Service Commission. It has been estimated that this act could save the government US$160,599/year in averted costs due to time lost from work because of childhood illnesses and lack of natural child spacing.^ieng

Events leading to the decision to introduce complementary feeding to the breast among a group of mothers in Istanbul.

A cross-sectional study carried out among 269 mother-infant pairs in Istanbul showed that the majority of infants began receiving regular complements or had been weaned before the age of three months. A prospective study carried out among 24 mothers beginning the last month of pregnancy and continuing until the time when regular complementation was instituted showed that the average duration of exclusive breastfeeding was 58 days. Infants began receiving complements on an irregular basis beginning the early postnatal days. Irregularly introduced complements often lead to gastro-intestinal reactions and weight loss. Mothers displayed sensitivity toward cues that suggested dissatisfaction in infants or other events that they conceived as threats to their milk yield in terms of quality and quantity. Mothers often discussed their decision to introduce complements with other people such as doctors and older female acquaintances who supported them toward complementation. Failure to gain sufficient weight with exclusive breastfeeding was seldom the cause of introducing complementary feeding.

Infant feeding in urban south Indian families.

PIP: A longitudinal study of feeding practices of South Indian infants 6-22 weeks of age revealed no differences between poor and middle class families. Even among the poor, artificial feeding was initiated in early infancy. The proportion of exclusively breastfed infants dropped from 82% at 6 weeks of age to 58% at 14 weeks and to 36% at 22 weeks. At 22 weeks of age, 16% of the 271 infants studied had been completely weaned from the breast. 58% of the bottle-fed infants were initially given diluted cow's milk while 28% received diluted commercial milk substitute. By the age of 22 weeks, 70% of the bottle-fed infants were receiving either full-strength cow's milk or formula. Commercial weaning foods were preferred up to the 18th week; after that point, rice and rice products were provided. At each age interval analyzed, the mean caloric intake from artificial food was less than half the daily caloric requirement. There was no significant difference between poor and middle class families in terms of the duration of breastfeeding or mean caloric intake from artificial feeds. At 22 weeks, 50% of poor infants and 71% of middle-class infants were receiving food supplements. 72% of infants who had been completely weaned by 22 weeks were from middle class families and 28% were from poor families. These findings confirm earlier observations that the urban poor in India are abandoning long-term breastfeeding and using up to 10% of family income on commercial infant food. Educational campaigns to promote prolonged breastfeeding and restricted use of artificial substitutes should be an important part of child health efforts in India.^ieng

[Breast-feeding during the process of transculturation]. / Alimentación al seno en el proceso de transulturación.

PIP: Sociocultural changes in Europe during the Industrial Revolution of the past century resulted in a decline in the practice of breastfeeding. Migration of a large part of the rural population to the city led to a substantial change of life styles, with the health of the population seriously affected. Poor sanitary conditions, deteriorating nutritional status, and other problems became more widespread. Some contemporary reports noted the adverse effects on infant health of the decline in breastfeeding. A researcher in Manchester, Englands found that 60% of infants who were breastfed showed satisfactory growth and nutritional status through 9 months, compared with only 10% of artificially fed infants. In some respects, developments in postwar Latin American reflect trends in Europe a century ago, with rural-urban migration, the incorporation of women into the labor market, the development of food technology, and the use of advertising and propaganda combining to produce a decline in the prevalence of breastfeeding. The proportions of infants breastfed declined from 15% to 6% in Chile between 1960-1968, while in Mexico a parallel but less marked decline in breastfeeding has occurred in both rural and low income urban areas. In 1973, 2/3 of 5000 mothers interviewed breastfed their infants in the 1st month, while by 1979 only 52.8% of a similar sample did so. 3 possible explanations of the decline in breastfeeding see it as a symptom of abandonment of traditional ways by mothers in a process of cultural change; as a decision made without reflection on its consequences for the baby and the family; or as a result of information received by the mother whose interpretation is influenced by her educational level. To understand the phenomenon, breastfeeding must be considered a form of instinctive behavior by which the mother promotes the growth of her baby during a phase of intense nutritional demand, but the practice of breastfeeding is also the result of interaction of the members of the mother's society. Breastfeeding must be considered a cultural trait. Although infant feeding practices have deep cultural roots, the interaction of technologically advanced societies in the western world with underdeveloped societies has produced a process of transculturation in the latter whereby breastfeeding is gradually being displaced. It is probable that only a process of education can combat the decline in breastfeeding.^ieng