Is there room for mothers' agency in the choice to breastfeed? A qualitative analysis of mothers' views on messages promoting breastfeeding in Quebec.

INTRODUCTION: This exploratory cross-sectional study focuses on the experiences of mothers regarding health messages promoting breastfeeding. The objective is to describe the content and context in which messages are conveyed. METHODS: A total of 944 new mothers responded to a questionnaire (15-31 January 2021) on their perception of health messages promoting breastfeeding and their feeling of agreement towards these messages, their intention to breastfeed, incentives received, and their relationship with the professionals. Frequencies were carried out for all non-textual data and textual data were analyzed using content thematic analysis. The recruitment was made through social media and snowball effect. RESULTS: Most of the respondents reported wanting to breastfeed; 91% breastfed their child, 80.8% participants agreed with the messages they received, and 67.9% of respondents strongly agreeing that breastfeeding was the best choice for their child. Moreover, the content of the messages could sometimes be judgmental and coercive, leading to emotions such as guilt. Sixty-two women also reported a lack of support when they expressed their desire or their need to feed their baby in other ways (e.g. breastmilk with bottles or formulas). CONCLUSIONS: The perceived issue of breastfeeding messages was not the content itself, but the way in which information was conveyed. Failure to take mothers' difficulties into account and failure to present alternatives to breastfeeding were seen as major issues by women. This study highlights the importance of rethinking the way in which information is provided by professionals, in order to reinforce the autonomy of new mothers regarding the feeding of their child.

[Preventing child abuse risk factors: A study of the ease of French professionals working in early prevention]. / Intervenir sur les facteurs de risque de maltraitance infantile : quelle aisance chez les professionnels français de prévention précoce ?

Research on child abuse prevention has been limited for the last forty years to the experimental field. While we know how home visiting interventions can help limit situations of child abuse, we do not know how these results can be replicated in routine care situations. The objective of this study was to identify, in French public services, how prevention professionals approach child abuse risk factors with families, and with what degree of ease. The results show that, beyond a form of versatility that allows them to discuss a wide range of topics with families, prevention workers are very uncomfortable dealing with topics of family intimacy, psychopathology, or child abuse. The political implications are discussed.

Recall and understanding of a communication campaign designed to promote positive parenting and prevent child maltreatment.

Evidence-based parenting support programs are among effective strategies for preventing child maltreatment. The launch of mass media campaigns accompanying the implementation of such programs has been recommended to optimize reach and parent enrollment. This paper focuses on a communication campaign developed to support the implementation of the Triple P - Positive Parenting Program in two French-Canadian communities. Proximal outcomes (recall and understanding) were assessed through a randomized telephone survey conducted between January and April 2017 among 1029 mothers of children aged 6 months to 8 years. Distribution and correlates of the respondents' recall and understanding of the campaign were examined. Results show that 32.1% of respondents recalled having seen the campaign material. Among these, a large majority reported having understood the intended messages (parenting difficulties are normal, seeking help is the right thing to do, and/or effective support is available). However, some respondents also retained unintended messages blaming parents and/or children, and almost half the sample retained mixed messages (intended and unintended). Multivariate logistic regression analyses revealed that community of residence, annual household income, and psychological aggression towards the child at home were three significant correlates of campaign recall + intended messages understood. None of the examined factors were associated with recall + mixed messages understood. Findings suggest a neighborhood effect on the proximal outcomes of the campaign, and a slightly higher reach and understanding among better-off families as well as families struggling with psychologically violent parenting practices. These results are discussed in light of the outcomes of similar campaigns.

Decreasing use of autopsy for stillbirths and infant deaths: missed opportunity.

OBJECTIVE: We assessed whether the tendency towards decreasing use of fetal and infant autopsy was associated with a greater proportion of deaths in which the cause is never found. STUDY DESIGN: We computed autopsy rates over time for 13,466 stillbirths and 16,880 infant deaths in Quebec, Canada, 1981-2015. We assessed the proportion of deaths with an undetermined cause and determined the relationship with non-autopsy over time. RESULT: Autopsy rates declined by 29% for stillbirths and 36% for infant deaths during the study. The proportion of non-autopsied cases with an undetermined cause of death increased only for stillbirths, however. Among non-autopsied stillbirths, the risk of having an undetermined cause of death was 1.64 times higher in 2005-2015 compared with 1981-1992 (95% confidence interval 1.25, 2.15). CONCLUSION: Greater use of autopsy has potential to minimize the number of stillbirths with an undetermined cause of death, and may be helpful for prevention.

Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services.

BACKGROUND: Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners. METHODS: This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). DISCUSSION: This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will refine our understanding of regional perinatal services networks. Results will assist decision-making regarding service organization and delivery models of prenatal education services. PROTOCOL VERSION: Version 1 (February 9 2018).