What factors explain socioeconomic inequality in exclusive ......Socioeconomic inequality in...
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What factors explain socioeconomic inequality in exclusive breastfeeding in Norway? Anne Bærug, nutritionist, PhD Norwegian National Advisory Unit on Breastfeeding Oslo University Hospital Norwegian National Advisory Unit on Breastfeeding Photo: Norwegian Directorate of Health
Transcript of What factors explain socioeconomic inequality in exclusive ......Socioeconomic inequality in...
What factors explain socioeconomic inequality in exclusive breastfeeding in Norway?
Anne Bærug, nutritionist, PhD Norwegian National Advisory Unit on Breastfeeding
Oslo University Hospital
Norwegian National Advisory Unit on Breastfeeding
Photo: Norwegian Directorate of Health
Presenter
Presentation Notes
-In our Nordic countries high income, long educated women breastfeed longer than those in low-income groups with fewer years of education. It is no news that we have this socioeconomi inequality in breastfeeding. In Norway, this inequalith has persisted since the second world war. Before then, it was the less priviledged women who breastfed for the longest period. --So my question was: What factors explain the socio-economic inequality in breastfeeding in Norway? And i looked specifially on exclusive breastfeeding.
Socioeconomic inequality in exclusive breastfeeding
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Time (months)
Primary /Secondary school
High school
College/ University ≤4 y
College/University > 4 y
Bærug, Laake, Fossum Løland, Tylleskär, Tufte, Fretheim. Arch Dis Child (2017)
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Therfore it was no surprise – in a recent study from different parts of Norway, we found this typical pattern of socioeconomic inequality in exclusive breastfeeding. - Education - indicator of socioeconomic position. -x-axis and y-axis -rates of EBF was much lower in those with short education, compared to those with long education. -EBF at 4 mo, only 23% vs 51%
Breastfeeding for the privileged or breastfeeding for all?
Illustration: Interaction Institute for Social change. Artist: Angu Maguire http://interactioninstitute.org/illustrating-equality-vs-equity/
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Breastfeeding for the privileged or breastfeeding for all? -rhethorical question – all agree thatt it is unfair that some groups systematically do not succeed in breastfeeding. In modern societies there are many barriers to breastfeeding. Good start: give support to all to overcome the barriers, however, for certain groups it may not be enough. To overcome the barriers and to reach equity, some groups may need extra or tailored support. The term health inequity refers to at specific type of health inequality that is an unjust difference in health. Health differences that are preventable and unnecessary are denoted as health inequities….
Breastfeeding, intelligence and educational attainment Pelotas, Brazil cohort 30 y follow-up: «Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.» .
Victora et al. Association between breastfeeding and intelligence, educational attainment, and income 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health 2015;3:e199-205
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Why is equaity in BF important? Well, simply because it is important for equity in health of both mother and child. Of particular interest in this contex, is the follow-up study from Pelotas in Brazil published in the Lacncet in 2015, that found that «breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood”
Socioeconomic inequality in breastfeeding:
What factors may explain this?
Explaining socioeconomic inequality in exclusive breastfeeding?
Socieconomic position
Exclusive breastfeeding
Breastfeeding difficulties: Perceived breastmilk insufficiency
Maternal age, parity, family status, employment
Low birth weight, prematurity
Lactation counselling: Observation
?
Smoking
Presenter
Presentation Notes
We know that there are many factors that influence breastfeeding. But do these factors also influence socioeconomic inequalities in breastfeeding? My question was: Can we be sure that it is the socioeconomic position in itself that explains the inequalities in breastfeeding? Or could it be that there are other factors that are the actual cause of the socioeconomic inequality? Could it be that the inequality is because among those with short education there are more young mothers, more first time mothers, more single and more unemployd? …among those with short education there are more low birth weight or premature babies? …due to more smokers? …lactation counselling is given or perceived in different ways? …mothers with less education have more breastfeeding difficulties? The only BF difficulty that differed between educational groups was perceived breastmilk insufficiency.
Factors influencing socioeconomic inequality in exclusive breastfeeding at 5 mo
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3,35 2,91
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Eductation Education +maternal age,
parity..
Education + lowbirth weight +
premature
Eductaion +smoking
Education +observation
Education + BFdifficulties
Utdanning +alle faktorer
Soci
oeco
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ic in
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s in
EB
F (O
dds r
atio
, 95%
CI)
Bærug et al. Arch Dis Child (2017)
Presenter
Presentation Notes
-To find out, I analyzed how socieconomic inequality in EBF changed by adjusting for each of the categories shown in the previous slide. -This is a somewhat complicated slide, but I will try to walk you through it. -y-axis - socioeconomic inequality in EBF 5 months. The higher the values, the larger the differences in EBF between the groups with the longest and shortest educaion: 3.39 - looked at each of the categories to see if the social inequality was reduced. - adjusted for other sociodemographic factors social inquality was reduced. - smoking, the inquality was reduced. - Breastfeeding difficulties/ that was perceived milk insufficiency seemed also to reduce inequalites. - While low birth weight/prematurity and our indicator of quality lactation counselling, did not seem to make any difference. -Adjusting for all, - the social inequality in breastfeeding was no longer significant. -Thus the factors in green seem to largely explain socioeconomic inequalities in breastfeeding.
Socieoeconomic inequality in breastfeeding: Inevitable or can it be reduced?
Presenter
Presentation Notes
Second when we have identified some of the explanatory factors of EBF; the next question was whether these factors are amenable to intervention – whether we can do anything in order to reduce socioeconomic inequalities in breastfeeding?
Factors explaining socioeconomic inequality in exclusive breastfeeding
Socieconomic position
Exclusive breastfeeding
Perceived milk insuffiency
Maternal age, parity, family status, employment
Low birth weight, prematurity
Lactation counseling: Observation
Smoking
Presenter
Presentation Notes
Just to summarize; The green catergories seemed to reduce socioeconomic inequalities in exclusive breastfeeding.
Factors explaining socioeconomic inequality in exclusive breastfeeding
Socieconomic position
Exclusive breastfeeding
Perceived milk insuffiency
Maternal age, parity, family status, employment
Low birth weight, prematurity
Lactation counseling: Observation
Smoking
Presenter
Presentation Notes
What can we co? Well, we cannot do much/anything about the sociodemographic factors like maternal age, parity, family status
Extra support and remove barriers to breastfeeding
Presenter
Presentation Notes
But we can and should remove many barriers to breastfeeding in the society and health services. And some groups may need extra or tailored support to overcome the barriers. But when we do this , we must be careful not to stigmatize those belonging to any group.
Factors explaining socioeconomic inequalities in exclusive breastfeeding
Socieconomic position
Exclusive breastfeeding
Perceived milk insuffiency
Maternal age, parity, family status, employment
Low birth weight, prematurity
Lactation counseling: Observation
Smoking
Presenter
Presentation Notes
Smoking and percieved breastmilk milk insufficiency are possible modifiable factors. Enabling breastfeeding in mothers who continue to smoke, may reduce inequities in breastfeeding. And also focusing on the preventing of percieved breastmilk insufficiency may contribute to reduce inequalities in exclusive breastfeeding.
Supplementary feeding in hospital – effect on social inequality in breastfeeding? What is already known: Unsupplemented breastfeeding (EBF) in hospital predicts longer breastfeeding duration What is new: Unsupplemented breastfeeding in hospital in short vs. long education: 35 vs. 16% reduced risk of early BF cessation Vehling et al. Birth (2018)
Do not provide breastfed newborns any food or fluids other than breastmilk, unless medically indicated (BFHI STEP 6)
Presenter
Presentation Notes
Before I finish, I would like to draw your attention to an important study from Canada. EBF in hospital predicts longer breastfeeding duration In fact: EBF hospital median duration 11 mo vs. non-EBF hospital 7 mo The positive effect of unsupplemented breastfeeding in hospital was much stronger in women with short education. Unsupplemented BF women with short education resulted in 35% reduced risk of early BF cessation, compared to women whose babies were supplemented. The corresponding difference in women with long education was 16%. Thus, this is were we should begin to reduce unfair inequalities in breastfeeding : Do not provide breastfed newborns any food or fluids other than breastmilk, unless medically indicated. (BFI Step 6).
What can we do to reduce socioeconomic inequality in breastfeeding?
o Reduce barriers to breastfeeding in the health services and society
o Do not provide breastfed newborns any food or fluids other than breastmilk, unless medically indicated (BFHI STEP 6)
o Perceived breastmilk insufficincy - prevention o Some groups may need extra or tailored support:
- young, first-time, single, unemployed mothers - mothers who continue to smoke
Presenter
Presentation Notes
Thank you!
Photo: Norwegian Directorate of Health
