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. 2022 Oct;18(4):e13410.
doi: 10.1111/mcn.13410. Epub 2022 Jul 31.

Trends and disparities in breastfeeding initiation in France between 2010 and 2016: Results from the French National Perinatal Surveys

Andrea Guajardo-Villar  1 , Virginie Demiguel  2 , Sabira Smaïli  1 , Julie Boudet-Berquier  2 , Hugo Pilkington  3 , Beatrice Blondel  4 , Benoit Salanave  2 , Nolwenn Regnault  2 , Camille Pelat  1
Affiliations

Trends and disparities in breastfeeding initiation in France between 2010 and 2016: Results from the French National Perinatal Surveys

Andrea Guajardo-Villar et al. Matern Child Nutr. 2022 Oct.

Abstract

Breastfeeding (BF) initiation rates in French maternity units are among the lowest in Europe. After increasing for several years, they decreased between 2010 and 2016, although several maternal characteristics known to be positively associated with BF in France were more frequent. We aimed to (1) quantify adjusted trends in BF initiation rates between 2010 and 2016; (2) examine associations between BF initiation rates and newborn, maternal, maternity unit, and department-level characteristics. Using data from the 2010 (n = 12,224) and 2016 (n = 11,089) French National Perinatal Surveys, we analysed BF initiation (exclusive, mixed, and any) through a succession of six mixed-effect multinomial regression models, progressively adding adjustment covariates. Adjusted exclusive and any BF initiation rates decreased by 9.6 and 4.5 points, respectively, versus by 7.7 and 1.8 points, respectively, in the crude analysis. In both years, adjusted exclusive and any BF initiation rates were lowest in the following categories of mothers: low education level, single, high body mass index and multiple or premature births. Exclusive BF initiation decreased most in primiparous mothers, those with the lowest household income, mothers that had a vaginal delivery, women born in an African country and those who delivered in a maternity unit without Baby-Friendly Hospital Initiative designation. The 2010-2016 decrease in BF initiation rates in France cannot be explained by changes in mothers' characteristics; quite the opposite, adjustment increased its magnitude. Additional efforts should be put in place to understand why this decrease is particularly sharp in some subgroups of mothers.

Keywords: France; breastfeeding initiation; exclusive breastfeeding; inequalities; mixed breastfeeding; trends.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Difference in predicted exclusive, mixed and any breastfeeding (BF) initiation rates between 2016 and 2010 (i.e., marginal effect of the year), estimated with six nested models that adjusted for an increasing number of covariates. Any BF initiation rates are equal to the sum of exclusive and mixed BF initiation rates. The six models were built cumulatively including a year index (Model 1), spatial random effect (Model 2), individual characteristics (Model 3), maternity unit characteristics (Model 4), French department characteristics (Model 5) and interaction terms between the year and the covariates (Model 6). Data for metropolitan France from the 2010 and 2016 French National Perinatal Surveys.
Figure 2
Figure 2
Marginal predictions of exclusive (light grey circle), mixed (grey triangle) and any (black square) breastfeeding (BF) initiation rates, for the different levels of the covariates included in the final model (Model 6). Any BF initiation rates are equal to the sum of exclusive and mixed BF initiation rates. Model 6 was built cumulatively including a year index (Model 1), spatial random effect (Model 2), individual characteristics (Model 3), maternity unit characteristics (Model 4), French department characteristics (Model 5) and interaction terms between the year and the covariates (Model 6). Section (a) includes the individual covariates; section (b) the maternity unit covariates and section (c) the French department covariates. The vertical lines indicate the mean prediction in the whole sample for each type of BF initiation. Data for metropolitan France from the 2010 and 2016 French National Perinatal Surveys.
Figure 3
Figure 3
Difference in predicted breastfeeding (BF) initiation rates between 2016 and 2010 (i.e., marginal effect of the year). Exclusive (light grey circle), mixed (grey triangle) and any (black square) BF initiation rates are presented for the different levels of the covariates interacting with time in the final model (Model 6). Any BF initiation rates are equal to the sum of exclusive and mixed BF initiation rates. Model 6 was built cumulatively including a year index (Model 1), spatial random effect (Model 2), individual characteristics (Model 3), maternity unit characteristics (Model 4), French department characteristics (Model 5) and interaction terms between the year and the covariates (Model 6). Section (a) includes the individual covariates; section (b) the maternity unit covariates and section (c) the French department covariates. The vertical lines indicate the mean difference in predicted BF initiation rates for each type of BF initiation. Data for metropolitan France from the 2010 and 2016 French National Perinatal Surveys.
Figure A1
Figure A1
Selection process of the study population. Data for metropolitan France from the 2010 and 2016 French National Perinatal Surveys (NPS).
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