Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers' perspectives.

Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed. To explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices. A critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers' narratives. Analysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers' differing views and positions on infant feeding practices and their influence on breastfeeding. This study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers' influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.

Maviso MK ，Kaforau LM ，Hastie C 《-》

Mothers' and Grandmothers' misconceptions and socio-cultural factors as barriers to exclusive breastfeeding: A qualitative study involving Health Workers in two rural districts of Ghana.

Nsiah-Asamoah C ，Doku DT ，Agblorti S 《PLoS One》

Grandmothers' knowledge positively influences maternal knowledge and infant and young child feeding practices.

Karmacharya C ，Cunningham K ，Choufani J ，Kadiyala S ... -  《-》

Maternal empowerment, feeding knowledge, and infant nutrition: Evidence from rural China.

Maternal empowerment - the capacity to make decisions within households - is linked to better child feeding and nutritional outcomes, but few studies have considered the mediating role of caregiver knowledge. Further, existing literature centres primarily on the husband-wife dyad while overlooking grandmothers as important childcare decision-makers. We collected primary data through household surveys in 2019 and 2021 from 1190 households with infants zero to six months living in rural western China. We identified the primary and secondary caregivers for each infant and assessed their feeding knowledge and practices, as well as infant nutritional status. We constructed a maternal empowerment index using a seven-item decision-making questionnaire and examined the relationship between maternal empowerment in childcare and household decisions, caregivers' feeding knowledge, and infant feeding practices and nutritional outcomes. Mothers had significantly higher levels of feeding knowledge than secondary caregivers (most were grandmothers, 72.7%), with average knowledge scores of 5.4 vs. 4.1, respectively, out of 9. Mothers and secondary caregivers with higher levels of feeding knowledge had significantly higher exclusive breastfeeding rates by 13-15 percentage points (P < 0.01) and 11-13 percentage points (P < 0.01), respectively. The knowledge of secondary caregivers was even more strongly associated with not feeding formula (15 percentage points, P < 0.01). Mothers empowered to make childcare decisions were more likely to exclusively breastfeed (12-13 percentage points, P < 0.01), less likely to formula feed (9-10 percentage points, P < 0.05), and more likely to have children with higher Z-scores for length-for-age (0.32-0.33, P < 0.01) and weight-for-age (0.24-0.25, P < 0.05). Effects remained after controlling for maternal feeding knowledge. While mothers' and grandmothers' feeding knowledge was both important for optimal infant feeding, grandmothers' knowledge was particularly critical for practicing exclusive breastfeeding. Given the disparity in feeding knowledge between the two caregivers, our study further shows that mothers empowered in childcare decision-making were more likely to exclusively breastfeed their infants. This implies that some mothers with adequate knowledge may not practice optimal feeding because of lower decision-making power. Overall, our study highlights the role of secondary caregivers (grandmothers) in infant care and suggests that future child nutritional interventions may benefit from involving secondary caregivers (grandmothers). Parent trial registration: ISRCTN16800789.

Chen Y ，Guo Y ，Wu Y ，Medina A ，Zhou H ，Darmstadt GL ... -  《-》

Grandmother breastfeeding support: what do mothers need and want?

Grassley J ，Eschiti V 《-》