Comparing Iraqi Regional Differences on Infant Feeding through Breastfeeding and Formula

Anna Grace Tribble

doi:10.24017/science.2018.2.2

Authors

Anna Grace Tribble Anthropology and Epidemiology College of Arts and Sciences, School of Public Health Emory, University Atlanta, United States of America

Abstract

Research tends to focus on the health implications of breastfeeding, but understanding associations that might drive maternal choice in infant feeding practice is also very important. To understand the relationship between women’s feeding strategies for their children and the context in which they live in Iraq, mixed methods are deployed through analysis of surveys and interviews. Using data from the 2000 and 2011 Multiple Indicator Cluster Survey, trends are quantitatively examined in breastfeeding and infant formula use for Iraq using linear probability models. Interviews are qualitatively analyzed that were collected from women in Sulaimani governorate in the Kurdish region of Iraq to begin understanding the reasons why Iraqi women initiate breastfeeding and formula use. Being urban, wealthier, and more educated increases the probability of a mother using infant formula, while only increasing wealth and increasing education are associated with increasing the probability of breastfeeding. In 2000, governorates significantly differ in the probability of mothers using infant formula (e.g. Karbala = 24.32 percentage points lower probability of using infant formula relative to Sulaimani, (p<0.0001), but differences in breastfeeding seem to be between the southern and northern governorates (e.g. Karbala = 6.78 percentage points higher probability of breastfeeding relative to Sulaimani, (p<0.01). Over the ensuing decade, the probability of breastfeeding decreases, and the probability of infant formula use increases across most governorates. Interviews provide narratives that help explain these trends such as mothers continuing to breastfeed during stressful times but using infant formula when working outside of the home. Between governorate differences could be driven by differences in conflict over the decade. This study contributes to a more nuanced perspective on infant feeding practices in Iraq at the governorate level, suggesting that future maternal-child nutrition studies need to account for the effects of where a mother lives within Iraq.

Keywords:

breastfeeding, formula, Iraq, maternal-child nutrition, infant feeding practices.

References

[1] U. Shaikh and O. Ahmed, "Islam and Infant Feeding," Breastfeeding Medicine, vol. 1, no. 3, pp. 164-167, 2006.
https://doi.org/10.1089/bfm.2006.1.164
[2] N. E. Zelman, "The Nestle Infant Formula Controversy: Restricting the Marketing Practices of Multinational Corporations in the Third World," Transnational Law, vol. 3, p. 697, 1990.
[3] K. D. Rosenberg, C. A. Eastham, L. J. Kasehagen, and A. P. Sandoval, "Marketing Infant Formula Through Hospitals: the Impact of Commercial Hospital Discharge Packs on Breastfeeding," American Journal of Public Health, vol. 98, no. 2, pp. 290-295, 2009.
https://doi.org/10.2105/AJPH.2006.103218
[4] K. D. Gribble and N. J. Berry, "Emergency preparedness for those who care for infants in developed country contexts," International Breastfeeding Journal, vol. 6, no. 16, 2011.
https://doi.org/10.1186/1746-4358-6-16
[5] F. D. Miller, Out of the Mouths of Babes: The Infant Formula Controversy. Bowling Green, OH: Bowling Green State University, 1983.
[6] A. P. Simopoulos and G. D. Grave, "Factors associated with the choice and duration of infant-feeding practice," Pediatrics, vol. 74, pp. 603-614, 1984.
https://doi.org/10.1542/peds.74.4.603
[7] V. Diwakar, M. Malcolm, and G. Naufal, "The Impact of Violent Conflict on Breastfeeding " Feminist Economics, no. under review, 2015.
[8] S. Harding and K. Libal, "Chapter 2: War and the Public Health Disaster in Iraq," in The War Machine and Global Health: A Critical Medical Anthropological Examination of the Human Costs of Armed Conflict and the International Violence Industry, M. Singer and G. D. Hodge, Eds. Lanham, MD: AltaMira Press, 2010, pp. 59-88.
[9] R. Garfield, "The Impact of Economic Sanctions on Health and Well-Being," in "Relief and Rehabilitation Network," Overseas Development Institute, London, UK1999, Available: https://www.essex.ac.uk/armedcon/story_id/The%20Impact%20of%20Econmoic%20Sanctins%20on%20Health%20abd%20Well-Being.pdf.
[10] G. R. Popal, "Impact of sanctions on the population of Iraq," Eastern Mediterranean Health Journal, vol. 6, no. 4, pp. 791-795, 2000.
https://doi.org/10.26719/2000.6.4.791
[11] S. Rawaf, "The health crisis in Iraq," Critical Public Health, vol. 15, no. 2, pp. 181-188, 2005.
https://doi.org/10.1080/09581590500134208
[12] W. A. K. Abbas, N. G. Azar, L. G. Haddad, and M. G. Umlauf, "Preconception health status of Iraqi women after trade embargo," Public Health Nursing, vol. 25, pp. 295-303, 2008.
https://doi.org/10.1111/j.1525-1446.2008.00709.x
[13] J. Drèze and H. Gazdar, "Hunger and Poverty in Iraq, 1991 " World Development, vol. 20, no. 7, pp. 921-945, 1992.
https://doi.org/10.1016/0305-750X(92)90121-B
[14] USAID. (2006). Public Distribution System: FAQ Sheet, Iraq. Available: http://www.12thcav.us/112CAV_OIF0608_A07.htm
[15] H. I. Tawfeek and A. H. Salom, "Iraqi national survey data on malnutrition and breastfeeding practices among children under five years of age," Food and Nutrition Bulletin, vol. 22, no. 1, pp. 19-22, 2001.
https://doi.org/10.1177/156482650102200104
[16] A. J. Abdul-Ameer, A.H.Al-Hadi, and M. M. Abdulla, "Knowledge, attitudes and practices of Iraqi mothers and family child-caring women regarding breastfeeding," Eastern Mediterranean Health Journal, vol. 14, no. 5, pp. 1003-14, 2008.
[17] N. Z. Shaker, S. S. Hasan, and Z. A. Ismail, "Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq," Eastern Mediterranean Health Journal, vol. 21, no. 12, pp. 885-890, 2015.
https://doi.org/10.26719/2015.21.12.885
[18] Y. S. Benyamen and M. K. Hassan, "Feeding patterns in the first two years of life in Basra, Iraq," Eastern Mediterranean Health Journal, vol. 4, no. 3, pp. 448-451, 1998.
https://doi.org/10.26719/1998.4.3.448
[19] J. M. Almarzoki and A. H. Abdulkareem, "Sociocultural Influences On Feeding Practices Of Children Below Two Years In Babylon / Iraq," Journal of Advanced Medical Research vol. 5, no. 2, pp. 7-14, 2015.
[20] E. A. A.-M. Ali, H. F. Aljawadi, and A. a. R. Obaid, "The Cost of Formula Milk Feeding in Infancy in Al-Amarah City, South East of Iraq," International Journal of Pediatrics, vol. 4, no. 8, pp. 3239-3247, 2016.
[21] J. M. Wooldridge, Introductory Econometrics: A Modern Approach, Fifth Edition. Mason, OH: South-Western Cengage Learning, 2012.
[22] G. A. Tommaselli, M. Guida, S. Palomba, M. Barbato, and CarmineNappi, "Using complete breastfeeding and lactational amenorrhoea as birth spacing methods," Contraception, vol. 61, no. 4, pp. 253-257, 2000.
https://doi.org/10.1016/S0010-7824(00)00101-3
[23] E. E. Stevens, T. E. Patrick, and R. Pickler, "A History of Infant Feeding," The Journal of Perinatal Education, vol. 18, no. 2, pp. 32-39, 2009.
https://doi.org/10.1624/105812409X426314
[24] T. Amin, H. Hablas, and A. A. A. Qader, "Determinants of Initiation and Exclusivity of Breastfeeding in Al Hassa, Saudi Arabia," Breastfeeding Medicine vol. 6, no. 2, 2011.
https://doi.org/10.1089/bfm.2010.0018
[25] M. Khassawneh, Y. Khader, Z. Amarin, and A. Alkafajei, "Knowledge, attitude and practice of breastfeeding in the north of Jordan: a cross-sectional study," International Breastfeeding Journal, vol. 1, no. 17, pp. 1-6, 2006.
https://doi.org/10.1186/1746-4358-1-17
[26] M. G. Schwab, "Mechanical Milk: An Essay on the Social History of Infant Formula," Childhood, vol. 3, no. 4, pp. 479-497, 1996.
https://doi.org/10.1177/0907568296003004005
[27] K. Merchant, R. Martorell, and J. Haas, "Maternal and fetal responses to the stresses of lactation concurrent with pregnancy and of short recuperative intervals," The American Journal of Clinical Nutrition, vol. 52, no. 2, pp. 280-288, 1990.
https://doi.org/10.1093/ajcn/52.2.280
[28] T. Vishwanath, D. Sharma, N. Krishnan, and B. Blankespoor, "Where are Iraq's Poor: Mapping Poverty in Iraq," World Bank2015, Available: http://documents.worldbank.org/curated/en/889801468189231974/pdf/97644-WP-P148989-Box391477B-PUBLIC-Iraq-Poverty-Map-6-23-15-web.pdf.
[29] S. S. Hasan, "Factors influence on primigravida's knowledge regarding exclusive breastfeeding benefits in Maternity Teaching Hospital: Erbil City - Kurdistan Region, Iraq. ," Zanco Journal of Medical Sciences, vol. 20, no. 3, pp. 1505-1512, 2016.
https://doi.org/10.15218/zjms.2016.0051
[30] T. A. Rahim, B. A. Saeed, H. M. Farhan, and R. R. Aziz, "Trends of Indigenous Healing Among People with Psychiatric Disorders: Comparative Study of Arabic and Kurdish Ethnicities in Iraq," Journal of Religion and Health, vol. 54, no. 1, pp. 316-326, 2015.
https://doi.org/10.1007/s10943-014-9915-2
[31] S. I. I. AL-Azzawi, K. A. Hussein, and N. Z. Shaker, "Knowledge, Attitude and Practices (KAP) of Mothers toward Infant and Young Child Feeding in Primary Health Care (PHC) Centers, Erbil City," Kufa Journal for Nursing Sciences, vol. 2, no. 2, pp. 118-126, 2012.