Public Health Nutrition

Social, economic, political and environmental determinants

Determinants of breast-feeding in a Finnish birth cohort

Maijaliisa Erkkolaa1a2 c1, Maija Salmenhaaraa2, Carina Kronberg-Kippiläa2, Suvi Ahonena3, Tuula Arkkolaa4, Liisa Uusitaloa2, Pirjo Pietinena2, Riitta Veijolaa4, Mikael Knipa5a6 and Suvi M Virtanena2a3a6

a1 Division of Nutrition, Department of Applied Chemistry and Microbiology, University of Helsinki, PO Box 66, FIN-00014 Helsinki, Finland

a2 Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland

a3 Tampere School of Public Health, University of Tampere, Tampere, Finland

a4 Department of Paediatrics, University of Oulu, Oulu, Finland

a5 Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

a6 Department of Paediatrics and Research Unit, Tampere University Hospital, Tampere, Finland


Objective To assess milk feeding on the maternity ward and during infancy, and their relationship to sociodemographic determinants. The validity of our 3-month questionnaire in measuring hospital feeding was assessed.

Design A prospective Finnish birth cohort with increased risk to type 1 diabetes recruited between 1996 and 2004. The families completed a follow-up form on the age at introduction of new foods and age-specific dietary questionnaires.

Setting Type 1 Diabetes Prediction and Prevention (DIPP) project, Finland.

Subjects A cohort of 5993 children (77 % of those invited) participated in the main study, and 117 randomly selected infants in the validation study.

Results Breast milk was the predominant milk on the maternity ward given to 99 % of the infants. Altogether, 80 % of the women recalled their child being fed supplementary milk (donated breast milk or infant formula) on the maternity ward. The median duration of exclusive breast-feeding was 1·4 months (range 0–8) and that of total breast-feeding 7·0 months (0–25). Additional milk feeding on the maternity ward, short parental education, maternal smoking during pregnancy, small gestational age and having no siblings were associated with a risk of short duration of both exclusive and total breast-feeding. In the validation study, 78 % of the milk types given on the maternity ward fell into the same category, according to the questionnaire and hospital records.

Conclusions The recommendations for infant feeding were not achieved. Infant feeding is strongly influenced by sociodemographic determinants and feeding practices on the maternity wards. Long-term breast-feeding may be supported by active promotion on the maternity ward.

(Received March 05 2009)

(Accepted September 08 2009)

(Online publication October 13 2009)


c1 Corresponding author: Email