Infant feeding practices in home countries and Australia: Perth Chinese mothers survey.

Abstract

Objective: This study aimed to document the infant feeding practices of Chinese-Australian mothers in their home countries and following migration to Australia. The factors that influenced infant feeding practices are also described.

Design: A cross-sectional survey.

Subjects: A sample of 506 Mandarin-speaking mothers with at least one child, who were born outside of Australia, resident in the Perth area and aged between 23 and 59 years.

Setting: Community-based household telephone interviews in Perth, Western Australia.

Statistical analysis: [chi square]-statistics was used to test the differences in the rates and factors influencing infant feeding practices between mothers' home countries and Australia.

Results: There were no significant differences between any breastfeeding rates among Chinese women delivering in either their home countries where breastfeeding initiation was 86.6% or in Australia. Full breastfeeding rates at three and six months for Chinese women were lower than recent Australian rates. Chinese women delivering in Australia received more breastfeeding support and assistance from health professionals. In Australia, 78% stated that they received support form their doctors and nurses for breastfeeding compared with 37.6% in their home countries (P < 0.001). In particular, they were more likely to have put their infant to the breast immediately after birth (47.9%) compared with women delivering in their home countries (4.1%) (P < 0.001). Solid foods were introduced earlier in their home countries.

Conclusion: The Chinese-Australian mothers' infant feeding practices in Australia reflected both Western and Eastern influences. The Chinese mothers introduced complementary foods earlier than in other Australian studies, suggesting that culturally specific programs will be needed to encourage exclusive breastfeeding to six months.

Key words: breastfeeding, Chinese immigrants, infant feeding practice

(Nutr Diet 2005;62:82-88)

Introduction

Breast milk has long been recognised as the perfect infant food. Due to its superiority over formula, it is considered the optimal feeding method for meeting the nutritional needs of term infants up to the age of six months and beyond. (1) Epidemiological studies show that human milk provides numerous short- and long-term advantages to the infant and mother in both developed and developing countries. Breastfeeding has positive effects on the nutritional, health and psychological make-up of the infant and brings health and fertility-control benefits for the mother. (2) The 'Dietary Guidelines for Australians' nominate breastfeeding as a key dietary guideline (3) and the Infant Feeding Guidelines set goals to increase the initiation and duration of breastfeeding. (4)

Infant feeding practices are associated with the context of ethnic and cultural beliefs. Among ethnic groups, culturally based feeding beliefs influence how individual mothers make decisions. The context for mothers' beliefs changes for those who immigrate to another culture and geographical regions where practices are different. (5) Australia is a multicultural society where immigrants come from diverse ethnic backgrounds. While the majority of women in Australia choose to breastfeed, initiation rates are not consistent across all ethnic groups. For instance, in a study of women in Perth and rural Queensland, mothers born outside of Australia had substantially lower breastfeeding initiation rates than their Australian-born counter-parts. (6) In particular, mothers who were born in Asia had the lowest rates of breastfeeding. (7)

Over the last 30 years, many studies have investigated the socioeconomic parameters of breastfeeding, but to date fewer have attempted to explore ethnic, societal and cultural attitudes about breastfeeding. There remains a need to understand cultural influences on the initiation and duration of breastfeeding. Without an understanding of the factors that have an impact on the Chinese women's decisions to initiate and maintain breastfeeding, health care professionals are limited in developing and implementing effective strategies for promoting breastfeeding in this population. This study used survey interviews to explore differences of infant feeding practices in the mothers' home countries and Australia, for Mandarin-speaking women who had children born in Australian or overseas, and were living in Perth, Western Australia at the time of the study.

Methods

A survey was undertaken of 532 Mandarin-speaking mothers living in Perth, Western Australia. Potential participants were recruited from places frequented by Chinese women (e.g. Chinese shops and markets), from university student organisations, church organisations and university telephone books. The inclusion criteria were women with at least one child, who were born outside of Australia and spoke Mandarin, were resident in the Perth area and aged less than 60 years. The purpose and demands of the study were explained in detail to each participant, and all women were assured of anonymity and confidentiality. Informed consent was obtained from participants before the interview.

The study was approved by the Human Research Ethics Committees of Curtin University of Technology. The survey materials were translated into Chinese, and the first author who spoke the language conducted all the interviews in Mandarin by telephone.

Mothers were asked to complete a questionnaire based on that used in the 1992 Perth Infant Feeding Study, (8) but made more culturally relevant. The questionnaire contained questions on infant feeding practices in their home countries and Australia with additional questions specific to the Chinese culture. The questionnaire included mainly closed-ended questions containing information on factors related to breastfeeding. Mothers were asked to provide infant feeding information on their last-born child in both their home countries and Australia, and were asked whether they had breastfed this child and if the child was no longer being breastfed, the total length of time that the child had been breastfed. They were also asked about the introduction and use of infant formula and/or cow's milk. Information about the introduction and types of solid foods fed to infants, and factors influencing infant feeding choices were also collected. In addition to data on feeding practices, data on socioeconomic and demographic characteristics of the household were obtained, including birth-place, household income, parental education, marital status and couple's occupation.

Two categories of breastfeeding practices were considered: any breastfeeding and full breastfeeding. Any breast-feeding category included all infants fed human milk or a combination of human milk and formula and/or cow's milk. Full breastfeeding included no supplemental formula and/or cow's milk. Because of the economic status in the mothers' home countries, most mothers fed their infants with cow's milk, but some could afford to buy formula for their infants. It is difficult for this population to distinguish whether they fed their babies with infant formula or cow's milk, so infant formula and cow's milk were grouped into one category. Data on breastfeeding rates were compared with the 1995 Australia's National Health Survey. (9,10)

All data were coded, checked and analysed using the Statistical Package for Social Sciences (SPSS for Windows, version 10, SPSS Inc., Chicago, IL, USA). [chi square]-statistics was used to test the differences of infant feeding practices between mothers' home countries and Australia.

Results

A total of 532 Mandarin speakers who met the inclusion criteria were contacted and 506 completed the questionnaire, representing 95% of women contacted. The response rate of 95% for these women is high for this type of survey. Of the 506 mothers who completed the questionnaire, 292 mothers had given birth in their home countries and 313 mothers in Australia, among whom 99 mothers had a child in both their home countries and Australia. For those 99 women, their infant feeding practices in both their home countries and Australia have been included in analyses.

Table 1 presents the socio-demographic characteristics of the subjects. The age of the women ranged from 23 to 59 years, with a mean age of 40. More than half of the women (63.6%) had resided in Australia for more than five years. Most were married (98.2%), came from mainland China (81.6%) and were relatively affluent. In total, 82% of the participants' mothers had breastfed their children.

The mean age at time of delivery of the mothers who had given birth in their home countries was 28.0 years (SD 3.1), and of mothers giving birth in Australia was 33.6 years (SD 5.4). Caesarean delivery rates were 27.9% of births in mothers' home countries, and 31.6% in Australia. The mean age of the children born in their home countries was 13.5 years (SD 6.1) and of children born in Australia was 4.6 years (SD 3.5). For the 292 children born in their home countries, 53.2% were boys and 46.8% were girls. For the 316 children born in Australia, 51.9% were boys and 48.1% were girls.

Table 2 reports the percentage of Chinese women breastfeeding at selected time points in their home countries and Australia compared with rates in Western Australia and breastfeeding targets for Australia. For the 292 mothers who had given birth in their home countries, 86.6% breastfed their last infants; for the 313 mothers who had given birth in Australia, 88.5% breastfed their last infants. This level is not maintained, the rates for any breastfeeding fell to 63.0% and 55.6% by six months postpartum in the mothers' home countries and Australia, respectively. Of the mothers who had given birth in their home countries, 74.0% fully breastfed at hospital discharge; of the mothers giving birth in Australia, 73.8% fully breastfed at hospital discharge. There is a sharp decline in full breastfeeding rates, so that by six months post-partum, only 6% of the mothers were still fully breast-feeding in their home countries and Australia.

Table 3 reports the percentage of Chinese infants receiving selected drinks and solid foods in their home countries and Australia at selected time points, compared with the 1995 National Health Survey. Among the infants, almost half of them were introduced to formula and/or cow's milk by three months of age both in their home countries (45.2%) and in Australia (46.3%). By three months of age, 12.3% home country-born children had been introduced to rice porridge but significantly fewer (3.2%) Australian-born children had received rice porridge at this same age. Similarly, 17.8% of home country-born children had received other solid foods by three months but significantly fewer (6.4%) Australian-born children had received other solids by this age. Most infants (79.3%) were introduced to egg-yolk as the first solid food in their home countries, compared with 31.8% of Australian-born children. More than half of Australian-born children (51.4%) had received commercial infant food (usually infant cereal) as the first solid food compared with 1.7% in their home country. (P < 0.001).

Table 4 shows the comparison of the reasons for the mother's decision on baby feeding in their home countries and Australia. The main reasons that the mothers gave for choosing how they fed their babies were the same in both their home countries and Australia. The most common reason for using bottle-feeding was a perceived lack of breast milk, both in their home countries and in Australia. This is also the most serious breastfeeding problem reported by Australian mothers. (12)

Table 5 compares the factors influencing infant feeding practices in the mothers' home countries and Australia. Nearly half (45.2%) of the mothers who had given birth in their home countries did not put their newborn babies to their breasts until the next day. Whereas, Australian-born babies were generally put to their mothers' breasts soon after birth, with 47.9% of the mothers describing it as 'immediately after birth' (P < 0.001). Around half of the mothers made their decision about how to feed their babies before becoming pregnant both in their home countries (48.3%) and Australia (55.3%). More than half of the infants (58.9%) slept in the same bed with their mothers in their home countries, compared with 38.7% of infants who slept in the same bed with their mothers in Australia (P < 0.001).

Most of the mothers (93.0%) who had given birth in Australia had received enough help and information about feeding their babies from hospital staff, compared with 38.7% of the mothers who had given birth in their home countries (P < 0.001). Most of the mothers (80.2%) had received pamphlets or booklets on breastfeeding before having babies in Australia, compared with only 47.9% of the mothers in their home countries, and 44.9% of the mothers had not got any help or information about breast-feeding before having babies in their home countries (P < 0.001). Most of the mothers (78.0%) said that doctors and nurses supported them to breastfeed in Australia, compared with 37.6% of the mothers in their home countries (P < 0.001, see Table 5). The majority of women who gave birth in their home countries (67.5%) used some form of traditional methods to help produce more breast milk, whereas less than half of the women giving birth in Australia (46.3%) did so (P < 0.001, see Table 5).

Discussion

The findings from this study show that breastfeeding initiation rates for Chinese immigrant women were relatively high both for infants born in their mother's home countries and for those born in Australia, and were almost the same as the current Australian level. (9) The proportion of women who continued to breastfeed at six months post-partum in their home countries was significantly higher than the Australian figure, while the proportion of Chinese immigrant women breastfeeding at six months in Australia was similar to the Australia figure. Nevertheless, the rates in either country were lower than the breastfeeding goals set for Australia. (13) Full breastfeeding rates at three and six months for Chinese women were lower than current Australian levels and the breastfeeding targets for Australia in the year 2000. The percentage of infants given solid foods was significantly higher in the Chinese infants (80%) than the rate in the National Health Survey of 61% (see Table 3). The majority of this population were not being exclusively breastfed for six months as recommended by the National Health and Medical Research Council and the World Health Organization. (13) These results suggest the retention of infant feeding patterns after migration to Australia.

Jain (14) from the 1989/90 Australia's National Health Survey and Scott et al. (8) from the 1992 Perth Infant Feeding Study both found that mothers born in Asia tended to breastfeed for shorter durations than Australian-born mothers. Similarly, Taveras et al. in their prospective study of 1163 mothers in America also found higher breastfeeding discontinuation rates among mothers of Asian race/ethnicity. (15) Reasons for shorter duration may include perceived milk insufficiency, return to work or school and a desire to allow others to assist in feeding. In addition, some mothers perceived that formula feeding was more common in Western countries, and some mothers were ambivalent about the benefits of breastfeeding. We have reported in an earlier paper that this group of women incorrectly perceived that Australian women bottle-fed their infants. (16)

The level of usage of infant formula and/or cow's milk by Chinese women at hospital discharge, three and six months were higher than recent Australian rates, irrespective of whether women had delivered in their home countries or Australia. The rate of full breastfeeding at six months was very low and the rate of exclusive breastfeeding would be even lower. This is well below Australian target of 80% exclusive breastfeeding to six months. (13) This practice has been directly associated with diminished milk supply and in shortening the duration of breastfeeding. (17,18) In the present study however, the higher use of formula by Chinese women did not appear to affect duration of 'any breastfeeding' as there were no differences in the proportion of Chinese women breastfeeding at six months compared with recent Australian rates.

Nevertheless, 'not having enough breast milk' was the main reason for the mothers to choose bottle-feeding. Jing et al. in their study in China also found that insufficient milk was claimed to be the most important factor contributing to a failure to continue breastfeeding. (19) It appears unlikely that many women truly experience insufficient milk, since physiologic studies have suggested that only 1-5% of women have genuine problems with milk production and supply. (20) While women everywhere express concern over the sufficiency of their breast milk supply, it has been suggested (21) that 'insufficient breast milk' is a socially acceptable excuse given by a woman to justify her decision to discontinue breastfeeding.

The results also showed that solid foods were introduced earlier in their home countries, while for Chinese infants born in Australia the timing of the introduction of solids was similar to the introduction of solids to other Australian infants. The early introduction of solid foods might reflect the beliefs that mothers cannot provide sufficient nutrition to their infants and the need to introduce solid foods. A longitudinal infant growth study in Scotland of 127 infants found that the most common reason for offering solids was the perception that the infants were not satisfied with milk feeds. (22)

Some traditional infant feeding practices have been kept after migration to Australia. There were no significant differences of the percentages of the infants introduced to rice porridge by six and nine months of age between the infants born in their home countries and Australia. Similarly, almost half of women giving birth in Australia used traditional methods to help produce more milk. Sit et al. in a cross-sectional study of 130 first-generation Chinese Canadian infants found that the complementary food choices of the Chinese Canadian parents reflected both Western and Eastern influences. (23) For instance, while the first complementary food introduced to the majority (80.8%) of infants was commercial infant cereal, the majority of infants were also introduced to home-prepared carbohydrates, which included traditional Chinese infant staples, such as rice porridge and soft rice. (23)

There is evidence that starting to breastfeed within the first hour of birth is good for both mother and infant and for continued breastfeeding. (24) In our study, the mothers giving birth in Australia put their baby to the breast much earlier (47% <1 hour) than those giving birth in China (4%) and this may reflect the encouragement of health workers in Australia. Furthermore, the mothers giving birth in Australia got more information and support about breastfeeding from hospital staff than the those giving birth in their home countries.

Infants sleeping in a bed with their parents is a practice referred to as bed sharing. One reason that more home-country mothers choose to bed share than those in Australia was the cramped living conditions in their home countries. The potential advantages of bed sharing include increased parent-infant bonding, close physical contact enabling babies to feel secure and facilitation of breastfeeding. Frequent sucking helps to increase breastfeeding rates, and there are long-term psychological outcomes from bed sharing such as increased self-esteem and discipline. (25) In the present study however, lack of bed sharing by Australian-born infants did not appear to have a negative impact on breastfeeding duration, with a similar proportion of Chinese infants in both groups being breastfed at six months.

Limitations of the study

The generalisability of the present study was limited by the fact that a convenience sample was drawn from the Perth population, although the relatively large sample size may make its results more widely applicable. The major limitation of this study is the cross-sectional nature of the study. A larger, more detailed prospective study would more accurately identify barriers to breastfeeding and suggest ways of solving them.

Another possible limitation of the data is recall bias, especially in the case of older children. However, the data may be relatively accurate because 93.8% of the mothers who had given birth in China only had one child with an average age of 13.5 years due to the one-child policy in China, which was issued in 1979. (26) Two Australian studies suggest that maternal recall of breastfeeding is accurate. It has been found that duration of breastfeeding, but not the time of starting other milk feeds could be remembered accurately up to 10 years later. (2,10) Because recall of total duration of breastfeeding is more accurate than recall of when other foods and liquids were introduced, the estimates of total breastfeeding (i.e. exclusive and partial) and full breastfeeding may be more reliable than those for exclusive breastfeeding.

Conclusion

The present study described Chinese women's experiences of breastfeeding in their home countries and Australia, and showed similar overall breastfeeding rates in both situations. The most common reason for the cessation of breastfeeding was breast milk insufficiency. Culturally specific breastfeeding education is needed to allay the common concerns of the mothers. Further research is needed on the reasons for the early introduction of solid foods by the Chinese mothers. Culturally specific programs are needed about the importance of continuing to breastfeed exclusively until six months of age and beyond.

Acknowledgements

We are grateful for the support of the Mandarin-speaking mothers who participated in our interviews.

References

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14. Jain S. Breastfeeding in Australia (Results of the 1989 NHS). Occasional Paper. Report No.: ABS Catalogue No. 4394.0. Canberra: ABS, 1996.

15. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003; 112: 108-15.

16. Li L, Zhang M, Binns CW. Chinese mothers' knowledge and attitudes about breastfeeding in Perth, Western Australia. Breastfeed Rev 2003; 11 (3): 13-19.

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18. Sheehan D, Bridle B, Hillier T et al. Breastfeeding outcomes of women following uncomplicated birth in Hamilton-Wentworth. Can J Public Health 1999; 90 (6): 408-11.

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School of Public Health, Curtin University of Technology, Perth

L. Li, BSc, GradDip

M. Zhang, PhD, GradDip, BM

C.W. Binns, MB BS, MPH, PhD, FRACGP, FACOM, FAFPHM

Department of Public Health, Medical School of Xi'an Jiao Tong University, Xi'an, China

L. Li, BSc, GradDip

Division of Developmental Medicine, University of Glasgow, Glasgow

J.A. Scott, PhD, MPH, GradDipDiet, BappSc, Division of Developmental Medicine

Correspondence: C. W. Binns, School of Public Health, Curtin University, GPO Box U 1987, Perth WA 6845, Australia. Email: [e-mail]

Table 1. Socio-demographic characteristics of the sample (n = 506)

Characteristics                     No.  Frequency (%)

Age (years)
  <30                                33       6.5
  31-40                             297      58.7
  41-50                             156      30.8
  <60                                20       4.0
Marital status
  Married                           498      98.2
  Divorced or separated               8       1.8
Education
  Primary                             5       1.0
  Secondary                         115      22.7
  Tertiary                          386      76.3
Occupation
  Self-employment                    63      12.5
  Part-time work                     44       8.7
  Professional work                 129      25.5
  Student                            57      11.3
  Housewife                         213      42.1
Partner's occupation (a)
  Self-employment                   135      27.1
  Part-time work                     43       8.6
  Professional work                 268      53.8
  Student                            44       8.8
  Househusband                        8       1.6
Family income in the previous year
  <15 000                            20       4.0
  15 001-25 000                      68      13.4
  25 001-40 000                      60      11.9
  40 001-50 000                      41       8.1
  50 000-60 000                     112      22.1
  >60 000                           205      40.5
Place of birth
  China                             413      81.6
  Taiwan                             29       5.7
  Malaysia                           41       8.1
  Hong Kong                          12       2.4
  Singapore                          11       2.2
Resident in Australia (years)
  [less than or equal to]5          184      36.4
  >5-10                             167      33.0
  >10                               155      30.6

(a) Data missing for eight participants who could not provide the
information.

Table 2. Percentage of Chinese women breastfeeding at selected time
points in their home countries and in Australia compared with rates in
Western Australia (9) and breastfeeding targets for Australia (11)

                         In home countries  In Australia
                         (n = 292)          (n = 313)
Breastfeeding practice   % (95% CI)         % (95% CI)

Any breastfeeding
  At hospital discharge  86.6 (82.7-90.7)   88.5 (85.0-92.0)
  At 3 months            74.7 (69.8-79.6)   74.1 (69.3-78.9)
  At 6 months            63.0 (57.5-68.5)   55.6 (50.1-61.1)
  At 12 months           28.8 (23.6-34.0)   24.0 (19.3-28.7)
Full breastfeeding
  At hospital discharge  74.0 (69.0-79.0)   73.8 (68.9-78.7)
  At 3 months            43.9 (38.2-49.6)   49.9 (44.4-55.4)
  At 6 months             5.5 (2.9-8.1)      6.4 (3.7-9.1)

                         1992-95 Western   Targets for
                         Australia Survey  Australia, 2000
Breastfeeding practice   % (95% CI)        %

Any breastfeeding
  At hospital discharge  87.0 (83.7-90.3)  90
  At 3 months            69.0 (64.5-73.5)  80
  At 6 months            50.6 (46.1-55.1)  80
  At 12 months           21.2 (NA)
Full breastfeeding
  At hospital discharge  NA                90
  At 3 months            62.8 (58.3-67.3)  60
  At 6 months            21.9 (17.8-25.9)  50

NA = not available.

Table 3. Percentage of Chinese infants receiving selected drinks and
solid foods in their home countries and in Australia at selected time
points, compared with the 1995 National Health Survey (10)

                                                       1995 National
Time of specific  In home countries  In Australia      Health Survey
foods introduced  % (n = 292)        % (n = 313)       % (n = 2470)

Formula and/or
  cow's milk (a)
  At hospital     26.0 (21.0-31.0)   26.2 (21.3-31.1)  16.0 (14.5-17.5)
    discharge
  By 3 months     45.2 (39.5-50.9)   46.3 (40.8-51.8)  38.8 (36.9-40.7)
  By 6 months     67.4 (62.4-72.8)   61.6 (56.2-67.0)  57.0 (55.1-58.9)
Solid food
  By 1 month       0.3 (0.4-3.6)      0                NA
  By 3 months     17.8 (13.4-22.2)    6.4 (3.7-9.1)     7.0 (6.0-8.0)
  By 6 months     77.0 (72.2-81.8)   79.7 (75.2-84.2)  61.4 (59.5-63.3)
Rice porridge
  By 3 months     12.3 (8.6-16.0)     3.2 (1.3-5.1)    NA
  By 6 months     66.4 (61.0-71.8)   64.0 (59.3-69.3)  NA
  By 9 months     78.1 (73.4-82.8)   70.6 (65.6-75.6)  NA

(a) Figure for 1995 National Health Survey is for formula only.
NA = not available.

Table 4. Comparison of the reasons for the mother's decision on baby
feeding in their home countries and in Australia

                                         In home countries  In Australia
Reasons                                  % (n = 292)        % (n = 313)

Decision for breastfeeding
  Breast milk is better for the baby     77.2               79.2
  Breastfeeding is cheaper                5.9                4.5
  Breastfeed baby is more intelligent    20.0               16.3
  Breastfeeding is more convenient       19.7               16.9
  Breastfed infant has fewer             71.0               67.4
    infections
  Breastfeeding is natural               74.1               70.3
  Breastfeeding promotes mother--infant  43.8               42.8
    bonding
Decision for bottle-feeding
  Did not have enough milk               56.6               65.9
  Needed to go back to work              21.0*               8.8*
  Dislike breastfeeding                  13.8               21.2
  Disease                                 8.6                4.0

In the home countries, a total of 184 mothers had used bottles and in
Australia the number was 171.
[chi square]-statistics was used to test the differences of the rates
between their home countries and Australia.
*P < 0.05.

Table 5. Comparison of factors influencing infant feeding practices in
the mothers' home countries and in Australia

                                In home countries  In Australia
Factors                         % (n = 292)        % (n = 313)   P-value

Contact time of newborn baby
  with mother's breasts
  Immediately after birth        4.1               47.9          <0.001
    (<1 hour)
  Within a few hours            14.1               25.6          <0.001
  Within 24 hours               13.1                9.9          NS
  The next day                  45.2               11.8          <0.001
  3-4 days                      23.3                4.8          <0.001
Methods used for breast milk
  supply
  None                          36.3               53.7          <0.001
  Chinese herbs or acupuncture   4.8                0.6           0.001
  Others (fish/pig-feet/        62.7               45.7          <0.001
    chicken soup)
Solids first introduced to                         31.8          <0.001
  babies
  Egg yolk                      79.3               31.8          <0.001
  Fruit                          8.6               16.1           0.005
  Biscuit                        5.4                0.7           0.001
  Rice                           4.6               --
  Commercial infant food         1.7               51.4          <0.001
First decision on
  breastfeeding
  Before became pregnant        48.3               55.3          NS
  Early in the pregnancy        13.0               16.9          NS
  Late in the pregnancy          3.8                1.6          NS
  After the baby was born       34.9               26.2           0.02
Newborn baby slept                                 38.7          <0.001
  In the same bed with mother   58.9               38.7          <0.001
  In separate bed               37.7               53.7          <0.001
  In another room                3.4                7.7           0.02
Enough help from hospital
  staff for breastfeeding
  Yes                           38.7               93.0          <0.001
Breastfeeding information
  received before having
  baby (a)
  Pamphlets or booklet          47.9               80.2          <0.001
  Lectures or classes            8.9               43.5          <0.001
  Demonstrations                13.4               57.8          <0.001
  Video or television            7.2               35.1          <0.001
  Consulting hospital staff      6.5               11.5           0.03
  None of the above             44.9               10.2          <0.001
Doctors and nurses support      37.6               78.0          <0.001
  breastfeeding
Baby's father's preference for
  infant feeding
  Bottle-feeding                 5.8                2.5           0.04
  Breastfeeding                 45.5               50.5          NS
  Don't mind about baby         43.2               43.5          NS
    feeding
  Never discussed the matter     5.1                3.5          NS
Grandmother's preference for
  infant feeding
  Bottle-feeding                 9.2                2.6          <0.001
  Breastfeeding                 56.5               50.6          NS
  Don't mind about baby         16.8               24.7           0.02
    feeding
  Never discussed the matter    17.5               22.4          NS

[chi square]-statistics was used to test the differences of factors
between their home countries and Australia.
(a) More than one answer could be given to this question.
NS = non-significant.