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Breastfeeding Practices in the Twin Town of India — A Cross-Sectional Study

Published online by Cambridge University Press:  02 October 2024

Geeta Bhardwaj  and
Moonjelly V. Smitha Open the ORCID record for Moonjelly V. Smitha [Opens in a new window]
Geeta Bhardwaj
Affiliation:
Nursing College, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
Moonjelly V. Smitha*
Affiliation:
College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
*
Corresponding author: Moonjelly V. Smitha; Email: speak2smitha@gmail.com
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Abstract

The global rise in twinning rates poses health challenges due to increased risks for infants and mothers. Despite the benefits, breastfeeding rates among multiples are low, with exclusive breastfeeding (EBF) particularly scarce compared to singletons. Our study focuses on the mothers of twins in a unique population in Kodinhi village, Kerala, India, known for its high twinning rates, which aims to contribute to existing knowledge of breastfeeding practices and perspectives in a high twinning environment and offer valuable insights to promote optimal breastfeeding among mothers of twins. A retrospective cross-sectional survey was adopted. Seventy-five mothers with twins under 3 years of age from Kodinhi and neighboring areas were interviewed face to face using structured validated tools. Data collection focused on quantitative data supplemented by narrative descriptions. Most women delivered preterm (57.3%), operative delivery (58.7%), and had a late initiation of breastfeeding (32.9% within 24 hours). Colostrum feed was common (86.7%). The EBF rate was 4%, with 47.9% initiating nonexclusive breastfeeding before 3 months, and most of the twins (46.6%) were breastfed for 1−2 years. Fatigue (69.9%) and low milk supply (38.7%) were chief concerns. While 16.4% of mothers opted for a tandem breastfeeding technique, many preferred consecutive feeding as tandem was challenging. Mothers in Kodinhi demonstrated commendable efforts in breastfeeding twins; despite the low rate of EBF, breastfeeding extended to 1−2 years. Evidence-based interventions and personalized support, primarily focusing on maternal perspectives of milk insufficiency, fatigue and breastfeeding techniques, are crucial for sustaining optimal breastfeeding practices among mothers of twins.

Keywords

Human milkTwinTandem breastfeedingExclusive breastfeedingPreterm twin
Type
Article
Information
Twin Research and Human Genetics , Volume 27 , Issue 4-5 , August 2024 , pp. 241 - 250
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of International Society for Twin Studies

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References

Allihaibi, M. M. (2020). Factors associated with failure of exclusive breastfeeding among mothers of twins in Saudi Arabia. World Family Medicine, 18, 69–77.Google Scholar
Anjarwati, N., Waluyanti, F. T., & Rachmawati, I. N. (2019). Exclusive breastfeeding for twin babies and its influencing factors: a study in East Java, Indonesia. Comprehensive Child and Adolescent Nursing, 42, 261–266. https://doi.org/10.1080/24694193.2019.1594458 CrossRefGoogle ScholarPubMed
Asiodu, I. V. (2015). What does infant feeding mean to African American women and their support persons. Journal of Obstetric, Gynecologic & Neonatal Nursing, 44, 73. https://doi.org/10.1111/1552-6909.12649 CrossRefGoogle Scholar
Badr, H. A., & Zauszniewski, J. A. (2017). Meta-analysis of the predictive factors of postpartum fatigue. Applied Nursing Research, 36, 122–127. https://doi.org/10.1016/j.apnr.2017.06.010 CrossRefGoogle ScholarPubMed
Basu, S., Aundhakar, C. D., & Galgali, A. (2014). Gender discrimination in relation to exclusive breastfeeding practices amongst twins in rural India. International Journal of Health Sciences, 4, 139–143.Google Scholar
Callahan, S., Séjourné, N., & Denis, A. (2006). Fatigue and breastfeeding: An inevitable partnership? Journal of Human Lactation, 22, 182–187. https://doi.org/10.1177/0890334406286972 CrossRefGoogle ScholarPubMed
Cinar, N. D., Alvur, T. M., Kose, D., & Nemut, T. (2014). Breastfeeding twins: A qualitative study. Journal of Health, Population and Nutrition, 31, 504–509. https://doi.org/10.3329/jhpn.v31i4.20049 CrossRefGoogle Scholar
Damato, E. G., Dowling, D. A., Standing, T. S., & Schuster, S. D. (2005). Explanation for cessation of breastfeeding in mothers of twins. Journal of Human Lactation, 21, 296–304. https://doi.org/10.1177/0890334405277501 CrossRefGoogle ScholarPubMed
Delobel-Ayoub, M., Arnaud, C., White-Koning, M., Casper, C., Pierrat, V., Garel, M., Burguet, A., Roze, J.-C., Matis, J., Picaud, J.-C., Kaminski, M., Larroque, B., & the EPIPAGE Study Group. (2009). Behavioral problems and cognitive performance at 5 years of age after very preterm birth: The EPIPAGE study. Pediatrics, 123, 1485–1492. https://doi.org/10.1542/peds.2008-1216 CrossRefGoogle ScholarPubMed
Demirtas, B., Ergocmen, B., & Taskin, L. (2012). Breastfeeding experiences of Turkish women. Journal of Clinical Nursing, 21, 1109–1118. https://doi.org/10.1111/j.1365-2702.2011.03848.x CrossRefGoogle ScholarPubMed
Flidel-Rimon, O. (2006). Breast feeding twins and high multiples. Archives of Disease in Childhood, 91, 377–380. https://doi.org/10.1136/adc.2005.082305 CrossRefGoogle ScholarPubMed
Gromada, K. K., & Spangler, A. K. (1998). Breastfeeding twins and higher-order multiples. Journal of Obstetric, Gynecologic & Neonatal Nursing, 27, 441–449. https://doi.org/10.1111/j.1552-6909.1998.tb02668.x CrossRefGoogle ScholarPubMed
Hattori, R., & Hattori, H. (1999). Breastfeeding twins: Guidelines for success. Birth, 26, 37–42. https://doi.org/10.1046/j.1523-536x.1999.00037.x CrossRefGoogle ScholarPubMed
International Institute for Population Sciences. (2021). National Family Health Survey (NFHS-5). https://rchiips.org/nfhs/factsheet_NFHS-5.shtml Google Scholar
Jodalli, P., Panchmal, G. S., Sonde, L., & Somaraj, V. (2016a). A non-identical twin from the village of twins with identical occlusal characteristics ¾ A case report. International Journal of Health Sciences, 10, 260–264.Google Scholar
Jodalli, P., Panchmal, G. S., Sonde, L., & Somaraj, V. (2016b). Village of twins: A mystery. Journal of Applied Dental and Medical Sciences, 2, 3–6.Google Scholar
Johnson, R. C., & Schoeni, R. F. (2011). The influence of early-life events on human capital, health status, and labor market outcomes over the life course. The B.E. Journal of Economic Analysis & Policy, 11, 2521. https://doi.org/10.2202/1935-1682.2521 CrossRefGoogle ScholarPubMed
Kim, B.-Y. (2016). Factors that influence early breastfeeding of singletons and twins in Korea: A retrospective study. International Breastfeeding Journal, 12, 4. https://doi.org/10.1186/s13006-016-0094-5 CrossRefGoogle ScholarPubMed
McGovern, T. (2014). The challenges of breastfeeding twins. Kai Tiaki: Nursing New Zealand, 20, 26.Google ScholarPubMed
Mehta, A. R., Panneer, S., Ghosh-Jerath, S., & Racine, E. F. (2017). Factors associated with extended breastfeeding in India. Journal of Human Lactation, 33, 140–148. https://doi.org/10.1177/0890334416680179 CrossRefGoogle ScholarPubMed
Mikami, F. C. F., Francisco, R. P. V., Rodrigues, A., Hernandez, W. R., Zugaib, M., & Brizot, M. L. (2018). Breastfeeding twins: Factors related to weaning. Journal of Human Lactation, 34. https://doi.org/10.1177/0890334418767382 CrossRefGoogle Scholar
Monden, C. W. S., & Smits, J. (2017). Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: A pooled analysis of data from 90 demographic and health surveys in 30 countries. The Lancet Global Health, 5, 673–679. https://doi.org/10.1016/S2214-109X(17)30197-3 CrossRefGoogle ScholarPubMed
NEOVITA Study Group. (2016). Timing of initiation, patterns of breastfeeding, and infant survival: Prospective analysis of pooled data from three randomised trials. The Lancet Global Health, 4, e266–e275. https://doi.org/10.1016/S2214-109X(16)00040-1 CrossRefGoogle Scholar
Nyqvist, K. H. (2002). Breast-feeding in preterm twins: Development of feeding behavior and milk intake during hospital stay and related caregiving practices. Journal of Pediatric Nursing, 17, 246–256. https://doi.org/10.1053/jpdn.2002.126716 CrossRefGoogle ScholarPubMed
Odei, J. A. (2013). Factors associated with exclusive breastfeeding of Ghanaian twins [Unpublished thesis]. https://catalog.ihsn.org/citations/21380 Google Scholar
Ooki, S. (2008). Breast-feeding rates and related maternal and infants’ obstetric factors in Japanese twins. Environmental Health and Preventive Medicine, 13, 187–197. https://doi.org/10.1007/s12199-008-0028-y CrossRefGoogle ScholarPubMed
Östlund, Å., Nordström, M., Dykes, F., & Flacking, R. (2010). Breastfeeding in preterm and term twins — Maternal factors associated with early cessation: A population-based study. Journal of Human Lactation, 26, 235–241. https://doi.org/10.1177/0890334409359627 CrossRefGoogle ScholarPubMed
Quitadamo, P. A., Comegna, L., Palumbo, G., Copetti, M., Lurdo, P., Zambianco, F., Gentile, M. A., & Villani, A. (2021). Feeding twins with human milk and factors associated with its duration: A qualitative and quantitative study in Southern Italy. Nutrients, 13, 3099. https://doi.org/10.3390/nu13093099 CrossRefGoogle ScholarPubMed
Reddy, N. S., Dharmaraj, A., Jacob, J., & Sindhu, K. N. (2023). Exclusive breastfeeding practices and its determinants in Indian infants: Findings from the National Family Health Surveys-4 and 5. International Breastfeeding Journal, 18, 69. https://doi.org/10.1186/s13006-023-00602-z CrossRefGoogle Scholar
Salih, N. M. (2016, October 26). Scientists to unravel mystery of high twinning rate in Kodinhi. Deccan Chronicle. https://www.deccanchronicle.com/lifestyle/viral-and-trending/261016/scientists-to-unravel-mystery-of-twinning.html Google Scholar
Sharma, K. (1997). The twinning rates and epidemiological characteristics of births in Southeast Uttar Pradesh, India. Acta Geneticae Medicae et Gemellologiae, 46, 47–56. https://doi.org/10.1017/S000156600000074X CrossRefGoogle ScholarPubMed
Singh, B. (2021). Kodinhi: Mysterious village where 200 pair of twins were born and even scientists don’t know why. https://www.indiatimes.com/trending/social-relevance/twin-village-kodinhi-550087.html Google Scholar
Tahiru, R., Agbozo, F., Garti, H., & Abubakari, A. (2020). Exclusive breastfeeding and associated factors among mothers with twins in the Tamale Metropolis. International Journal of Pediatrics, 2020, 5605437. https://doi.org/10.1155/2020/5605437 CrossRefGoogle ScholarPubMed
Terdal, P., & Prabhakar, J. S. C. (2021). Born twins: Fascinating fact of nature. Antrocom: Journal of Anthropology, 17, 157–164.Google Scholar
Torres, C., Caporali, A., & Pison, G. (2023). The human multiple births database (HMBD): An international database on twin and other multiple births. Demographic Research, 48, 89–106. https://doi.org/10.4054/DemRes.2023.48.4 CrossRefGoogle Scholar
Upreti, P. (2018). Twin pregnancies: Incidence and outcomes in a tertiary health centre of Uttarakhand, India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7, 3520. https://doi.org/10.18203/2320-1770.ijrcog20183375 CrossRefGoogle Scholar
Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387, 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7 CrossRefGoogle ScholarPubMed
Wang, S., Li, M., Xiang, X., Guo, X., Peng, C., Wang, D., & Chen, Y. (2023). Analysis on the current situation of twin breastfeeding and its influencing factors. Medicine, 102, e35161. https://doi.org/10.1097/MD.0000000000035161 CrossRefGoogle ScholarPubMed
Whitford, H. M., Wallis, S. K., Dowswell, T., West, H. M., & Renfrew, M. J. (2017). Breastfeeding education and support for women with twins or higher order multiples. Cochrane Database of Systematic Reviews, (2). https://doi.org/10.1002/14651858.CD012003.pub2 CrossRefGoogle Scholar
World Health Organization (WHO). (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding Google Scholar
Yokoyama, Y., & Ooki, S. (2004). Breast-feeding and bottle-feeding of twins, triplets and higher order multiple births. Nihon Koshu Eisei Zasshi (Japanese Journal of Public Health), 51, 969–974.Google ScholarPubMed
Yokoyama, Y., Wada, S., Sugimoto, M., Katayama, M., Saito, M., & Sono, J. (2006). Breastfeeding rates among singletons, twins and triplets in Japan: A population-based study. Twin Research and Human Genetics, 9, 298–302. https://doi.org/10.1375/183242706776382347 CrossRefGoogle ScholarPubMed
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