Soziale Ungleichheit beim Stillen in Deutschland

Stand der empirischen Forschung und Handlungsempfehlungen

Breastfeeding: socio-economic differences in Germany

State of empirical analyses and recommendations

Zusammenfassung

Hintergrund

Der Zusammenhang zwischen dem sozioökonomischen Status (SES) der Mutter einerseits und dem Stillen andererseits wurde bereits in mehreren empirischen Studien beschrieben, meist jedoch nur am Rande. Eine deutschsprachige Veröffentlichung speziell zum Thema „Stillen und SES“ liegt unseres Wissens bisher noch nicht vor. Es fehlt auch ein Überblick über die bereits verfügbaren empirischen Informationen zu diesem Thema. Dies hat dazu geführt, dass bis heute kaum über das Thema „soziale Ungleichheit beim Stillen“ diskutiert wird. Die hier vorgestellte Arbeit soll eine Antwort auf die Frage geben, in welchen sozialen Statusgruppen ein besonders großer Bedarf an Maßnahmen zur Förderung des Stillens vorhanden ist, und welche Handlungsempfehlungen sich daraus ableiten lassen.

Methoden

Der Überblick basiert auf einem systematischen Review epidemiologischer Studien, in denen (meist im Rahmen anderer Fragestellungen) Daten zum Stillen und/oder zur Stilldauer sowie zum SES erhoben wurden. Hauptquelle war dabei die elektronische Datenbank „Medline“.

Ergebnisse

Insgesamt wurden 15 Publikationen aus Deutschland gefunden, die eine Aussage über den Zusammenhang zwischen Stillen und SES beinhalten. In einer Studie wurde kein klarer Zusammenhang gefunden, sie weist allerdings eine sehr kleine Fallzahl auf. Die anderen 14 Studien ergeben dagegen ein deutliches Bild: Mütter mit einem höheren sozialen Status (zumeist definiert über den Bildungsabschluss) stillen häufiger und länger als Mütter mit einem niedrigen sozialen Status. In 8 weiteren Untersuchungen wurden zwar Daten zu Stillen und SES erhoben, jedoch nicht miteinander in Beziehung gesetzt.

Schlussfolgerung

In der Diskussion über das Stillen wird immer wieder betont, dass Muttermilch die beste Form der Ernährung für Säuglinge bis zu einem Alter von mindestens 6 Monaten sei. In Deutschland ist beim Stillen (nach einem deutlichen Tiefstand in den 1970er Jahren) in letzter Zeit wieder eine „Renaissance“ zu beobachten, aber offenbar ist eine intensivere Stillförderung besonders bei den unteren Statusgruppen erforderlich. Als Ansatz zur Erklärung dieser statusspezifischen Unterschiede beim Verbreitungsgrad gesundheitsrelevanten Verhaltens bietet sich das Modell „diffusion of innovations“ an.

Abstract

Background

In Germany, the association between breastfeeding behaviour (BF) and socio-economic status (SES) has not been studied in detail. However, ancillary reports from epidemiological research pursuing different objectives provide some information.

Methods

This systematic review, based on the search engine ‘MEDLINE’, summarizes the available information regarding initiation and duration of breastfeeding in the upper and lower social groups in Germany. Recommendations to enhance breastfeeding behaviour are presented.

Results

Fifteen studies with relevant information were identified. The paper with the smallest number of cases did not detect any differences between social groups, but all other studies reported a clear association of BF and SES, with mothers of the lower social groups breastfeeding significantly less frequently. Eight other study groups collected data on BF and SES but did not link them together.

Conclusion

Breast milk is known to be the very best nutrition for infants up to the age of 6 months. Despite a renaissance of breastfeeding after 1970, BF must still be encouraged in Germany, especially in women with lower SES. The concept of ‘diffusion of innovations’ by EM Rogers provides some explanation of these differences between socio-economic groups.

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Literatur

  1. 1.

    Abou-Dakn MSM, Strecker JR (2003) Does breast-feeding prevent breast cancer? Zentralbl Gynakol 125: 48–52

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Afzal M, Quddusi AI, Iqbal M, Sultan M (2006) Breast feeding patterns in a military hospital. J Coll Physicians Surg Pak 16: 128–131

    PubMed  Google Scholar 

  3. 3.

    Bergmann RL, Edenharter G, Bergmann KE et al. (2000) Socioeconomic status is a risk factor for allergy in parents but not in their children. Clin Exp Allergy 30: 1740–1745

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Chang-Claude J, Eby N, Kiechle M et al. (2000) Breastfeeding and breast cancer risk by age 50 among women in Germany. Cancer Causes Control 11: 687–695

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Dulon M, Kersting M, Bender R (2003) Breastfeeding promotion in non-UNICEF-certified hospitals and long-term breastfeeding success in Germany. Acta Paediatr 92: 653–658

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Dulon M, Kersting M, Schach S (2001) Duration of breastfeeding and associated factors in Western and Eastern Germany. Acta Paediatr 90: 931–935

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Flacking R, Hedberg Nyqvist K, Ewald U (2007) Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health

  8. 8.

    Friedman NJ, Zeiger RS (2005) The role of breast-feeding in the development of allergies and asthma. J Allergy Clin Immunol 115: 1238–1248

    PubMed  Article  Google Scholar 

  9. 9.

    Garbe U, Martin K (1983) Breast-feeding in the clinic and following discharge. Fortschr Med 101: 2133–2136

    PubMed  CAS  Google Scholar 

  10. 10.

    Gatrell CJ (2007) Secrets and lies: breastfeeding and professional paid work. Soc Sci Med 65: 393–404

    PubMed  Article  Google Scholar 

  11. 11.

    Gerstner GJ, Leodolter S, Matznetter T (1982) Breast-feeding in industrialized and agricultural countries. Clin Exp Obstet Gynecol 9: 193–198

    PubMed  CAS  Google Scholar 

  12. 12.

    Giashuddin MS, Kabir M (2004) Duration of breast-feeding in Bangladesh. Indian J Med Res 119: 267–272

    PubMed  CAS  Google Scholar 

  13. 13.

    Grjibovski AM, Yngve A, Bygren LO, Sjostrom M (2005) Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia. Acta Paediatr 94: 588–594

    PubMed  Article  Google Scholar 

  14. 14.

    Guttman N, Zimmerman DR (2000) Low-income mothers‘ views on breastfeeding. Soc Sci Med 50: 1457–1473

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Helmert U, Lang P, Cuelenaere B (1998) Smoking behavior of pregnant patients and mothers with young children. Soz Praventivmed 43: 51–58

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Kalies H, Heinrich J, Borte N et al. (2005) The effect of breastfeeding on weight gain in infants: results of a birth cohort study. Eur J Med Res 10: 36–42

    PubMed  CAS  Google Scholar 

  17. 17.

    Karmaus W, DeKoning EP, Kruse H et al. (2001) Early childhood determinants of organochlorine concentrations in school-aged children. Pediatr Res 50: 331–336

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Kelly YJ, Watt RG (2005) Breast-feeding initiation and exclusive duration at 6 months by social class – results from the Millennium Cohort Study. Public Health Nutr 8: 417–421

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Kersting M, Dulon M (2002) Fakten zum Stillen in Deutschland. Ergebnisse der SuSe-Studie. Monatsschr Kinderheilkd 150: 1196–1201

    Article  Google Scholar 

  20. 20.

    Kersting M, Wember T, Goddemeier T et al. (1987) Breast feeding studies 1981–1983 in 1,500 mothers in Dortmund and Haltern. III. Rates of breast feeding and duration of breast feeding in the first half year. Monatsschr Kinderheilkd 135: 314–319

    PubMed  CAS  Google Scholar 

  21. 21.

    Kools EJ, Thijs C, Kester AD, de Vries H (2006) The motivational determinants of breast-feeding: predictors for the continuation of breast-feeding. Prev Med 43: 394–401

    PubMed  Article  Google Scholar 

  22. 22.

    Lampert T, Thamm M (2004) Social inequality and smoking behavior in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 47: 1033–1042

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Lange C, Schenk L, Bergmann R (2007) Distribution, duration and temporal trend of breastfeeding in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50: 624–633

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Langnäse K, Mast M, Danielzik S et al. (2003) Socioeconomic gradients in body weight of German children reverse direction between the ages of 2 and 6 years. J Nutr 133: 789–796

    PubMed  Google Scholar 

  25. 25.

    Laubereau B, Brockow I, Zirngibl A et al. (2004) Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life – results from the GINI-birth cohort study. J Pediatr 144: 602–607

    PubMed  Article  Google Scholar 

  26. 26.

    Leung GM, Ho LM, Lam TH (2002) Breastfeeding rates in Hong Kong: a comparison of the 1987 and 1997 birth cohorts. Birth 29: 162–168

    PubMed  Article  Google Scholar 

  27. 27.

    Li R, Darling N, Maurice E et al. (2005) Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey. Pediatrics 115: e31–37

    PubMed  Article  Google Scholar 

  28. 28.

    Liese AD, Hirsch T, von Mutius E et al. (2001) Inverse association of overweight and breast feeding in 9 to 10-y-old children in Germany. Int J Obes Relat Metab Disord 25: 1644–1650

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Link B, Gabrio T, Zollner I et al. (2007) Sentinel health department project in Baden-Wuerttemberg (Germany) – a useful tool for monitoring children’s health and environment. Int J Hyg Environ Health 210: 351–355

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Lluch Fernandez C, Rodriguez Torronteras A, Casitas Munoz V et al. (1996) Influence of health centers and social class in the prevalence of breast feeding. Aten Primaria 18: 253–256

    Google Scholar 

  31. 31.

    Mielck A (2005) Soziale Ungleicheit und Gesundheit: Einführung in die aktuelle Diskussion, 1. Aufl. Huber, Bern Göttingen

  32. 32.

    Montgomery SM, Ehlin A, Sacker A (2006) Breast feeding and resilience against psychosocial stress. Arch Dis Child 91: 990–994

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Newburg DS, Ruiz-Palacios GM, Morrow AL (2005) Human milk glycans protect infants against enteric pathogens. Ann Rev Nutr 25: 37–58

    Article  CAS  Google Scholar 

  34. 34.

    Owen CG, Martin RM, Whincup PH et al. (2005) The effect of breastfeeding on mean body mass index throughout life: a quantitative review of published and unpublished observational evidence. Am J Clin Nutr 82: 1298–1307

    PubMed  CAS  Google Scholar 

  35. 35.

    Owen CG, Martin RM, Whincup PH et al. (2006) Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. Am J Clin Nutr 84: 1043–1054

    PubMed  CAS  Google Scholar 

  36. 36.

    Papadimitriou G, Kotzaeridou U, Mouratidis C et al. (2005) Rates and social patterning of household smoking and breastfeeding in contrasting European settings. Child Care Health Dev 31: 603–610

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Perez-Escamilla R, Cobas JA, Balcazar H, Holland Benin M (1999) Specifying the antecedents of breast-feeding duration in Peru through a structural equation model. Public Health Nutr 2: 461–467

    PubMed  CAS  Google Scholar 

  38. 38.

    Perez-Escamilla R, Lutter C, Segall AM et al. (1995) Exclusive breast-feeding duration is associated with attitudinal, socioeconomic and biocultural determinants in three Latin American countries. J Nutr 125: 2972–2984

    PubMed  CAS  Google Scholar 

  39. 39.

    Peters E, Wehkamp KH, Felberbaum RE et al. (2006) Breastfeeding duration is determined by only a few factors. Eur J Public Health 16: 162–167

    PubMed  Article  Google Scholar 

  40. 40.

    Plesse R, Krohmann S, Heinze M (1981) Readiness for breast-feeding – A psychosocial problem (author’s transl). Zentralbl Gynakol 103: 810–817

    PubMed  CAS  Google Scholar 

  41. 41.

    Rapp K, Schick KH, Bode H, Weiland SK (2005) Type of kindergarten and other potential determinants of overweight in pre-school children. Public Health Nutr 8: 642–649

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Riva E, Banderali G, Agostoni C et al. (1999) Factors associated with initiation and duration of breastfeeding in Italy. Acta Paediatr 88: 411–415

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Rogers E (2003) Diffusion of innovations, 5. Aufl. The Free Press, New York London

  44. 44.

    Rogers IS, Emmett PM, Golding J (1997) The incidence and duration of breast feeding. Early Hum Dev 49(Suppl): 45–74

    Article  Google Scholar 

  45. 45.

    Rothenbacher D, Bode G, Brenner H (2002) History of breastfeeding and Helicobacter pylori infection in pre-school children: results of a population-based study from Germany. Int J Epidemiol 31: 632–637

    PubMed  Article  Google Scholar 

  46. 46.

    Rothenbacher D, Weyermann M, Beermann C, Brenner H (2005) Breastfeeding, soluble CD14 concentration in breast milk and risk of atopic dermatitis and asthma in early childhood: birth cohort study. Clin Exp Allergy 35: 1014–1021

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Saha P (2002) Breastfeeding and sexuality: professional advice literature from the 1970 s to the present. Health Educ Behav 29: 61–72

    PubMed  Article  Google Scholar 

  48. 48.

    Schellscheidt J, Ott A, Jorch G (1997) Epidemiological features of sudden infant death after a German intervention campaign in 1992. Eur J Pediatr 156: 655–660

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Schoetzau A, Filipiak-Pittroff B, Franke K et al. (2002) Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age. Pediatr Allergy Immunol 13: 234–242

    PubMed  Article  Google Scholar 

  50. 50.

    Scott JA, Aitkin I, Binns CW, Aroni RA (1999) Factors associated with the duration of breastfeeding amongst women in Perth, Australia. Acta Paediatr 88: 416–421

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Seibt AC, Deneke C, Heinze F et al. (2004) Stillfreundlichere Bedingungen – Handlungsempfehlungen für sozial benachteiligte Mütter und Väter. In: Geene R, Halkow A (Hrsg) Armut und Gesundheit – Strategien der Gesundheitsförderung. Marbuse, Frankfurt, S 115–124

  52. 52.

    Toschke AM, Beyerlein A, von Kries R (2005) Children at high risk for overweight: a classification and regression trees analysis approach. Obes Res 13: 1270–1274

    PubMed  Article  Google Scholar 

  53. 53.

    Vennemann MM, Findeisen M, Butterfass-Bahloul T et al. (2005) Modifiable risk factors for SIDS in Germany: results of GeSID. Acta Paediatr 94: 655–660

    PubMed  Article  Google Scholar 

  54. 54.

    von Kries R, Koletzko B, Sauerwald T et al. (1999) Breast feeding and obesity: cross sectional study. BMJ 319: 147–150

    Google Scholar 

  55. 55.

    Weyermann M, Rothenbacher D, Brenner H (2006) Duration of breastfeeding and risk of overweight in childhood: a prospective birth cohort study from Germany. Int J Obes (Lond) 30: 1281–1287

    Google Scholar 

  56. 56.

    WHO (2007) The WHO Global Data Bank on Breastfeeding and Complementary Feeding. http://www.who.int/research/iycf/bfcf/bfcf.asp?menu=10, Stand Juli 2007

  57. 57.

    Wurmser H, Laubereau B, Hermann M et al. (2001) Excessive infant crying: often not confined to the first 3 months of age. Early Hum Dev 64: 1–6

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Yadava KN, Jain SK, Kumar A (1999) Breastfeeding in rural northern India: levels and differentials. Warasan Prachakon Lae Sangkhom 8: 107–141

    PubMed  CAS  Google Scholar 

  59. 59.

    Zhou SJ, Baghurst P, Gibson RA, Makrides M (2007) Home environment, not duration of breast-feeding, predicts intelligence quotient of children at four years. Nutrition 23: 236–241

    PubMed  Article  Google Scholar 

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Correspondence to Dipl.-Soz. Dr. phil. A. Mielck.

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Rückert, IM., Mielck, A. Soziale Ungleichheit beim Stillen in Deutschland. Präv Gesundheitsf 3, 56–66 (2008). https://doi.org/10.1007/s11553-007-0088-7

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Schlüsselwörter

  • Stillen
  • Sozioökonomischer Status
  • Deutschland
  • Diffusion of innovations
  • Systematischer Review

Keywords

  • Breastfeeding
  • Socio-economic status
  • Germany
  • Diffusion of innovations
  • Systematic review