To mark World Breastfeeding Week, we invited Professor Julie Jomeen, Dean of the Faculty of Health and Social Care at the University of Hull, to select a few of the most important papers on breastfeeding published recently in JAN.
Promotion of breastfeeding (BF) is a public health priority at an international level, yet many countries fail to enhance sustained BF rates and reach the WHO target of exclusive breastfeeding for six months. Many factors are acknowledged to influence intention, initiation and continued BF. In recognition of World Breastfeeding Week and, in the US, National Breastfeeding Month, I have selected five papers to discuss in this blog, published in JAN since 2013 that explore factors that might be influential to BF outcomes.
Artieta-Pinedo et al (2013) explore the association between attendance at antenatal education sessions and BF across the first postnatal year. The study was undertaken in Spain, where antenatal education is free to all women. Using a prospective observational design, 614 women were classified into 3 groups according to the level of education sessions received (0; 1-4; >5); telephone interviews assessed risk of cessation up to 12 months. Despite a 90% initiation rate across groups, by one month there was a dose response relationship between BF and level of attendance. However, there were no statistically significant differences between groups at 6 or 12 months. The authors suggest BF continuation for the first postnatal month was linked to greater awareness of physical changes and BF problems, gained through the antenatal education sessions. Sustained rates were less influenced, but the authors suggest may still be related to modifiable antecedents.
Wu et al (2014) explore BF self-efficacy as one such potential variable and sought to examine the effect of a self-efficacy intervention in Chinese mothers. In a pre-post test two group design, participants in the intervention group showed significantly greater increases in both BF exclusivity and duration than those in the control group. This study is limited by a small sample and that findings relate to short rather than long term outcomes, although results are promising enough to warrant further investigation. This paper successfully highlights that understanding the role of psychological aspects on BF initiation and duration as important to improving rates and supporting new mothers.
Brown (2014) sought to explore associations between BF duration and maternal personality; attitudes and experiences. Personality has been shown to be associated with characteristics such as self-efficacy as well as confidence and locus of control. Using a cross sectional survey design, 602 mothers with infants of 6-12 months competed self-report measures for all variables. Women with high levels of conscientiousness were more likely to initiate BF, with extroversion and emotional stability both significantly associated with both initiation and longer duration of BF. These women were generally more confident in BF. Women who were more introverted were more likely to stop BF due to embarrassment and feeling pressured to stop. Mothers who were more anxious reported greater difficulty and lack of support. Lower conscientiousness was associated with greater body image concerns and pain. The author suggest that self-efficacy interventions may play a role in supporting women with introverted and anxious personality types, as well as interventions to increase maternal support.
Understanding potential modifiable factors that may be of importance in supporting BF initiation and continuation is useful, yet other influential factors have also been identified. Brown and Jordan (2013) explored the role of birth complications in BF cessation. In an exploratory cross-sectional design using an online survey the researchers found that women who experienced birth complications had shorter BF duration. Specifically, caesarean birth, foetal distress, failure to progress and postpartum haemorrhage were significant, due to associated pain and physical difficulties. Whilst these exploratory findings are limited by data collection methods and sample size, they raise interesting questions about targeted BF support for ‘at risk’ women. Whilst the causality here appears to be related to physical consequences, the authors suggest a potential link between physical complications and the psychological effects of birth complications on BF consequences, which may exacerbate low BF rates.
The recent paper by Spencer et al (2015) presents fascinating qualitative findings, which may illuminate the mismatch between BF initiation and continuation rates that international statistics and academic literature continue to demonstrate. The overarching theme that emerged from the data was ‘illusion of compliance’. Women described pressure to initiate BF to comply with ‘good mother’ discourse and conform to the moral obligation to BF, hiding the difficulties they encountered to avoid being labelled ‘a failure’. Successful BF to women did not mean exclusive BF; differing constructions of meaning led to women turning away from healthcare professionals. This paper raises important questions for healthcare professionals about their content and approach to providing interventions for women in support of BF.
Together these papers and many others published in JAN and elsewhere remind us that what would seem a simple and natural health behaviour may not be in our increasingly complex world. However, and despite challenges to achievement, international goals for BF or, at the least, breast milk provision to the world's children are important and worth the support of all who advocate for a healthier world.
Isabel Artieta-Pinedo, Carmen Paz-Pascual, Gonzalo Grandes, Amaia Bacigalupe and Janire Payo
Maternal trait personality and breastfeeding duration: the importance of confidence and social support
Amy Brown and Sue Jordan
‘I thought it would keep them all quiet’. Women's experiences of breastfeeding as illusions of compliance: an interpretive phenomenological study
Rachael L. Spencer, Sheila Greatrex-White and Diane M. Fraser
The effects of a breastfeeding self-efficacy intervention on short-term breastfeeding outcomes among primiparous mothers in Wuhan, China
Di Shi Wu, Jie Hu, Thomas P. McCoy and Jimmy T. Efird