Typologies of postnatal support and breastfeeding at two months in the UK: Research participant commentary

The differential role of practical and emotional support in infant feeding experience in the UK

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Typologies of postnatal support and breastfeeding at two months in the UK: Response to comments by Harpur & Haddon

We welcome the comments by Harpur and Haddon (2020) on our paper on the typologies of social support and its associations with breastfeeding at two months in a UK sample. We share their concerns around the under-acknowledged costs of breastfeeding, and the need for a truly family-centred approach to breastfeeding support. However, they are mistaken to assume we do not view breastfeeding problems as an important cost of breastfeeding: We explicitly comment on breastfeeding challenges within our paper, and such challenges are theoretically incorporated into the "costs of breastfeeding" following an evolutionary anthropological framework. They are also incorrect in their statement that we recommend breastfeeding promotion messages to wider family members. In fact, we outline in our manuscript that breastfeeding promotional messages can have negative consequences for mothers, and are unlikely to be supportive. What we do suggest is a family-centred approach that recognises that women interact with, and may be supported by, a wide range of individuals (including fathers and grandmothers); and the importance of taking a nuanced approach to support without assuming that all types of support necessarily leads to "more breastfeeding." We hope our response is useful in clarifying the key points of our paper.