The ones that got away: when breastfeeding mothers wean their infants despite our efforts

Reasons for Stopping Exclusive Breastfeeding Between Three and Six Months: A Qualitative Study

PURPOSE

Scant published qualitative literature exists focusing on why exclusive breastfeeding rates decline between three and six months. This study aims to develop an understanding of why exclusive breastfeeding tails off so dramatically between three and six months after birth in New Zealand.

DESIGN AND METHODS

A generic qualitative methodology was employed in this study and social constructionism selected as the main epistemological framework underpinning the research. This study was carried out between September 2013 and July 2014, involving face-to-face interviews with 30 women who were characterised as highly motivated to complete six months exclusive breastfeeding prior to the birth of their child. In order to gain an in-depth understanding of the research material, thematic analysis of the interview transcripts was completed using manual coding techniques.

RESULTS

After thematic analysis of the data four key themes were identified: 1) The good employee/good mother dilemma. 2) Breastfeeding is lovely, but six months exclusively is demanding. 3) Exclusive breastfeeding recommendations should be individualised. 4) Introducing solids early as a cultural practice.

CONCLUSIONS

Most studies have linked barriers to six months exclusive breastfeeding to difficulties within the mother-infant dyad, as well as negative maternal socioeconomic and socio-demographic characteristics. However, this study has shown that the maintenance of six months exclusive breastfeeding is also challenging for this group of mothers who were socially advantaged, well-educated and highly motivated to breastfeed their babies exclusively for six months.

Resistance to breastfeeding: A Foucauldian analysis of breastfeeding support from health professionals

BACKGROUND

Despite widespread consensus regarding the health benefits of breastfeeding, the prevalence of six months exclusive breastfeeding is very low in developed countries including New Zealand.

AIM

This paper aims to evaluate the role that health professionals play in promoting exclusive breastfeeding in New Zealand.

METHODS

Qualitative research involving face to face postpartum interviews conducted four to six weeks after the birth with 30 new mothers who lived in New Zealand and had identified in a short antenatal questionnaire that they intended to practice exclusive breastfeeding for six months. Themes related to exclusive breastfeeding support from health professionals were extracted from the interview transcripts and interpreted using Foucault's ideas about governmentality and bio-power.

RESULTS

Four themes related to the quality of health care support were identified in the interview transcripts. 'Breastfeeding self-efficacy support from the community midwives', 'mothers need to know more about breastfeeding during pregnancy', 'experiencing difficulties breastfeeding' as well as 'pressure and resistance to breastfeeding'.

DISCUSSION

Most mothers in this research spoke about feeling pressured to breastfeed within the New Zealand health system. However, the participating mothers acknowledged the effective support that they had received from community midwives who respected their autonomy, strengthened their self-esteem and encouraged them to breastfeed.

CONCLUSION

Negative historical experiences related to the medicalization of infant feeding in Western countries suggests that health professionals need to provide effective skill support for breastfeeding mothers so that mothers do not consider it a form of "quiet coercion" or as an exercise of "power".

Relationship between level of education and breastfeeding duration depends on social context: breastfeeding trends over a 40-year period in Spain

This article presents trends of breastfeeding in Spain from the 1960s to the end of the century, analyzing the relationship between level of education and breastfeeding duration. A sample of 666 adult women provided data about breastfeeding practices for children born between 1958 and 2002. Joinpoint regression models for breastfeeding duration for the firstborn child throughout these years show a U-shaped curve, with a sharp decrease at the beginning of the 1970s (-17.2%) and a gradual increase toward the end of the century (1.9%). However, the trend for women with primary studies shows a constant decrease throughout the whole period (-7.4%), while higher education levels relate to a positive trend from the 1970s onward (3.4%). The authors conclude that in the Spanish context, maternal level of education is not associated with breastfeeding duration in the same direction or with the same magnitude across time. Factors related to breastfeeding should be studied, taking into account social context.

Caregiver- vs infant-oriented feeding: a model of infant-feeding strategies among special supplemental nutrition program for women, infants, and children participants in rural east Tennessee

The aim of this project was to collect data from focus-group participants to inform the future development of region-specific educational strategies to modify infant-feeding practices that may predispose children to obesity. Infant-feeding perceptions and practices were collected from participants of the Special Supplemental Nutrition Program for Women, Infants, and Children, through recorded focus groups, in two East Tennessee counties. Focus groups replaced the participants' required, prescheduled nutrition-education classes for participants with infants younger than 6 months of age. Twenty-nine focus groups were convened and recorded, reaching a total of 109 participants. Results of this series of focus groups indicate that the Special Supplemental Nutrition Program for Women, Infants, and Children population in rural East Tennessee was similar to populations elsewhere in terms of early solid-food introduction, frequent switching of formula, and sources of and valuation of infant-feeding advice. However, this population seemed to be different in the magnitude at which they introduce infant cereal early (primarily as an addition to the bottle). For this reason, interventions designed to reduce inappropriate infant-feeding behaviors in this population should focus on early introduction of solid food (especially infant cereal) first. In addition to these findings, a model of infant-feeding strategy development based on caregiver-orientation (framed within parenting styles) is presented and discussed.

Are US mothers meeting the Healthy People 2010 breastfeeding targets for initiation, duration, and exclusivity? The 2003 and 2004 National Immunization Surveys

Using data from the National Immunization Surveys (2003 and 2004), the authors model the influence of child, maternal, and state- or metropolitan-level factors on the initiation, duration, and exclusivity of breastfeeding to determine the characteristics of groups meeting the Healthy People 2010 targets. Analyses indicate that only children of college graduates meet the targets for breastfeeding at initiation, 6 months, and 12 months; no groups meet the target for exclusive breastfeeding. Results indicate a low prevalence of breastfeeding among children of single mothers, less educated mothers, participants in the Women, Children, and Infants program, and those living in nonwestern states and in areas of high newborn risk. Hispanic children, children of college graduates, and children living in the West consistently have higher odds of breastfeeding. Only the prevalence of breastfeeding early postpartum is near the Healthy People 2010 target of 75%, the percentages for 6 or 12 months and exclusive breastfeeding are well below.