Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization.1 While the literature exploring breastfeeding beliefs and practices is growing, it offers various and sometimes conflicting explanations regarding women’s attitudes towards and experiences of breastfeeding. This research explores existing empirical literature regarding women’s perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices.
Methods: This paper uses a scoping review methodology developed by Arksey and O’Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of keywords. After removing duplicates, papers published in 2010–2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data.
Results: In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it difficult to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women’s decision to breastfeed.
Conclusion: While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. It is important to acknowledge that breastfeeding is associated with challenges and provide adequate supports for mothers so that their experiences can be improved, and breastfeeding rates can reach those identified by the World Health Organization.
Excerpts from the article
Women’s perceptions of breastfeeding were discussed in 83% (n = 49) of the articles. Most articles (n = 31) suggest that women perceive breastfeeding as a positive experience and believe that breastfeeding has several benefits. The phrases “breast is best” and “breast milk is best” were used frequently by participants in the studies included in the literature reviewed. Breastfeeding was seen to enhance the emotional bond between mother and child, strengthen the child’s immune system, and build the mother’s self-esteem. The convenience of breastfeeding (e.g., availability and low cost) and the role of breastfeeding in postpartum weight loss were mentioned in the literature as other factors that positively shape mothers’ perceptions of breastfeeding.
The literature suggests that women’s perceptions of breastfeeding and food choices are also influenced by the advice of health professionals. Paradoxically, messages about the importance and relative simplicity of breastfeeding may also contribute to a mismatch between women’s expectations and actual breastfeeding experiences. For example, studies published in Canada and Sweden found that women expected breastfeeding to be “natural”, easy and enjoyable. As a result, some women did not feel prepared for the challenges associated with initiating or continuing breastfeeding. The literature indicates that mothers may feel overwhelmed by the frequency of feedings and the amount of physical difficulty associated with initiating breastfeeding. Because women generally associate breastfeeding with being a good mother, researchers suggest that the inability to breastfeed may lead to a sense of personal failure.
Women’s personal experiences and perceptions of breastfeeding were also influenced by cultural pressure to breastfeed. Welsh mothers interviewed in the UK, for example, revealed that they faced judgment and disapproval when people around them found out that they had decided not to breastfeed/no longer to breastfeed. Women recalled being questioned by others, including strangers, when they bottle-fed their child.
Barriers to breastfeeding
The vast majority (n = 50) of studies in the literature identified several barriers to successful breastfeeding. A considerable proportion of the literature (41%, n = 24) explored women’s experiences with the physical aspects of breastfeeding. In particular, latching problems and pain associated with breastfeeding were often cited as barriers to initiating breastfeeding.
Insufficient milk production, whether real or perceived, was mentioned as another barrier to initiating and continuing breastfeeding. Breastfeeding mothers were sometimes unable to determine how much milk their child was consuming (as opposed to what they could see when the child was bottle-fed), making them anxious and uncertain about the timing of feedings. Some researchers suggest that women’s inability to overcome these challenges is linked to low confidence in their ability to breastfeed, as well as feelings of exhaustion or postpartum depression.
In addition to the personal and physical challenges faced by mothers who planned to breastfeed, the literature has also highlighted the importance of the social environment as a potential barrier to breastfeeding. Mothers’ personal networks were identified as a key factor in shaping their breastfeeding behaviors in 43 (73%) articles included in this review. In a study published in the United Kingdom, lack of role models – mothers, other female relatives and breastfeeding friends – was cited as a potential barrier to breastfeeding. Some family members and friends also actively discouraged breastfeeding, while questioning the benefits of breastfeeding compared to bottle feeding. Breastfeeding during family gatherings or in the presence of others was also reported as a challenge for some women from ethnic minority groups in the UK and for black women in the US.
The literature has reported occasional instances in which decisions related to breastfeeding have created conflict in women’s relationships with their family members and close friends. Some reported that they were pressured by them to stop breastfeeding, especially when women continued to breastfeed six months after delivery. Overall, the literature suggests that partners play a crucial role in women’s breastfeeding practices, although there was no consistency in the articles reviewed regarding the level of support shown by partners for breastfeeding.
Knowledge, particularly practical knowledge about breastfeeding, was cited as a barrier in 17% (n = 10) of the articles included in this review. While health professionals were seen as a primary source of breastfeeding information, some studies reported that mothers felt that the information provided was not helpful and sometimes contained conflicting advice. This finding was reported in various countries, including the United States, Sweden, the United Kingdom, and the Netherlands, where mothers reported that they had no support from their health care providers, making it difficult to resolve breastfeeding issues.
Breastfeeding in public spaces emerged as a key barrier in the literature reviewed and was cited in 56% (n = 33) of the articles. In examining the experiences of breastfeeding mothers in the United States, Spencer, Wambach, & Domain suggested that some participants reported feeling left out of conversations when breastfeeding in public space, making them symbolically invisible. The lack of breastfeeding-friendly public spaces forced many women to change the way they fed their babies in public, withdrawing to a private or more secluded space, such as their personal car. The sexualization of women’s breasts has been repeatedly noted as the primary reason for American women’s negative experiences and feelings of embarrassment about breastfeeding in front of others. Studies have reported that women have felt disapproval or disgust from others when breastfeeding in public, and some have reported that women have chosen not to breastfeed in public because they did not want to make those around them uncomfortable.
Finally, returning to paid employment was mentioned in the literature as a significant challenge to continued breastfeeding. Lack of support in work environments or inability to express milk were cited by women as barriers to continued breastfeeding in the United States and New Zealand.
Authors :Bridget Beggs*, Liza Koshy and Elena Neiterman
Source : Beggs et al. BMC Public Health (2021) 21:2169 https://doi.org/10.1186/s12889-021-12216-3
- WHO recommends exclusive breastfeeding for 6 months and continued breastfeeding for 2 years or more, with appropriate complementary foods. Infant and young child feeding (IYCF) 2002.
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