What Are Some Factors That Would Influence a New Mother to Breast Feed
Open access peer-reviewed affiliate
Factors Influencing Maternal Decision-making on Infant Feeding Practices
Submitted: October 15th, 2019 Reviewed: January 23rd, 2020 Published: June 1st, 2020
DOI: 10.5772/intechopen.91325
From the Edited Volume
Babe Feeding
Edited by Isam Jaber Al-Zwaini, Zaid Rasheed Al-Ani and Walter Hurley
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Abstract
The decision to formula feed or breastfeed a child typically begins with an established prenatal intention. This chapter will examine the multiple dimensions influencing maternal determination-making in regards to the feeding practices of infants including i) individual maternal characteristics, 2) organizational factors, 3) hospital/provider recommendations, and 4) systematic/policy factors. The affiliate will also examine the affect of babe feeding practices on early on babe and childhood health outcomes. Research has demonstrated the benefits of breastfeeding on infants and early on babyhood which includes but is not limited to protection against common illnesses and infections, improved IQ , and even increased schoolhouse attendance. Moreover, the Earth Wellness Assembly global nutrition objectives focus on encouraging breastfeeding support beyond all sectors in add-on to implementing tailored customs-based approaches, limiting the excessive marketing of infant formula, and enforcing supportive breastfeeding legislation. The aim of this chapter is to provide an overview of the dynamic interplay betwixt private, interpersonal, community, and societal factors, such as policies that impact breastfeeding rates and more than specifically the health of infants.
Keywords
- babe feeding
- breastfeeding
- wellness outcomes
*Address all correspondence to: whitney.hamilton@mga.edu
1. Introduction
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The World Wellness Organization recommends mothers exclusively breastfeed their children for the first 6 months of life and thereafter, supplement nutritious foods and breastmilk for up to 2 years and beyond in order for children and mothers to reap the optimal health benefits associated with breastfeeding.
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Despite the known health and economic benefits of breastfeeding, global breastfeeding prevalence remains an underachieved target, where less than xl% of infants are globally breastfed co-ordinate to the WHO'due south recommendations [1].
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The World Health Assembly (WHA) has a goal of increasing the prevalence of exclusive breastfeeding to at to the lowest degree 50% past the year 2025 [1].
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In lodge to increase global breastfeeding prevalence agreement and addressing the private maternal characteristics, customs, organizational, and political factors affecting breastfeeding practices is crucial.
Breastfeeding is a child's first barrier confronting expiry and illness, providing protection against respiratory infection, gastrointestinal illness, and other adverse health outcomes [i, 2, 3]. Breastfeeding has likewise been associated with increased IQ , school attendance, as well as higher income in adult life [2, 3] The World Health Organization recommends infants exclusively receive breastmilk for the start vi months of life and consume nutritionally acceptable foods in improver to breastmilk for 2 years and beyond in order for children and mothers to reap the optimal health benefits associated with breastfeeding [1]. Well-nigh 1 one thousand thousand deaths of children under the historic period of five worldwide could be averted through breastfeeding lonely, if families adhered to the Globe Wellness Organization'south breastfeeding recommendation [two]. Improving maternal compliance to optimal breastfeeding recommendations can too reduce a mother'southward take a chance of ovarian cancer, center disease, and diabetes and prevent approximately twenty,000 maternal deaths from breast cancer alone. Breastfeeding also delays the return of the menstrual bicycle which can assist with birth spacing. Global adherence to optimal breastfeeding practices tin can pb to an array of wellness benefits coupled with economic benefits contributing to a worldwide economic savings of 300 billion U.S. dollars [1, 2].
Despite the recognized benefits of breastfeeding, simply 38% of infants worldwide are exclusively breastfed for half dozen months [4]. The maternal decision on infant feeding practices begins with an established prenatal intention to breast or formula feed. Macro-level factors such as media broadcasting, babe formula marketing, and breastfeeding legislation interact with the micro-level factors which include hospitals, workplaces, and cultural norms that are supportive or discouraging to a woman'south intent to breastfeed [6]. The prevalence of breastfeeding remains variable around the world due to the lack of necessary support for a mother to sustain breastfeeding [7]. Economic pressures, societal factors, and the lack of positive media coverage on breastfeeding has resulted in a cultural shift that does not fully support breastfeeding and are cited reasons for reduced breastfeeding rates globally [8]. The excessive marketing, support of, and reliance on infant formula has created a new civilisation and standard for babe feeding practices [8].
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2. Breastfeeding prevalence
As aforementioned, the overall charge per unit of exclusive breastfeeding for infants under 6 months of age is slightly less than 40% despite the known benefits of breastfeeding [4]. Notwithstanding, the least developed countries have experienced the greatest improvement in exclusive breastfeeding rates, where exclusive breastfeeding prevalence at half-dozen months increased from 38% in 2000 to 50% in 2012 [9]. In such developing countries a bulk of infants are too nevertheless breastfeeding at 1 year in contrast to the judge twenty% in developed countries and the less than i% nonetheless breastfeeding in the U.k. [iii, 4]. According to the Earth Health System, only 23 countries have achieved at least threescore% of infants less than 6 months being exclusively breastfed and nearly 40% of countries have breastfeeding initiation rates above eighty%. In Africa, approximately 70% of countries take extended duration rates of continued breastfeeding for at least ane twelvemonth. In contrast, simply iv countries in the Americas accept reached such high rates of breastfeeding duration at 1 year. The duration of breastfeeding for 2 years dramatically drops to 45% and no land in the Americas experiences a continued breastfeeding elapsing of 2 years [4].
The high initiation charge per unit and reduced duration rate suggest many mothers intend to breastfeed but may face barriers to continue breastfeeding. The almost commonly cited breastfeeding barriers as indicated in research include misinformation regarding the specific benefits of breastfeeding, social norms, lack of spousal and family unit back up, child-birth complications, maternal employment, and lack of healthcare provider breastfeeding recommendations [10].
| Sectional breastfeeding | The practice of giving an infant only breastmilk for the first 6 months of life (no additional nutrient or water) [1]. |
| Optimal breastfeeding | Exclusively breastfeeding an babe for the offset vi months of life followed past continued breastfeeding supplementary to nutritious nutrient for 2 years of age and beyond [1]. |
Table 1.
Key breastfeeding terminology.
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three. Determinants of breastfeeding in developing and developed countries
Unique factors exist in developing and developed countries that influence breastfeeding behaviors. Enquiry illustrates child and maternal morbidities such equally infant colic and maternal infection are disquisitional factors influencing breastfeeding in developing countries in dissimilarity to developed countries. In developing countries, mothers who feel chest infections, swelling, pain, and/or chronic conditions or had infants with congenital or acquired disease were less likely to breastfeed [12, 13]. Ecology factors besides take a great influence on breastfeeding in developing countries due to the limited availability of electricity to refrigerate breastmilk and the fear of contagion due to unsanitary feeding environments prevalent in some underdeveloped areas [12, 13]. Unlike developing countries that face major challenges associated directly with maternal and child health, major influences of breastfeeding practices in adult countries stem from health systems, political, and societal factors. However, in both developing and developed countries in that location is an interaction between individual maternal characteristics, interpersonal, community, and societal factors, such as policies and legislation that impact a mother'southward conclusion to offset and go on breastfeeding [12, thirteen]. It may be difficult for mothers to sustain breastfeeding even after initiating due to sociodemographic, social-cultural, and systematic factors that are not supportive of breastfeeding practices (see Figure 1 below).
Effigy one.
Social determinants of breastfeeding.
three.i Maternal characteristics
Correlates of breastfeeding initiation and elapsing as indicated in research include maternal marital status, vaginal delivery, previous live nascency, multiple live nativity (plurality), smoking and drinking habits, prenatal care within the first trimester, chat with a healthcare provider nigh breastfeeding, and birth intendedness [14, 15]. Additional factors associated with breastfeeding behaviors include maternal age, race and ethnicity, level of educational attainment, employment status, annual household income, and Torso Mass Index (BMI) [14, fifteen]. Teenage mothers, specifically those who had a cesarean section, experienced postpartum depression, and/or perceived an inadequate supply of breastmilk reported a shorter duration of exclusive breastfeeding. The ethnicity of mothers too has a significant clan with elapsing of exclusive breastfeeding, which could be related to the traditions of various ethnicities in addition to religious recommendations and views [14, fifteen]. For case, in the U.S., black women have the lowest breastfeeding initiation and elapsing rates of all ethnicities [xiv]. The racial breastfeeding disparity among blackness women in the U.Due south. persists due to several cultural misperceptions. For case, a common cultural belief prevalent in the blackness community is that the improver of cereal to an baby's canteen volition assistance the infant sleep longer [sixteen]. Furthermore, a mother's pre-existing health issues including obesity, experiencing multiple pregnancy complications, or giving birth to a premature child were also associated with a shorter duration of exclusive breastfeeding [15]. A mother's lack of knowledge regarding breastfeeding, limited breastfeeding guidance, poor family and social support are as well associated with a lack or shorter duration of exclusive breastfeeding.
In dissimilarity, the likelihood of breastfeeding is higher among mothers who received a high school diploma, married, and older at childbirth. Married mothers are more likely to breastfeed because they are more likely to receive spousal support that helps overcome breastfeeding challenges. Other factors that significantly better the duration of exclusive breastfeeding include a singleton pregnancy, breastfeeding friendly birthing facility, natural vaginal delivery, babies' proper weight gain during breastfeeding, and the calmness of the infant [xv].
3.2 Community factors (cultural values and norms)
iii.2.1 Common misperceptions and attitudes toward breastfeeding
The post-obit are actual quotes from diverse members of global communities illustrating mutual misconceptions associated with breastfeeding [17].
Cultural attitudes, lack of public acceptance, and social norms which sexualize breasts may discourage women from breastfeeding in public [10]. Interventions promoting beliefs change with regards to breastfeeding should focus on dispelling the negative cultural beliefs and practices that result in suboptimal breastfeeding practices. Infant feeding practices are strongly influenced past family unit members and spouses who may not be well informed nigh optimal breastfeeding practices. In some communities, breastfeeding in public is perceived as a culturally unacceptable practice. Therefore, disseminating tailored communication messages addressing prevailing misperceptions that build on the positive aspects of breastfeeding while involving spouses and other family members is too disquisitional in shifting the negative perceptions of breastfeeding.
3.3 Organizational factors
three.3.1 Hospital/provider recommendations
Pediatricians, obstetricians, and other healthcare workers are usually the most trusted and credible source on infant health and nutrition [xviii]. The practices of motherhood hospitals regarding breastfeeding and the recommendation of health providers contribute to a female parent's decision to breastfeed. New mothers may lack the confidence or relevant cognition regarding breastfeeding and health workers can play an important office past providing lactation guidance and helping to resolve challenges [1]. Lactation issues that may ascend tin can be addressed through breastfeeding support and counseling. Thus, healthcare workers should be adequately trained to support breastfeeding and help mothers manage common lactation barriers and challenges. The back up of healthcare providers enables women to attain the confidence and skills needed to successfully and optimally breastfeed
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All the same, when wellness intendance workers provide expectant and/or new mothers with baby formula promotion materials they mistakably reduce an baby's likelihood of being breastfeed. Studies show mothers who receive discharge packages containing items useful for breastfeeding are more likely to breastfeed than mothers who receive discharge packages including free formula samples and coupons [18]. The sooner a female parent opts out of breastfeeding, the more formula is purchased, which creates an incentive for formula companies to market infant formula to women even before giving nativity which is usually when prenatal intention to breast or formula feed is established.
The practices of maternity hospitals regarding breastfeeding likewise as the attitudes and information provided past healthcare workers regarding infant feeding largely influences babe feeding behaviors. Health providers and maternity facilities that disseminate information regarding the benefits of breastfeeding also as provide useful breastfeeding resources have the potential to significantly increase breastfeeding prevalence [18]. In 1991, the WHO and UNICEF initiated the Babe-Friendly Hospital Initiative, with the goal of improving maternity facilities to better support and promote breastfeeding. A facility must follow the "Ten Steps to Successful Breastfeeding" (described in Tabular array 2 below) in society to be designated as a "Baby-friendly" facility [1] (Table 3).
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Table 2.
The World Wellness Associates call to action to support breastfeeding [11].
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Tabular array 3.
10 steps to successful breastfeeding [1].
3.4 Societal factors
iii.4.one Legislation
Policies that protect and support breastfeeding are necessary in order to enable a mother's determination to initiate and sustain breastfeeding. A majority of the approximate ane one thousand thousand women who are employed full-time around the earth do not benefit from supportive workplace policies regarding breastfeeding [2, 4]. The big prevalence and increment of women working outside the dwelling is oftentimes cited for the low rates of breastfeeding indicating the necessity of workplace policies to support working mothers [vii]. It is necessary that a woman has the time, space, privacy, and place to limited milk in the workplace and in public areas [x]. Legislation in support of a women'due south choice to breastfeed can help overcome employment barriers and aid in the return of breastfeeding condign the societal norm and standard feeding practice [10].
The lack of legislative accommodation in the workplace is a meaning predictor of shorter elapsing of sectional breastfeeding. Cardinal workplace barriers include the lack of flexibility for milk expression in the piece of work schedule, lack of accommodations such as a nursing room equipped to enable mothers to pump or store breastmilk, and concerns virtually employer or co-worker support [x]. Additional workplace barriers include the perception that breastfeeding may hinder a mothers' chore functioning, lack of privacy for expressing chest milk or for breastfeeding, and the disability to find a kid care facility near the workplace, the high cost of day care, insurance regulations, employer building codes, and other rules that may limit infants and children in the workplace. Studies illustrate that supportive work site environments that provide a private place to express milk and access to a quality breast pump helps women to go along breastfeeding upon return to work [19].
Workplace policies such as paid breaks for expressing milk, the provision of lactation rooms, and public awareness of the breastfeeding policies, have the power to improve the ability of mothers to sustain breastfeeding while working. Using data from 182 countries, Atabay and colleagues (2015) found the prevalence of exclusive breastfeeding amid infants six months and younger was virtually 9 pct points higher in countries with guaranteed paid breastfeeding work breaks compared to those without paid breaks [nine]. Another study conducted in 2014, constitute 136 out of 176 countries, or approximately 71% of the earth, provided mothers the right to have paid breaks during the workday in order to provide breastmilk for their kid until 6 months post-obit birth while four countries permitted shorter or unpaid breastfeeding breaks. Withal, 51 countries, the remaining 29% of the world, did non take policies that protected the right of mothers to breastfeed [9].
Farther, inquiry illustrates extended motherhood leave is associated with college prevalence of exclusive breastfeeding because women are able to go along breastfeeding without choosing betwixt employment and providing breastmilk for her kid. A report by the International Labor System found that in most developed countries 75–100% of pay was guaranteed for up to xvi weeks of motherhood exit. In over lxx countries, employers are paid through social security systems in guild to subtract cost burdens [20]. The U.s.a. does not have a universal policy that guarantees paid maternity leave and also has 1 of the lowest rates of breastfeeding and one of the highest rates of infant mortality among developed countries. A study examining 16 countries found motherhood get out policies increase breastfeeding prevalence and prevent one to 2 neonatal deaths per 2000 live births [21]. In Norway, mothers can take upwardly to 42 weeks of maternity get out with full pay or receive fourscore% pay for 52 weeks. More than 97% of Norwegian women initiate breastfeeding and eighty% continue to do so until at to the lowest degree three months; this is largely different from the 79% of American women who initiate breastfeeding and the 41% who still exclusively breastfeed at 3 months [20, 22]. Other interventions implemented in Norway to encourage breastfeeding include the availability of breastfeeding informational material, training health workers to help mothers have positive breastfeeding experiences, and establishing back up groups where mother are able collectively share breastfeeding experiences [22]. Norwegian mothers who are employed are entitled to lx- to 90-infinitesimal daily breaks and tin fifty-fifty leave to breastfeed their infant or have their babe brought to work. Supportive policies workplace policies are needed in order to meliorate breastfeeding rates and reach the maximum benefits breastfeeding can offering [20].
iii.four.2 Infant formula marketing
Women inbound the labor force and the promotion of large-scale baby formula brands have drastically altered infant feeding practices. The provision of gratis infant formula samples in maternity facilities and the promotion of breastmilk substitutes past the media and healthcare providers have been shown to reduce breastfeeding prevalence [23]. Research indicates the employ of infant formula is twice as high amongst mothers who have viewed and recalled an baby formula ad compared to mothers who had not viewed the advertisements [23].
The media, including marketing and advertisements, influence social norms, which are the shared beliefs regarding the acceptable behaviors within a social group [23]. The media also influences the attitudes toward behaviors and tend to appeal to prevalent values and perceptions in society to generate views and boost profits. For example, in 1997, Tabitha Walrond, a young blackness mother, was convicted of negligent homicide after her 2-calendar month old child died from malnutrition. The mother was unaware that her breast reduction surgery from years prior would issue in an insufficient supply of breastmilk. Years subsequently, Walrond's instance was depicted on a popular TV prove, "Chicago Hope," which depicted breastfeeding to be potentially fatal. However, the episode portrayed white and middle-grade parents (a more "appealing" demographic) who were being criminally investigated following the death of a breastfed kid every bit a result of malnutrition. Rather than illustrating the -Friendly Hospital Initiative as an attempt to enable successful breastfeeding the episode suggested the initiative was forcing mothers to breastfeed leading to infant deaths as a upshot of malnourishment. Alarmingly, the episode was also establish to be a ploy by pharmaceutical companies to inform the public of the risks associated with breastfeeding [24].
Infant formula advertisements also appeal to mutual maternal experiences and concerns often suggesting breastmilk substitutes have ingredients that improve babe intelligence, solve digestive bug, and even assist infants sleep through the dark. Such claims have not been substantiated by research. However, research has recognized the association of breastfeeding with higher intelligence and reduced risk of gastrointestinal illness amidst many other health benefits. Digestive problems such every bit colic are no less prevalent in formula fed than breastfed infants and formula fed infants take non been found to sleep more than breastfed infants. Hunger is one of many reasons infants cry, thusly, infant formula is not associated with a reduced response of infant crying [23].
Farther, media is often driven by profits and audition appeals. The external pressures stemming from the aggressive marketing of babe formula and media messages regarding formula can bear on a mother'southward intent to breastfeed and provide the most optimal form of nutrition to her kid [25]. The excessive marketing of baby formula and inaccurate portrayal of breastfeeding can undermine the significance of breastfeeding past spreading biased information and diminishing a female parent'southward confidence in her ability to breastfeed. Infant formula is frequently portrayed to be as good equally breastfeeding and a viable solution to a user-friendly lifestyle for working mothers. The labels displayed on infant formula often include descriptions such as "gold standard" and images depicting happy infants. This type of labeling implies positive health and developmental benefits, while ignoring the potential economic and wellness consequences associated with formula feeding [23]. Even so, families of breastfed infants tin can experience economical advantages in addition to health benefits. Infant formula can cost over $1500 throughout an infant's first yr of life, even so, women who breastfeed avert the substantial cost brunt [ten]. Breastfed infants likewise crave less medical attending rendering decreased medical expenses and fewer missed days of work for parents. A study found that a group of formula-fed infants had accrued $68,000 in wellness care costs over a 6-month timeframe, while an equal number of breastfeeding babies accrued but $4000 of similar medical expenses [26]. Breastfeeding is also better for the surroundings because less waste is produced compared to the waste created by formula products and bottle supplies. The media tin can play an integral function in disseminating such accurate and positive messages regarding breastfeeding. Media campaigns that are short, tailored to the needs and values of the audience, and displayed through the appropriate channel (e.g., radio, television, social media) that reaches and appeals to the target audience are most successful.
All the same, formula companies tend to brand unsubstantiated claims regarding breastmilk substitutes and utilize trusted healthcare workers to promote infant formula. The provision of free babe formula samples in maternity facilities and the promotion of breastmilk substitutes by the media and healthcare providers take also been shown to reduce breastfeeding prevalence [23]. Infant formula companies concenter new consumers by providing costless samples and information on breastmilk substitutes to expectant and new mothers through providers and infirmary facilities. Physicians are commonly the most undisputed consultant on infant wellness and nutrition, making them a prime vehicle for promoting infant formula. Formula companies give doctors free or discounted products in substitution for physicians recommending and encouraging their brand of baby formula to expectant and new mothers. Many hospitals provide new mothers with packages containing complimentary infant formula and coupons upon infirmary discharge [23].
The marketing tactics employed by formula companies sparked international disapproval based on the assertion formula marketing led to preventable infant deaths. The international opposition prompted the WHO and UNICEF to develop the International Code of Marketing of Breastmilk Substitutes. The Code prohibits the unethical marketing of infant formula as equal to or superior to breastmilk and restricts the promotion of infant formula by medical practices [eighteen]. Distributing accurate, unbiased information regarding the benefits of and importance of breastfeeding through the media too as healthcare workers is critical to improving breastfeeding prevalence and reducing the dispersion of false information and misperceptions regarding the significance of breastfeeding.
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4. Conclusion
Breastfeeding is considered the single most effective solution to preventing deaths of children under the historic period of five globally [26]. Because the substantial economic and health savings that breastfeeding alone provides, exclusive breastfeeding should be supported and promoted within families, communities, workplaces, and hospital facilities that provide care to mothers and their infants. Agreement and addressing the dynamic coaction between private, interpersonal, community, organizational and societal factors, such as policies and legislation that impact breastfeeding rates and the health of infants is key to improving breastfeeding prevalence. Below is an example of prove-informed approaches used to meliorate the prevalence of exclusive breastfeeding that can be adapted and applied in both developing and developed countries.
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5. Central strategies employed to increase global exclusive breastfeeding prevalence
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Disharmonize of interest
The author declares no conflict of interest.
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Submitted: Oct 15th, 2019 Reviewed: January 23rd, 2020 Published: June 1st, 2020
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