Elsevier

Women and Birth

Volume 23, Issue 4, December 2010, Pages 135-145
Women and Birth

Review
Factors that positively influence breastfeeding duration to 6 months: A literature review

https://doi.org/10.1016/j.wombi.2010.02.002Get rights and content

Summary

Question

What modifiable factors positively influence breastfeeding duration to 6 months postpartum?

Aim

This question was posed in order to be able to develop a midwifery intervention aimed at prolonging breastfeeding.

Method

An online literature search was conducted in Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews. The search strategy included the following keywords: breastfeeding, duration, initiation, cessation, factors, intervention, education, partner, intention, confidence, self-efficacy and support. Additional studies were located and extracted from online publications of New South Wales Department of Health, Australia. Bio-psycho-social factors that are positively associated with breastfeeding duration were identified.

Results

Modifiable factors that influence women's breastfeeding decisions are: breastfeeding intention, breastfeeding self-efficacy and social support. Existing midwifery breastfeeding promotion strategies often include social support but do not adequately address attempts to modify breastfeeding intention and self-efficacy.

Conclusion

The modifiable factors that are positively associated with breastfeeding duration are the woman's breastfeeding intention, her breastfeeding self-efficacy and her social support. Intervention studies to date have focussed on modifying these factors individually with variable results. No interventional studies have been conducted with the aim of positively modifying all three factors simultaneously.

Introduction

Exclusive breastfeeding to 6 months of age is one of the primary aims of nutrition and public health programs across the world.1 Midwives and lactation consultants are actively engaged in attempting to increase women's rates of breastfeeding to at least 6 months postpartum. Yet, in spite of these efforts, in Western countries, most women do not continue breastfeeding until 6 months postpartum.2 This paper reviews the research literature and summarises the bio-psycho-social factors that are positively associated with prolonged breastfeeding. These factors are discussed under the following headings: socio-demographic factors, biophysical factors, psychosocial factors and interventional factors. Those factors that are potentially modifiable by a midwifery intervention are the main focus of discussion. The aim is to provide a firm evidence-base for designing an educational intervention that can be offered to woman and their families.

Key terms used in this paper: ‘breastfeeding’, ‘intention’, ‘confidence’, ‘self-efficacy’ and ‘support’ are defined first. The key terms related to breastfeeding are defined in Table 1. ‘Intention’ is defined as a plan that has been formulated in order to achieve a particular goal stated through certain instrumental actions.3 Intentions about breastfeeding are formed based on a woman's inner desire to breastfeed or not. ‘Self-efficacy’ is defined as an individual's confidence in his or her perceived ability to perform a specific task or behaviour.4 Breastfeeding self-efficacy is a mother's perceived ability to breastfeed her newborn.5 The word ‘confidence’ is usually translated to ‘self-efficacy’ in the research literature. In this paper ‘self-efficacy’ will be used consistently throughout, even when the studies under review used the term ‘confidence’. Consistent with McGrath,6 ‘social support’ is defined as a woman's perception of supportive behaviours from others in her social network that she believes will ultimately be beneficial to her.6 Women experience support when they receive care, concern, respect, understanding, advice, encouragement and practical help.7 This definition is inclusive of professional, family, and peer support.

Section snippets

Methods

An online literature search was conducted in order to address the guiding question, “What modifiable factors positively influence breastfeeding duration to 6 months postpartum?” aiming at designing a midwifery intervention to increase duration of breastfeeding. Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews were searched. The search strategy was based on the following keywords, their synonyms and truncations: breastfeeding, duration, initiation,

Results

Factors that were reported to be positively associated with prolonged breastfeeding are categorised and discussed below. Consistent with the aim of this review, particular emphasis is given to factors that are potentially modifiable by midwife-provided educational intervention which would commence in the antenatal period.

Discussion

This literature review has been conducted with the aim of designing an intervention to support women to increase breastfeeding duration to 6 months postpartum. This review highlights the importance of focussing on the modifiable factors that are associated with prolonged breastfeeding: breastfeeding intention, self-efficacy and social support. Only one interventional study has examined a specific strategy to increase breastfeeding intention (the strongest predictor of breastfeeding duration).

Conclusion

Breastfeeding intention, self-efficacy and support have been reported as important, modifiable factors that influence breastfeeding duration. What is known is that women have positive and prolonged breastfeeding experiences when they have a strong desire to breastfeed for longer periods of time, when they are confident in their ability to breastfeed and are well supported by their family. There have been no interventional studies that have simultaneously aimed to address these three issues

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