Breast-Feeding Advice Should Be Realistic, Not Idealistic

Ricki Lewis, PhD

March 15, 2012

March 15, 2012 — The World Health Organization recommends breast-feeding for 6 months, but this may not be a realistic option for many women, according to a report published online March 14 in BMJ Open.

Evidence that in many nations women are not meeting the organization's recommendation inspired the study by Pat Hoddinott, PhD, from the Health Services Research Unit, University of Aberdeen, United Kingdom, and colleagues. The researchers conducted 220 qualitative serial interviews with 36 women (35 of whom planned to breast-feed), 26 partners, 8 mothers, 1 sister, and 2 healthcare professionals about diverse aspects of breast-feeding.

The interviews took place at 4-week intervals from the final pregnancy month until 6 months after birth. The first and last interviews were face-to-face, with those in-between usually conducted by telephone.

The questions covered the women's relationships with their partners and infant nutrition (duration of breast-feeding and introduction of other fluids and/or solid foods). The researchers also presented 7 vignettes that illustrated "a range of health or community services to help with infant feeding" to develop interventions for further studies.

The researchers used FrameWork (National Centre for Social Research) software to document information in the interview transcripts and the researchers' interpretations.

The report quotes extensively from the participants, and the researchers provide a detailed analysis of the comments. The responses reveal an "overarching theme emerging...as a mismatch between idealism and realism." In general, the participants reported that over time, they became more concerned with the well-being of their families than the biological benefits of breast-feeding, and switched to solid food or formula.

Women Find Breast-Feeding Education Patronizing

Some of the women reported breast-feeding as physically not as simple as healthcare providers had made it seem, resented being pressured to breast-feed, and would have liked more inclusion of their partners. They also mentioned preferring family-centered advice rather than being instructed to follow a checklist that induced a sense of failure if breast-feeding did not proceed smoothly for 6 months. Problems arose most often at "pivotal points" in the weeks after birth and when solids were introduced.

Respondents disliked breast-feeding education classes before the births, calling them "patronizing" and "overly scientific." They also objected to the presentation of breast-feeding as an absolute, with no advice on combining infant nutrition sources.

Breast-feeding should be realistic, rather than idealistic, the investigators recommend. They also advise presenting breast-feeding as 1 option among several healthful ways of providing infant nutrition.

The researchers propose a "family-centered narrative approach" consisting of discussions that cover the "practical and emotional realities" of breast-feeding, as well as formula feeding. They endorse incremental goal-setting, rather than a mandate to breast-feed exclusively for 6 months.

"More attention to the diverse values, meanings and emotions around infant feeding within families could help to reconcile health ideals with reality," the researchers conclude.

The study was supported by NHS Health Scotland. The Health Service Research Unit, University of Aberdeen, is supported by the Chief Scientist Office of the Scottish Government Health Directorates. The authors have disclosed no relevant financial relationships.

BMJ Open. Published online March 14, 2012. Full text

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