An online questionnaire study investigating the impact of psychosocial factors on the duration of breastfeeding

Highlights

• Online survey investigating psychosocial factors and duration of breastfeeding.

• Participants were first-time mothers who had their babies in the last six months.

• Infant feeding questions and established scales measured the main study variables.

• Stong intention to breastfeed but many stopped before their baby was six weeks old.

• There is a need for consistent and timely breastfeeding information and support.

Abstract

Objective

To examine the psychosocial factors of intention to breastfeed, perceived stress, social support, self-efficacy and their ability to predict the duration of breastfeeding in first-time mothers up to six months postnatally.

Design

Cross-sectional, quantitative study using a retrospective online survey.

Setting

Women across West Yorkshire, in the north of the United Kingdom.

Participants

First-time mothers (n=98) who had given birth in the past six months.

Measures

An online survey included three established survey instruments measuring the main study variables: The Perceived Stress Scale (Cohen et al., 1983), the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988) and the General Self-Efficacy Scale (Schwarzer and Jerusalem, 1995). The fourth variable was Intention to breastfeed and was measured using a single question. The survey was structured into five main sections 1) During pregnancy, 2) Once the baby was born, 3) Support to feed my baby, 4) Psychosocial factors and 5) Demographics. Open text responses allowed women to elaborate on their infant feeding experiences.

Findings

80% of the sample said they had intended to breastfeed their baby. Although 96% initiated breastfeeding while in hospital, this decreased to 82% at one week and 75% at six weeks. By six months, the rate had dropped to below 50%. Survival Analysis using Cox's Regression found no significant predictors of duration of breastfeeding at one week and six weeks. However, a significant negative correlation between perceived stress and self-efficacy suggests that greater perceived stress is linked to lower self-efficacy. Other findings included 91% of mothers decided how they would feed their baby before they were pregnant (57%) or during pregnancy (34%) and the majority answered that breastfeeding support was most useful straight after the birth and up to one week.

Key conclusions

The findings from this sample of new mothers showed that although many intended to breastfeed, a considerable number of them had stopped by the time their baby was six weeks old. The content analysis highlighted the multiple challenges new mothers can experience with breastfeeding and furthers understanding of the support needs of this group of women.

Implications for practice

Many of the mothers had already decided how to feed their baby before the baby was born. In this sample, a quarter of those who intended to breastfeed or thought they might breastfeed had stopped by six weeks. In order to increase breastfeeding duration, new mothers with high intention to breastfeed need to be better prepared for potential breastfeeding challenges and given more support with breastfeeding shortly after their baby is born.

Introduction

Breastfeeding is an important health behaviour that has substantial health benefits for both mother and baby (World Health Organisation, 2021). These include protection against infections for the baby, and a reduction in the risk of ovarian cancer and breast cancer in the mother (Victora et al., 2016; World Health Organisation, 2021). Recommendations are that women initiate breastfeeding within one hour of birth, breastfeed exclusively for the first six months of life and continue to breastfeed alongside complementary solid food up to two years of age and beyond (World Health Organisation, 2021).

The duration of breastfeeding refers to the amount of time a mother continues to breastfeed (Noel-Weiss et al., 2012). Currently, the most common measure of this in the UK is breastfeeding prevalence at 6-8 weeks after birth (Office for Health Improvement & Disparities, 2021; Public Health England, 2019). Findings from the last Infant Feeding Survey in 2010 showed that exclusive breastfeeding rates at birth were 69% in the UK (McAndrew et al., 2012). However, at one week, less than half of all mothers (46%) were exclusively breastfeeding and this figure dropped to under a quarter (23%) by six weeks (McAndrew et al., 2012). This indicates that mothers are likely to stop breastfeeding before the 6-8 week measure has taken place and that few women continue to breastfeed to the WHO and unicef recommedations (World Health Organisation, 2021). Only collecting prevalence at 6-8 weeks means means data on exactly when the mother stopped breastfeeding within this period and importantly, any reasons that led to this decision to stop, is missed. Given the importance of breastfeeding and the documented low uptake, and even lower continuation, of exclusive breastfeeding (Royal College of Paediatrics and Child Health, 2021), it is necessary for high-quality research to be conducted to explore factors that can predict the duration of breastfeeding.

According to the Theory of Planned Behaviour (TPB) (Ajzen, 1991), attitude towards the behaviour, subjective norms and perceived behaviour control are determinants of behavioural intentions. The TPB has been successfully applied to breastfeeding (Giles et al., 2014; Ismail et al., 2016; Kronborg and Vaeth, 2004; Meedya et al., 2010; Wilhelm et al., 2008; Zhang et al., 2018). Intention, when applied as the extent to which the individual plans to breastfeed once their baby is born, is predictive of breastfeeding duration (Bai et al., 2010; Blyth et al., 2004; Grano et al., 2022; Guo et al., 2015). As behavioural intention is seen as the strongest predictor of breastfeeding duration, this is the focus of this study.