Supporting the 75%: Overcoming Barriers After Breastfeeding Initiation

Abstract

There are many challenges to adequately supporting breastfeeding mothers in the primary care setting. Herein I will address: (1) what we mean by support; (2) the gap between initiation and duration that we hope to impact; (3) why women do not meet their goals and describe findings from our study on breastfeeding problems and cessation; (4) outline the challenges to support breastfeeding in primary care; and (5) briefly review the evidence around primary care interventions. We often talk about protecting, promoting, and supporting breastfeeding. I was intrigued to find that essentially all of the definitions of support1 apply. The first unfortunately applies too often to the status quo—as women bravely endure breastfeeding problems without enough other support. To maintain a desired level or keep something going could apply at either the individual or the public health level. To assist or help is primarily the focus of my talk, with emphasis on the clinical setting. But financial (to pay the costs of) and moral (to keep from yielding) support is also necessary. According to the 2007 National Immunization Survey, 75% of infants born in our country are ever breastfed.2 The mothers of these infants, the 75% of women who initiate breastfeeding, are the current focus. By 6 months, greater than 40% of mothers who initiate—almost one in two—are no longer breastfeeding, and by 12 months, almost three out of four have stopped. The 2020 goal is to increase the breastfeeding rate at 6 months to 60.5%, which represents a decrease to about one in four of the 81.9% targeted initiation rate stopping this early.3 We would of course like to also support breastfeeding exclusivity among the initiators, and the 44.3% exclusive breastfeeding target at 3 months represents an increase from around 45% to about 55% of initiators. We can see that supporting women who initiate breastfeeding to do so more exclusively and for longer is where the 2020 goals focus—more than on increasing initiation rates. So what are the barriers for breastfeeding mothers? We are familiar with many. For example, the recent retrospective study of Haughton et al.4 of 162 Connecticut Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants reported that breastfeeding duration was related to whether the pregnancy was planned as well as the mothers' age and length of time residing in the United States. The most common reasons for stopping breastfeeding were age of the child, work, sore nipples (as we might expect, more common among those stopping earlier), breast refusal, lack of access to breast pumps, and free formula provided by WIC. A couple of these reasons suggest intent is relevant to duration: The planned pregnancy and weaning because of the child's age. The latter suggests the mothers had reached their intended breastfeeding duration. We wanted to know more about barriers that prevented mothers from reaching their intended breastfeeding duration and therefore studied early lactation success prospectively.