Testing the buffering hypothesis: breastfeeding problems, cessation and social support

Abstract

Public Health England’s most recent breastfeeding rates for England (based on 140 of 144 local authorities) highlight that only 47.3% (95% CI 47.1-47.6%) of women were breastfeeding at 6-8 weeks (Public Health England, 2019). However, many women in the UK express the wish to breastfeed, and 73% do actually initiate breastfeeding feeding (A. Brown, 2016; NHS, 2017), and report they would have liked to breastfeed for longer (McAndrew F et al., 2012). Therefore, key questions remain as to what the barriers are to breastfeeding and most importantly, what can we do to mitigating these barriers? A large amount of literature regarding breastfeeding is devoted to the documentation and understanding the problems women suffer, particularly in the first few days and weeks after birth and during the first three months post-partum, while mothers are learning how to breastfeed. This literature reveals that breastfeeding is challenging for the vast majority of women, as studies report that breastfeeding problems are experienced by 80-90% of mothers (Bergmann et al., 2014; Binns & Scott, 2002; Lamontagne, Hamelin, & St-Pierre, 2008; Li, Fein, Chen, & Grummer-Strawn, 2008). While breastfeeding problems are frequently cited as reasons for stopping breastfeeding, many women experience problems with breastfeeding and yet continue with lactation. Collectively, this evidence suggests that problems are ‘normal’ when it comes to breastfeeding, and it is mothers who are ‘overwhelmed’ by breastfeeding problems are those at risk of early breastfeeding cessation (Binns & Scott, 2002). As perceived milk insufficiency is the most frequently reported reason for breastfeeding cessation, understanding factors which protect and promote a mother’s feelings of self-efficacy are important for informing more effective breastfeeding interventions going forward. Evidence suggests that maternal self-efficacy is positively influenced by her perception of social support from a diverse range of individuals in a mother’s social network, including fathers, grandmothers and friends (Ekstrom, Widstrom, & Nissen, 2003; Meedya et al., 2010; Wolfberg et al., 2004). In Western contexts, women with access to social support in the form of informational, emotional and practical support from family, friends and health professionals should be expected to be more able to overcome breastfeeding problems and continue breastfeeding. By expanding the evolutionary perspective beyond provisioning and childcare to include informational and emotional support and expanding the public health perspective beyond medicalised informational support, this paper seeks to explore the multidimensional nature of social support from a wide range of supporters and its impact on responses to breastfeeding problems.