The Role of Mixed-feeding in Undermining Breastfeeding: Analysis of the 2018 Scottish Infant Feeding Survey

Abstract

ObjectivesMixed-feeding (MF), the use of formula with breastfeeding is commonly followed by early breastfeeding cessation, but the actual mechanism for this is not yet clear. We aimed to investigate i) the reasons why breastfeeding mothers start mixed feeding, ii) its association with later lactation, and iii) the role health staff play in discouraging mixed-feeding and supporting continued breastfeeding. MethodsParticipants were mothers in the Scottish Maternal and Infant Feeding Survey (2018) cohort, who had ever breastfed their infants and completed questionnaires at infant age 8–12 weeks, reporting on feeding intentions, feeding practice, breastfeeding problems, reasons for use of formula and sociodemographic data. Mothers who planned to mixed-feed from the outset, were defined as early MF, while those who had not intended to mixed feed but did so, were defined as reactive MF. ResultsOf 1974 initially breastfeeding mothers, 65% had mixed-fed at some point. At 6 weeks, 32% had ceased breastfeeding, 22% were mixed-feeding and 46% were still exclusively breastfeeding. Early breastfeeding problems (<2 weeks) were common (65%) and related to stopping breastfeeding (Relative Risk [RR]:3.23, 95% Confidence Interval [CI]: 2.0, 5.3). Using survival modelling, adjusting for early and late breastfeeding problems, and sociodemographic factors, reactive MF were less likely than early MF to have stopped breastfeeding (Hazard Ratio [HR]:0.57, 95% CI: 0.4, 0.8). In multivariate analysis, increased risk of breastfeeding cessation was associated with intention to mixed-feed (RR:3.39, 95%CI: 2.4, 4.9), and introduction of formula due to convenience (RR:3.21, 95%CI: 2.3, 4.4); the latter was also associated with later lactational issues (RR:1.76, 95%CI: 1.3, 2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR:0.63, 95%CI: 0.5, 0.9) but other input was not protective. ConclusionsMothers often choose to mix-feed their infants from the first weeks, even in absence of breastfeeding problems. Maternal and child health programs need to counsel mothers against mixed-feeding and provide skilled help for breastfeeding issues. Funding SourcesN/A.