Barriers to Breastfeeding – A Global Survey on Why Women Start and Stop Breastfeeding
Table 4: Barriers to Continuing Breastfeeding Longer – Reasons Most Frequently Reported by Women Who Breastfed for Stopping Breastfeeding
What Stopped You Breastfeeding Longer?* Supply decreased
Child no longer wanted to nurse It became painful
The time commitment needed to breastfeed I needed to go back to work
It was awkward to breastfeed outside of home
All Mothers (%) US (%) UK (%) China (%) Brazil (%) India (%) Egypt (%) South Africa (%) 40
24 15 14 10 9
It was difficult to find time to pump throughout the day 7
70 32 58 5 24
30 20 9 3 16 5 13 2 16 2 10
*Multiple answers were allowed. For other reported reasons, see Philips Mother & Child Care report, 2011.30
Table 5: Barriers Related to Returning to Work – Percentage of Working Women in Agreement With Statements About Their Workplace in Relation to Their Breastfeeding Experiences
Breastfeeding Experience at Work
At my work location we did not have good facilities to pump my breasts*
I felt embarrassed to pump my breasts at work* I felt supported by my colleagues to breastfeed**
Mothers† 55
55
I felt supported by my employer to breastfeed longer** 50 59
(%) US (%) UK (%) China (%) Brazil (%) India (%) Egypt (%) South Africa (%) 45 77 81
80
64 69 80 76 49 38 80 67 55
63 79 92
56
56 74 73
34
39 43 39
40
31 24 36
†Working mothers only. *A high percentage of agreement with this statement is indicative of a barrier. **A low percentage of agreement with this statement is indicative of a barrier.
On a month-by-month basis (data not shown), the decrease in breastfeeding rates was fairly evenly distributed over the first three months but, for the period from Month 4 to Month 6, more than half of the decrease was reported for Month 6, suggesting that, for these women breastfeeding through, the first half-year was seen as an important milestone to achieve. About one-third to one-half of the reported decline in the second half of the first year happened at Month 12. A sharp decline was particularly visible in the US, with 52 % discontinuing between seven and 12 months, and only 3 % continuing beyond that. This decline was also visible to a lesser extent in China and Brazil. This might indicate that the reinforcement of messages around the importance of breastfeeding in this period should be supported to increase breastfeeding rates past the first year.
Stopping Table 4 summarises the reasons women mentioned that caused them to stop breastfeeding. The main reason, overall, was that 40 % of mothers felt that their supply decreased, with extremes in the US (70 %) and China (58 %), in contrast to South Africa (9 %) and Egypt (17 %). Another important reason women reported for stopping breastfeeding was that the baby no longer wanted to nurse (24 %), though this was more pronounced beyond the first six months, when weaning becomes more common through the introduction of solid foods.30
(15 %), especially in the first three months,30
breastfeed (14 %) or to pump (7 %). Other prominent reasons included the need to go back to work (10 %) and feeling awkward breastfeeding outside the home (9 %).
Table 5 shows underlying reasons why a return to work is perceived as a barrier to continued breastfeeding, highlighting embarrassment and the lack of facilities and support from co-workers.
When looking more closely at the need to go back to work, it appears that the relative importance of this barrier is much greater when considering only the women who work (28 % of them report it as a reason for stopping breastfeeding) versus all the women in the study
EUROPEAN OBSTETRICS & GYNAECOLOGY SUPPLEMENT
(10 %). Based on the views of working women only, the barrier applies to almost half (43 %) of all working women in China, whereas, in the US, it only relates to a minority (9 %). This difference between China and the US may be explained by differences in facilities at the work location and support from employers and colleagues (see Table 5).
Starting and Continuing Successfully
When asked about factors related to getting started with breastfeeding, almost half of all women were worried about how to breastfeed and/or whether it would be easy, though responses differed largely by country (see Table 6). Women in the US and the UK felt most at ease, whereas women in Brazil and Egypt were most worried. This indicates a need to inform women effectively about how to breastfeed. Indeed, help with preparing to breastfeed and getting started may have been present in various forms, notably through breastfeeding classes, hospital support and lactation consultants.
Some 41 % of women completed a breastfeeding class (see Table 6). Of the women who did not complete a breastfeeding class, 38 % felt it was not necessary, 23 % were not aware of the possibility and, for 13 %, such classes were not available.30
Table 7 shows breastfeeding
Other important reasons were pain associated with feeding and the time needed to
duration as a function of women’s completion of breastfeeding class. The proportion of women who completed a breastfeeding class tends to be larger in the group breastfeeding for 7–12 months compared with 0–3 months, except in Egypt and India where most women sustained breastfeeding over 12 months, irrespective of (a comparatively low) breastfeeding class attendance. Data for 13–18 months’ breastfeeding duration were less consistent to infer an effect of class attendance. The overall data seem to show that women were more likely to breastfeed longer (i.e., up to 12 months) if they had completed a breastfeeding class. This indicates a further promotion of these classes could increase breastfeeding success.
When it comes to hospital support, only 60 % of surveyed women felt there was adequate support for getting started with breastfeeding after giving birth – a number fairly consistent across countries (range 45–78 %, see Table 6).
27 31
12 30 10 6
34 35 4 7
18 1 1
50 20 14 9 1
28 16
17 33 19 39 -
5 7
9
21 12 14 -
7 13
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