Breastfeeding issues - Initiating and sustaining breastfeeding: a literature summary

The evidence for the benefits of breastfeeding over other feeding options for newborn infants’ health and development is clear. The WHO and UNICEF have recommended a global target that all infants should be exclusively breastfed up to 6 months. In Australia, policies and strategies have been developed and implemented to promote and support breastfeeding. Evidence indicates that almost all Australian women (~96%) initiate breastfeeding. This suggests an awareness and acceptance of the benefits of breastfeeding. However, the proportion of women who sustain exclusive breastfeeding to 6 months is low, in Australia and internationally. Research has shown that specific maternal and birth characteristics can help identify women who are more or less likely to initiate and sustain breastfeeding. Such evidence could help inform future strategies aimed at specific target groups. The evaluation of existing strategies can also help determine best options for further implementation. For example, research tells us the majority of women make infant feeding decisions prior to and irrespective of, contact with health professionals, suggesting the importance of familial, social and community factors. Information and support provided in the first days after birth by Lactation Consultants and midwives appears to contribute to women initiating breastfeeding, but not sustaining it. Breastfeeding problems are most likely to present once the mother has left hospital; such problems are well known predictors for early formula supplementation and breastfeeding cessation. Policies and programs should therefore give increased focus to this period. Research shows that professional, partner and family support positively influence the continuation of breastfeeding beyond a woman’s stay in hospital, so further efforts may be needed to engage with women and those closest to them. Further research is needed to understand the information and support needs of women, including potentially hidden and hard-to-reach groups, if we are to progress the global goal of exclusive breastfeeding to 6 months. Finally, women who make an informed choice not to breastfeed or who experience early feeding problems report feelings of guilt, failure and being judged. The extent to which current policies and programs meet these women’s needs, or indeed contribute to these negative feelings, also needs further investigation