Testing the buffering hypothesis: Breastfeeding problems, cessation, and social support in the UK

Abstract

Objectives Physical breastfeeding problems can lead women to terminate breastfeeding earlier than planned. In high‐income countries such as the UK, breastfeeding problems have been attributed to the cultural and individual “inexperience” of breastfeeding, ultimately leading to lower breastfeeding rates. Yet, cross‐cultural evidence suggests breastfeeding problems still occur in contexts where breastfeeding is common, prolonged, and seen publicly. This suggests breastfeeding problems are not unusual and do not necessarily lead to breastfeeding cessation. As humans evolved to raise children cooperatively, what matters for breastfeeding continuation may be the availability of social support during the postnatal period. Here, we test the hypothesis that social support buffers mothers from the negative impact breastfeeding problems have on duration. Methods We run Cox models on a sample of 565 UK mothers who completed a retrospective online survey about infant feeding and social support in 2017–2018. Results Breastfeeding problems were important predictors of cessation; however, the direction of the effect was dependent on the problem type and type of support from a range of supporters. Helpful support for discomfort issues (blocked ducts, too much milk) was significantly associated with reduced hazards of cessation, as predicted. However, helpful support for reported milk insufficiency was assoicated with an increased hazard of cessation. Conclusions Experiencing breastfeeding problems is the norm, but its impact may be mitigated via social support. Working from an interdisciplinary approach, our results highlight that a wide range of supporters who provide different types of support have potential to influence maternal breastfeeding experience.

Emotional and informational social support from health visitors and breastfeeding outcomes in the UK

“…While at first glance it may be surprising that participants who reported their health visitors to be emotionally supportive but informationally unhelpful had longer lactation durations than those who reported both informational and emotional supported positively, this may reflect a lack of need of informational support among these participants [5,50]. Earlier work with this sample has found that support clusters [48], suggesting participants with supportive health visitors were also likely to have ready access to other supporters who may duplicate information, dampening the perceived utility of their advice [51,52].…”

“…Informational support may also only be considered helpful if it solves a specific problem; parents without problems requiring assistance may give lower helpfulness ratings due to the nature of their experience, rather than the content or provision of support received. Since breastfeeding problems predict cessation [5], it may be that participants reporting health visitors as 'emotionally supportive and informationally not helpful' experienced fewer problems.…”

“…Conversely, when problems are encountered not all information considered helpful by parents is likely to encourage persistence with breastfeeding and may in fact have the opposite effect [5].…”

“…While the survey itself used breastfeeding-related language, we did not collect data regarding the gender identification of participants and acknowledge that this may not have been our participants' preferred descriptor. Only responses from participants who reported the variables of interest were used: from the initial survey of 738 eligible participants 625 mothers responded to questions concerning duration; however, 45 did not answer breastfeeding initiation questions and 14 did not respond to social support questions, resulting in a final sample of 565 for the analysis of breastfeeding duration [5], while a further 7 did not answer the experience questions (n = 558). An overview of the definitions for each variable used, including how they were measured in the initial survey, can be seen in Table 1.…”

“…Breastfeeding initiation rates are contrastingly higher at 81% and have steadily increased in recent years, increasing from 76% in 2005 [1]. Early breastfeeding cessation in high-income settings is associated with various factors, such as negative breastfeeding experiences [3,4], difficulties feeding [5,6], limited access to breastfeeding resources [7], and experience of social pressure without adequate emotional support [8]. When provided consistently and adequately, social support has been shown to mitigate these factors [9], resulting in increased breastfeeding durations [10] with benefits for infants' long-term health and wellbeing [11].…”