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

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 (Ekström, Widström, & 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.

英国公共卫生署最新的母乳喂养率报告指出，基于144个地方当局中的140个，仅有47.3%（95%置信区间为47.1-47.6%）的妇女在6-8周时进行母乳喂养（英国公共卫生署，2019年）。然而，许多英国女性表达出希望进行母乳喂养的愿望，其中73%的女性实际上开始了母乳喂养，并报告她们希望母乳喂养的时间更长（A. Brown，2016年；NHS，2017年；McAndrew F等，2012年）。因此，关于母乳喂养的障碍以及如何缓解这些障碍的关键问题依然存在。大量关于母乳喂养的文献专注于记录和理解女性所遭受的问题，尤其是分娩后的前几天和几周，以及产后头三个月内，母亲学习如何进行母乳喂养的过程中。这些文献揭示了母乳喂养对于绝大多数女性来说是一项挑战，因为研究报道有80-90%的母亲经历了母乳喂养问题（Bergmann等，2014年；Binns和Scott，2002年；Lamontagne，Hamelin和St-Pierre，2008年；Li，Fein，Chen和Grummer-Strawn，2008年）。尽管母乳喂养问题经常被引用为停止母乳喂养的原因，但许多女性在经历母乳喂养问题时仍继续哺乳。综合这些证据表明，在母乳喂养过程中，问题被视为‘正常’现象，而那些因母乳喂养问题而感到‘不堪重负’的母亲是早期停止母乳喂养的高风险群体（Binns和Scott，2002年）。由于感知到的奶水不足是停止母乳喂养最频繁报告的原因，因此了解保护并促进母亲自我效能感的因素对于制定更有效的母乳喂养干预措施具有重要意义。证据表明，母亲的自我效能感受到她感知到来自其社会网络中多种个体的社会支持的积极影响，包括父亲、祖母和朋友们（Ekström，Widström和Nissen，2003年；Meedya等，2010年；Wolfberg等，2004年）。在西方语境中，那些能够从家人、朋友和专业人士那里获得信息、情感和实际支持的女性，应预期能够更有能力克服母乳喂养问题并继续母乳喂养。本文通过超越供应和育儿，将信息和支持以及超越医学化信息支持的公共卫生视角纳入其中，旨在从广泛的支持者角度探讨社会支持的多维性质及其对应对母乳喂养问题的响应影响。