Breastfeeding in Young Mothers

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Introduction

Not all new mothers manage to follow the breastfeeding recommendations provided by health authorities. In Australia, compared to the general population of mothers, new mothers younger than twenty-five are significantly more likely to fail in implementing exclusive breastfeeding and, therefore, are listed among the priority populations for the national strategy to promote breastfeeding (COAG Health Council, 2019). This paper explores this demographic group in terms of factors that act as barriers to the continuation and initiation of breastfeeding, promising strategies to promote the practice, and the degree to which the existing strategies address the barriers to breastfeeding affecting young mothers.

Socio-Cultural and Personal Factors Influencing Breastfeeding in Young Mothers

Enough scholarly studies have been conducted to explore the factors affecting breastfeeding choices in women younger than twenty-five, including adolescent mothers, but recent studies that would focus only on this age group in Australia are few. Barriers to breastfeeding are likely to be similar across developed economies, which is why it is possible to use evidence from other English-speaking countries to understand the key factors that might be relevant to young mothers in Australia.

Young women’s determination to initiate and continue breastfeeding is affected by the degree to which the infrastructure is sustainable for breastfeeding activities. The evidence from a community-based participatory research study conducted in the United States suggests that the prominent socio-cultural factor that affects young mothers is access to places that are supportive of breastfeeding (Chopel et al., 2019). For some young mothers, the absence of places of worship where they could feed infants can become the reason to consider other approaches to infant nutrition (Chopel et al., 2019). Evidence from Australia also highlights the existence of this barrier to breastfeeding, especially in the workplace (Ogbo et al., 2016). Importantly, it is mentioned to be relevant to the entire population of mothers, not only those younger than twenty-five.

Another socio-cultural factor that is closely interconnected with the absence of breastfeeding-friendly places is the stigma against young mothers. Despite some attempts to destigmatize breastfeeding, the very act of nursing a child in public can still cause different reactions, including requests to leave or other disapproving comments (Chopel et al., 2019). For those becoming mothers relatively early in life, this stigma doubles and starts to include the perceptions of young mothers as irresponsible people that do not have goals in life (Chopel et al., 2019). It happens that young women that have children are automatically perceived as unmarried, which also adds to the stigma, thus encouraging them to avoid breastfeeding in public places (Australian Breastfeeding Association, 2016; Chopel et al., 2019). Although the Australian law considers breastfeeding in public legal and acceptable, the de facto situation is that even security guards and sales assistants happen to ask nursing mothers to leave public places (Ogbo et al., 2016). With that in mind, young mothers’ opportunities for breastfeeding are limited due to stigma, which may lead to suboptimal breastfeeding.

Personal factors that affect young mothers’ breastfeeding practices are diverse and mainly relate to knowledge about breastfeeding and relationships with others. According to the study by Chopel et al. (2019), support from others, including “peers, family members, and partners” facilitates young women’s adherence to breastfeeding recommendations, whereas its absence has an opposite effect (p. 313). The findings reported by Ogbo et al. (2016) provide further support for this factor and cite intimate partner violence and the lack of support from a woman’s partner as potential contributors to the poor maintenance of exclusive breastfeeding. Apart from receiving help from their partners, young women that have given birth often rely on their mothers and peers as sources of knowledge and advice concerning breastfeeding (ABA, 2016). With that in mind, the presence of informal support networks to compensate for young mothers’ inexperience in breastfeeding is the factor that can encourage more young women to initiate and continue the practice (ABA, 2016; Chopel et al., 2019; Ogbo et al., 2016). Conversely, the absence of such networks can hurt young mothers’ breastfeeding practices.

Strategies to Promote Breastfeeding and Their Links to Factors Affecting Breastfeeding

The various strategies have been implemented in Australia and worldwide to encourage more young mothers to strictly follow breastfeeding recommendations. One of the key strategies to disseminate information about breastfeeding is the establishment of peer support networks for women, including young mothers. The need for informal support networks for young women became clear as a result of the Younger Mothers Project initiated by ABA volunteers (ABA, 2016). Nowadays, the ABA provides a breastfeeding peer counselor support program for all new mothers (Smith et al., 2018). Importantly, breastfeeding counselors popularize breastfeeding and share their experiences with new mothers instead of providing any medical advice.

Peer support programs are known to be effective in different subgroups of the population, not only mothers younger than twenty-five. The effectiveness of peer support programs, in which trained counselors provide new mothers with information and advice, was demonstrated in a systematic review conducted by Hector in Australia (Smith et al., 2018). As per its results, peer counseling was shown to have strong positive effects on Australian mothers’ breastfeeding practices (Smith et al., 2018). The results of the UK-based time-series study conducted by Scott et al. (2017) demonstrate that peer support services for young mothers increase breastfeeding rates in new mothers younger than twenty-five. However, in their comprehensive review of strategies to support breastfeeding mothers, Smith et al. (2018) report that they did not find any meaningful differences between diverse at-risk groups in terms of the effect that popular strategies have on them. In other words, if the peer support approach is effective, it is probably equally effective for all subgroups of Australian mothers, including younger women.

The so-called peer support programs may involve different types of communication, including counseling by phone. Interventions that are based on proactive telephone communication between first-time mothers and those who have certain experiences in breastfeeding show positive results in Australian new mothers but are not widely used yet (Forster et al., 2019). Telephone communication, as well as e-mail counseling, are also parts of the peer support program offered by the ABA (2016). Such interventions are not aimed specifically at young mothers that are inexperienced in breastfeeding, but this demographic group benefits from it similarly to the general population. Peer support programs are likely to be implemented by child and family health professionals, as well as different breastfeeding associations.

Another strategy is the so-called Baby-Friendly Hospital Initiative proposed by the World Health Organization. Since 1991, the aforementioned initiative has been implemented in more than one hundred and fifty countries, including Australia (Esbati et al., 2019). Based on a series of national studies, including that by Kramer et al. in 2012, it has been demonstrated that the BFHI has quite pronounced positive effects on breastfeeding duration and increases the percentage of women that initiate breastfeeding, including young mothers (Esbati et al., 2019). The mentioned strategy is likely to be implemented by child and family health professionals in facilities providing postnatal services.

The BFHI approach consists of ten steps, two of which (staff education and policy/monitoring system development) are defined as “critical management procedures” (Esbati et al., 2019, p. 2). Other steps are defined as the recommended clinical practices and include educating pregnant women on the benefits of breast milk, explaining the risks of bottle-feeding, and supporting breastfeeding women in case of difficulties before discharge (Esbati et al., 2019). Despite the program’s effectiveness, only less than one-quarter of all maternity facilities in Australia have fully implemented these recommendations (Esbati et al., 2019). Thus, the implementation of this strategy involves specific difficulties that still need to be overcome.

Both strategies are associated with significant positive results in terms of popularizing breastfeeding among new mothers in Australia, including women younger than twenty-five. However, they effectively address only some of the factors affecting young mothers’ breastfeeding decisions. For instance, by initiating the dissemination of knowledge about breastfeeding and teaching new mothers, the BFHI approach addresses young mothers’ lack of knowledge regarding how to breastfeed with minimal risks and discomfort, which is a personal factor. Moreover, it can partially address the factor of partner and family support by informing pregnant young women’s partners about the benefits and peculiarities of breastfeeding – one of the BFHI clinical practices involves providing information about infant feeding to women and their families (Esbati et al., 2019). The factor that involves accessing breastfeeding-friendly places is only partially addressed since the BFHI improves opportunities for breastfeeding in health facilities, not public places. Finally, in terms of the stigma around breastfeeding and young mothers, the strategy does not adequately address this factor since it contains no steps to improve attitudes toward young mothers and destigmatize breastfeeding in public places.

Peer support networks provide young mothers with the opportunity to communicate with more experienced breastfeeders and receive emotional support. Therefore, they address certain personal factors affecting breastfeeding choices in young mothers, including inexperience in breastfeeding and the need for encouragement from others. However, it is unclear whether this strategy addresses the lack of support from women’s partners because breastfeeding counselors do not emphasize educating families. As for structural factors, although counselors can share their experiences with young mothers and give practical recommendations on how to deal with nursing a child in public and avoid conflicts with others, it would be an exaggeration to say that peer support networks destroy the stigma surrounding young mothers or make public places breastfeeding-friendly. It is because organizations and individuals involved in peer support networks do not actually work with people at large or promote positive images of young mothers countrywide. Based on the analysis of the two strategies, it is recommended to emphasize campaigns that would focus on changing society’s attitudes toward young mothers and the normalization of breastfeeding.

Conclusion

In summary, young mothers’ inability to follow the scientific community’s recommendations related to breastfeeding is a well-recognized public health issue. Young mothers in Australia and worldwide face multiple barriers to proper breastfeeding practices, including stigmatization, the lack of breastfeeding-friendly places, inexperience, and the lack of support from partners and peers. The existing strategies, including peer support networks and the BFHI, allow increasing breastfeeding initiation rates and promoting optimal breastfeeding duration in different demographic groups, including young mothers. However, further actions, for instance, campaigns, may be required to address the stigmatization of young mothers and breastfeeding in public places.

References

Australian Breastfeeding Association. (2016). Younger mothers and breastfeeding. Web.

Chopel, A., Soto, D., Joiner, B. J., Benitez, T., Konoff, R., Rios, L., & Castellanos, E. (2019). Multilevel factors influencing young mothers’ breastfeeding: A qualitative CBPR study. Journal of Human Lactation, 35(2), 301-317.

COAG Health Council. (2019). Australia National Breastfeeding Strategy: 2019 and beyond. Author.

Esbati, A., Henderson, A., Taylor, J., & Barnes, M. (2019). The uptake and implementation of the Baby Friendly Health Initiative in Australia. Women and Birth, 32(3), 1-11.

Forster, D. A., McLardie-Hore, F. E., McLachlan, H. L., Davey, M. A., Grimes, H. A., Dennis, C. L., & Shafiei, T. (2019). Proactive peer (mother-to-mother) breastfeeding support by telephone (ringing up about breastfeeding early [RUBY]): A multicentre, unblinded, randomised controlled trial. E Clinical Medicine, 8, 20-28.

Ogbo, F.A., Eastwood, J., Page, A., Arora, A., McKenzie, A., Jalaludin, B., Tennant, E., Miller, E., Kohlhoff, J., Noble, J., Chaves, K., Jones, J. M., Smoleniec, J., Chay, P., Smith, B., Oei, J. L., Short, K., Collie, L., Kemp, L., … Eapen, V. (2016). Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia. International Breastfeeding Journal, 12(1), 1-10.

Scott, S., Pritchard, C., & Szatkowski, L. (2017). The impact of breastfeeding peer support for mothers aged under 25: A time series analysis. Maternal & Child Nutrition, 13(1), e12241.

Smith, J., Cattaneo, A., Iellamo, A., Javanparast, S., Atchan, M., Gribble, K., Hartmann, B., Salmon, L., Tawia, S., Hull, N., Linkson, M., Blake, M., & Elliott-Rudder, M. (2018). Evidence check: Review of effective strategies to promote breastfeeding. The Sax Institute.

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Breastfeeding in Young Mothers

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