Factors Associated with Breastfeeding Initiation and Continuation

Conclusion

The aim of this meta-analysis was to investigate consistent results for certain perinatally identifiable factors associated with breastfeeding initiation and continuation. These should prove useful in developing targeted interventions to provide education and support for successful breastfeeding, thereby encouraging the prevalence of breastfeeding.

Background

Breastfeeding is the ideal form of infant nutrition. Exclusive breastfeeding through the first six months of the baby's life with continued breastfeeding up to their first birthday is generally recommended. However, breastfeeding rates frequently fall significantly soon after birth. In 2013 in the USA, 81% of infants were breastfed at birth but by three months of age, this figure had dropped to 44%.¹ Worldwide from 2007 to 2014, only approximately 36% of infants aged 0 – 6 months were exclusively breastfed.² This meta-analysis has identified factors to encourage the initiation and continuation of breastfeeding.

Methods

An initial search of the literature was conducted to identify characteristics that have been studied in relation to early breastfeeding. The main focus was on factors identifiable during the perinatal period and attainable from the event of the birth and/or during the early breastfeeding period. Postnatal changes in family, social or work-related events were not included. The search was conducted from January to May 2015 and included around 2,600 titles and abstracts, and 183 full text papers. After evaluating the evidence, six factors were identified for full systematic, quantitative evaluation:

1. Maternal smoking
2. Mode of delivery: vaginal or caesarean section
3. Parity (first pregnancy or multiple pregnancy)
4. Infant-mother separation (known as dyad)
5. Maternal level of education
6. Breastfeeding education

Key Findings

• Smokers breastfed less frequently and for shorter periods compared to non- smokers.
• Vaginal delivery was associated with an increase in exclusive breastfeeding and continuation compared to cesarean section.
• Multiparous women were more likely to breastfeed their infants exclusively and to continue breastfeeding after 6 months compared to primiparous women.
• Early skin-to-skin contact had a positive effect on breastfeeding.
• Breastfeeding initiation and continuation are more likely among women with a higher level of education.
• Prenatal breastfeeding education is associated with a higher breastfeeding rate.

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