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Background Many women find breastfeeding challenging to sustain beyond the first three postpartum months. Women rely on a variety of resources to aid and encourage breastfeeding, including ‘partner support’. Women’s perception of partner support during breastfeeding may influence maternal satisfaction and confidence but it remains understudied. We asked women about their perceptions of partner support during breastfeeding and measured the effect on maternal confidence, commitment, and satisfaction with respect to breastfeeding. Methods Using a descriptive, cross sectional design, we recruited 76 mothers from community health clinics in Calgary, Alberta. Participants completed a questionnaire addressing perceptions of partner support, the Breastfeeding Self-Efficacy Scale (BSES) measuring maternal confidence and ability to breastfeed, and the Hill and Humenick Lactation Scale (HHLS) measuring commitment, perceived infant satiety, and breastfeeding satisfaction. Descriptive analysis was performed on socio-demographic and survey responses. Multiple regression modeling was used to examine the association between partner support and breastfeeding outcomes. Results Women who reported active/positive support from their partners scored higher on the BSES (p < 0.019) than those reporting ambivalent/negative partner support when we controlled for previous breastfeeding experience and age of infant. There were no significant differences between the two groups of women on total score of HHLS or any of the subscales with respect to perceptions of partner support. Conclusion Mothers feel more capable and confident about breastfeeding when they perceive their partners are supportive by way of verbal encouragement and active involvement in breastfeeding activities. Mothers with partners who seemed ambivalent, motivated only by “what’s best for baby,” or provided negative feedback about breastfeeding, felt less confident in their ability to breastfeed. It is important that health care professionals appreciate the influence that positive and active partner support has upon the development of maternal confidence in breastfeeding, a known predictor for maintaining breastfeeding. Common support strategies could be communicated to both the partner and mother in the prenatal and postpartum periods. Health professionals can provide information, invite partners to become active learners and discuss supportive partner functions. Further research should address those functions that are perceived as most supportive by mothers and that partners are willing to perform.
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R E S E A R C H Open Access
Maternal perceptions of partner support during
Cynthia A Mannion
, Amy J Hobbs
, Sheila W McDonald
and Suzanne C Tough
Background: Many women find breastfeeding challenging to sustain beyond the first three postpartum months.
Women rely on a variety of resources to aid and encourage breastfeeding, including partner support. Womens
perception of partner support during breastfeeding may influence maternal satisfaction and confidence but it
remains understudied. We asked women about their perceptions of partner support during breastfeeding and
measured the effect on maternal confidence, commitment, and satisfaction with respect to breastfeeding.
Methods: Using a descriptive, cross sectional design, we recruited 76 mothers from community health clinics in
Calgary, Alberta. Participants completed a questionnaire addressing perceptions of partner support, the
Breastfeeding Self-Efficacy Scale (BSES) measuring maternal confidence and ability to breastfeed, and the Hill and
Humenick Lactation Scale (HHLS) measuring commitment, perceived infant satiety, and breastfeeding satisfaction.
Descriptive analysis was performed on socio-demographic and survey responses. Multiple regression modeling was
used to examine the association between partner support and breastfeeding outcomes.
Results: Women who reported active/positive support from their partners scored higher on the BSES (p < 0.019)
than those reporting ambivalent/negative partner support when we controlled for previous breastfeeding
experience and age of infant. There were no significant differences between the two groups of women on total
score of HHLS or any of the subscales with respect to perceptions of partner support.
Conclusion: Mothers feel more capable and confident about breastfeeding when they perceive their partners are
supportive by way of verbal encouragement and active involvement in breastfeeding activities. Mothers with partners
who seemed ambivalent, motivated only by whats best for baby,or provided negative feedback about
breastfeeding, felt less confident in their ability to breastfeed. It is important that health care professionals appreciate
the influence that positive and active partner support has upon the development of maternal confidence in
breastfeeding, a known predictor for maintaining breastfeeding. Common support strategies could be communicated
to both the partner and mother in the prenatal and postpartum periods. Health professionals can provide information,
invite partners to become active learners and discuss supportive partner functions. Further research should address
those functions that are perceived as most supportive by mothers and that partners are willing to perform.
Keywords: Breastfeeding, Perceived support, Partner
Efforts to increase breastfeeding rates have been
directed at all stages of a womans reproductive experi-
ence; during the preconception and prenatal periods,
within 24 hours of delivery, and throughout the
postpartum period in the hospital and at home. Since
1991 the Baby Friendly Hospital Initiative has been
implemented in many hospitals and recommends:
reduced use of infant formula; nurse assisted initiation
of breastfeeding immediately after delivery; the hiring
of lactation consultants for post-delivery assistance; and
referrals to outside breastfeeding resources upon dis-
charge [1]. None of these efforts seem to increase the
duration of breastfeeding.
Breastfeeding duration is highly variable and falls well
below the World Health Organization (WHO) and The
* Correspondence:
Equal contributors
University of Calgary, 2500 University Drive NW, Calgary AB T2N 1N4,
Full list of author information is available at the end of the article
© 2013 Mannion et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Mannion et al. International Breastfeeding Journal 2013, 8:4
United Nations Childrens Fund (UNICEF) recommen-
dations of exclusive breastfeeding (no artificial milk
substitutes or other fluids) for all infants to six months
of age [2]. Most Canadian women try to breastfeed their
infants and since 2003 breastfeeding initiation rates in
Canada have remained stable at about 87% [3]. However,
in 2007, only 23% of mothers reported exclusive breast-
feeding for six months [4]. Twenty-five percent of
women reported not enough milkas the most com-
mon reason for stopping breastfeeding. Insufficient milk
syndromewas recognized in the early 1980s and has
persisted to current day as the primary reason women
discontinue breastfeeding [5-7]. Although health care pro-
fessionals offer timely support to breastfeeding women,
the more constant presence and immediate support of the
babys father, or mothers partner offers opportunity to
influence the maintenance and duration of breastfeeding.
Fathers and partners have been identified as being
influential in mothersfeeding decisions and the con-
tinuation of breastfeeding [8,9]. If the mother feels that
the fathers attitude towards breastfeeding is positive and
supportive there is a greater likelihood that she will
continue breastfeeding [10,11]. Maternal perception of
a negative attitude from their partner influences when
a woman considers and decides to discontinue breast-
feeding [11].
As part of a larger study looking at breastfeeding self-
efficacy and medications used to increase milk supply [12],
we asked women about their decisions to breastfeed; to
identify breastfeeding supports and to describe their
perceptions of their partnerssupport and attitudes
throughout their breastfeeding experience. It was hypo-
thesized that those mothers reporting positive support
from their partners would have higher confidence in breast
milk production and higher breastfeeding self-efficacy.
Study design
This study is a descriptive, cross-sectional design using a
convenience sample of postpartum mothers. We mea-
sured maternal perception of partners attitudes towards
breastfeeding. The study was conducted in 2009 over a
five-month period at six Community Health Centres in
the Calgary region where women and breastfeeding in-
fants attended well-baby clinics. Calgary is located in
Southern Alberta with a growing and diverse population
of approximately one million people. The drop-in clinics
operated twice a week in the afternoons until the pan-
demic H1N1 protocols were initiated and the clinics
deployed for vaccination.
Recruitment posters describing the study were placed in
the Community Health Centres. Currently or recently
breastfeeding women were approached by clinic staff
nurses and referred to research assistants stationed at
each clinic. Study participants signed the consent form
and completed the demographic questionnaire, the
Breastfeeding Self-Efficacy Scale (BSES) and Hill and
Humenick Lactation Scale (HHLS) at the clinics.
Recruitment occurred over five months period from
June 2009 to October 2009 but ceased prematurely as
clinics focused on administration of H1N1 vaccinations
and mothers and infants were advised to stay away.
Criteria for inclusion were that the study participants
had to be English speaking, a mother of a breastfed
child, currently with a partner and residing in the
Calgary area. Participants were currently breastfeeding
or had recently attempted to breastfeed a singleton
infant. Exclusion criteria included mothers who had a
previous breast reduction or augmentation, illnesses such
as breast cancer that required mastectomy or breast lump
biopsy, and those who did not have a telephone. Babies
born less than 37 weeks gestation and infants with issues
that would have complicated breastfeeding, such as a cleft
lip or palate, were also excluded.
We collected data on variables known to affect breast-
feeding. Variables included: type of delivery; current
breastfeeding status; previous breastfeeding experience;
preparation for breastfeeding; period of time breast-
feeding and if formula was used at hospital or at home.
Perceived partner support was addressed on the demo-
graphic questionnaire with the open-ended questions
Do you feel supported by your partner to breastfeed
why or why not?and How do you think your partner
feels about breastfeeding?We also asked women to
identify all breastfeeding supports used and when they
decided to breastfeed.
The Breastfeeding Self-Efficacy Scale (BSES) is the
most widely used instrument employing the self-efficacy
concept [13-18]. It is a direct measure of a mothers
confidence in her ability to breastfeed [13]. Several stu-
dies have shown that women who have increased confi-
dence in their ability to breastfeed were more likely to
continue breastfeeding [14,19]. The BSES has been used
extensively for 10 years among a wide age range of
breastfeeding women in a variety of populations and has
been translated into four languages [20]. Dennis and
Faux reported a Cronbachs alpha co-efficient of 0.96
with 73% of all corrected item-total correlations ranging
from 0.3 to 0.70 [14]. The short form BSES is a 14-item
self-report instrument where all items are preceded by
the phrase I can alwaysand anchored with a 5-point
Likert scale where 1 = not at all confident and 5 = very
confident [14]. Items are summed to produce a score
Mannion et al. International Breastfeeding Journal 2013, 8:4 Page 2 of 7
ranging from 1470 with higher scores indicating higher
levels of breastfeeding self-efficacy [14].
The HHLS and perceived insufficient milk supply
The conceptual framework of perceived insufficient milk
supply was used to guide the development of the HHLS
[21]. Perceived insufficient milk persists as the primary
reason women discontinue breastfeeding [5,6,13,22-24].
The HHLS is a direct measure of the perception women
have of their milk production [21]. It has three subscales:
maternal commitment, maternal satisfaction, and infant
satisfaction. The HHLS is a 20-item self-report instru-
ment where all items are anchored with a 7-point Likert
scale where 1 = strongly disagree and 7 = strongly agree
and can be used for subscale analysis [21]. Items are
summed to produce a score ranging from 20 to 140 with
higher scores indicating higher levels of commitment
and perceived infant satiety [21]. All subscales show
moderate to high internal consistency (alphas 0.75 to
0.98) and concurrent and predictive validity [21]. It has
been used with diverse populations [20,25,26].
The study was approved by the Conjoint Health Re-
search Ethics Board of the University of Calgary (E ID-
Data analysis
Data were entered into a data file using Predictive
Analysis Software, (PAWS) 19.0 for analysis. Descriptive
statistics (means, standard deviation (SD), frequencies,
and percentages) were used to characterize the sample
and describe study variables. Chi-square tests and inde-
pendent sample t-tests were used to explore the relation-
ship between categorical and continuous variables,
respectively. Simple and multiple linear regression ana-
lyses were used to examine the association between
partner support and breastfeeding scales in unadjusted
and adjusted models for partner support, adjusting for
previous breastfeeding experience and infant age. A
p-value of < 0.05 was set as the level of significance.
Participantsresponses to How do you think your
partner feels about breastfeeding?were collated and
categorized by three independent reviewers, as positive,
negative or ambivalent. The responses to Do you feel
supported by your partner to breastfeed?were noted
and then matched to the previous questions catego-
rization for each woman. Where partners exhibited
active functions such as helped position the babyor
did the houseworkwomen responded they felt sup-
ported. We categorized that as positive/active. Com-
ments such as Glad it's me and not himand Does not
question me about itdid not elicit feelings of support
and we categorized them as negative. Ambivalent com-
ments included Wants me to do what Im comfortable
withand Not sure, I think he would rather me bottle
feed. We collapsed negative and ambivalent answers
together for comparison to the active/positive category.
The responses from the two questions were re-coded
into new variables labeled active/positive support and
ambivalent/negative support.
Seventy-six mothers were recruited to the study and
returned questionnaires. The participants were located
across the Calgary metropolitan area and represented a
range of incomes from all quadrants: the northwest,
northeast, southwest, and southeast. One third (n = 25)
of the women in our sample were less than 20 weeks
postpartum when they joined the study. The mean age
of the participants was 31 years (Table 1). The majority
of the women in our sample were highly educated and
Table 1 Demographic, pregnancy and postpartum characteristics for total sample and divided by maternal perception
of partner support
Characteristic Full sample
Active/positive support
p- value
More than high school education, n (%) 62 (82) 33 (87) 25 (78) 0.34
Married/living with partner n (%) 74 (97) 36 (95) 32 (100) 0.50 c
Age, mean (SD) 31.2 (4) 31.2 (4) 32.3 (4) 0.22
Infants age (weeks) 31 (17) 30.4 (17) 30.4 (17) 0.96
Ever attended prenatal classes, n (%) 58 (76) 29 (76) 24 (75) 0.90
C-section delivery, n (%) 24 (32) 11 (29) 11 (34) 0.67
Self-reported complications with delivery, n (%) 25 (33) 13 (34) 11 (34) 0.99
Previously breastfed a child, n (%) 32 (42) 13 (34) 15 (47) 0.28
Breastfeeding at study contact, (no formula) n (%) 43 (57) 26 (68) 14 (44) 0.04
Did not receive formula in hospital, n (%) 44 (58) 22 (58) 18 (56) 0.89
BSES score by type of support 59.71 SD = 9.33 55.13 SD = 7.58 0.03
Does not add to 76 because 6 women did not report.
p value of < .0.05 was considered significant.
Fishers exact test due to small cell sizes.
Mannion et al. International Breastfeeding Journal 2013, 8:4 Page 3 of 7
married or living with their partner. One third of women
decided to breastfeed during pregnancy (33%, n = 26).
Only four women (5%) reported discussing the decision
with their partner. Over half (58%, n = 44) reported they
were always going to breastfeed.
Many of the mothers in our study reported that they
had attended prenatal classes (76%, n = 56). Fifty-two
women (68%) gave birth vaginally and 24 (n = 32%) had
surgical deliveries. One third (n = 25) of our sample
reported complications with their delivery. Previous
breastfeeding experience was reported by 42% (n = 32) of
women. Over half the women (58%, n = 44) did not use
formula in hospital.
After partner support, the top three breastfeeding
supports reported by women were maternal mother
(65%, n = 49), friends (65%, n = 49), and physicians (61%,
n = 46). Women felt supported by health care profes-
sionals at the hospital (92%, n = 70) and following dis-
charge (96%, n = 73) with 77% (n = 59) seeking assistance
for breastfeeding post-discharge. Valuable information
was received from lactation consultants, nurses and
family members. The most useful information women
received for breastfeeding came from prenatal classes
and health care professionals. The information addressed
baby position and latch (25%, n = 15), supportive inter-
action (29%, n = 17), and advice on how to be patient
and to persevere (17%, n = 10) through breastfeeding
Two categories for perceived maternal support emerged
from the analysis of the open ended comments: active/
positiveand ambivalent/negative.Active/positive support
(n = 38) was characterized by reports of emotional and
functional support such as he is the transporter, brings
the baby to meand he is very encouraging.Fifty five
per cent of women perceived that their partner was
encouraging,23% said their partners thought breast-
feeding was best or healthiest for the baby. However, 22%
indicated that their partner felt indifferent or negatively
about breastfeeding. Ambivalent/negative support (n = 32)
was characterized by baby only related comments such as
Does not question me about itor good for baby and for
the economy.Frank negative comments about breast-
feeding included it was too time consuming,”“(he) feels
that it is healthy for baby but it interferes with intimacy,
and that (he) feels left out.
Descriptive characteristics for all women stratified by
type of partner support (active/positive and ambivalent/
negative) are shown in Table 1. There was a significant
difference between the two groups divided by perceived
type of support at study contact (p < 0.04). Women who
perceived active/positive support from their partners in
breastfeeding had higher mean scores of self-efficacy as
measured by the BSES than women who reported am-
bivalent/negative support (Score 59.7 (SD = 9.33) vs. 55.1
(SD = 7.58); p = 0.03). BSES scores ranged from 34 to 70
(total attainable score = 70), while for HHLS the range
was 62115 (total attainable score = 140). There were no
significant differences between the two types of perceived
support when comparing total HHLS scores or for any of
the HHLS subscales. In multiple regression analysis, the
effect of active/positive support remained a significant
predictor (p = 0.019) of BSES score, controlling for previ-
ous breastfeeding experience and age of infant (Table 2).
In this study we demonstrated that partner support and
encouragement were associated with maternal confi-
dence and a perceived ability to breastfeed. Women who
experienced positive and active support by their partners
showed higher confidence in their ability to breastfeed
than women with partners who were ambivalent or
negative towards breastfeeding. Partner support was pre-
dictive of maternal confidence in breastfeeding regard-
less of any previous breastfeeding experience or the age
of the infant.
In a mixed methods study examining fathers acting as
breastfeeding allies, Pontes, Osorio and Alexandrino
reported paternal attitudes towards breastfeeding includ-
ing ambivalence, conflict, exclusion, and insecurity. The
effect of these attitudes on maternal breastfeeding was
not mentioned [27]. We found similar behaviors per-
ceived by mothers that we termed ambivalent; (he) is
passive about it - goes along with my choices and what I
wanted to try;negative such as inconveniencedthat
adversely affected breastfeeding confidence. Mothers
also perceived that partners felt left out and that
Table 2 Unadjusted and adjusted regression models examining the association between partner support and
Breastfeeding Self-efficacy Scale (BSES) and Hill & Humenick Lactation Scale (HHLS) scores
Independent variable Unadjusted model Adjusted model
Unadjusted model Adjusted model
p- value
β(se) p- value β(se) p- value β(se) p- value
Active positive support 4.59 (2.06) 0.029 4.72 (1.97) 0.019 1.91 (1.92) 0.32 1.98 (1.94) 0.31
Previous breastfeeding experience 1.39 (2.01) 0.49 0.67 (1.97) 0.74
Age of infant (wks) 0.18 (0.06) 0.003 0.07 (0.06) 0.21
Partner support adjusted for previous breastfeeding experience and child age. β(se)
= regression coefficient; se = standard error.
p < 0.05. dReference group:
ambivalent /passive.
Mannion et al. International Breastfeeding Journal 2013, 8:4 Page 4 of 7
breastfeeding interfered with intimacy. The effect of
breastfeeding on intimacy is seldom mentioned in
studies but could be a marker of stress in the re-
establishment of sexual activity following childbirth and
a topic for sensitive discussion between parents and with
a health care professional.
We found that women breastfeeding at the time of the
study reported positive perceived paternal support when
compared to women who were not breastfeeding and
who recalled ambivalent or negative support. Fathers
may not recognize how influential active support is to
instilling and sustaining the confidence mothers develop
in breastfeeding. Active participation characterized by
fathers assisting with domestic chores, and presence
during breastfeedingwere perceived by mothers as posi-
tive support - he would sponge my breast before feeding,
with warm waterand he is the transporter...brings
the baby to me for feedingand he checked the (babys)
In contrast to earlier findings [10,11,28,29], our
study participants did not report that partners were
instrumental in their decision to breastfeed. The ma-
jority of our sample were always going to breastfeed,
often considered a predominant factor in infant feed-
ing decisions. A study by Datta, Graham and Wellings
found that although fathers were willing to support a
mothers decision to breastfeed, they did not feel that
they were able to be a part of the decision making
process [30]. This study found that fathers often felt
left out of the decision making process and that their
role was primarily one of providing supportive care
to the mother [30]. However, fathers who were
interviewed were conflicted as to how to provide sup-
port during specific breastfeeding challenges and were
thus,morelikelytosupportthemothers decision to
stop breastfeeding [30]. There is a growing body of lit-
erature suggesting that fathers should be included in
both the breastfeeding decision making process and
acquisition of positive, functional support behaviors
postpartum [8,27,31-34]. Fathers will require informa-
tion on the ways in which they can best support
mothers in meeting breastfeeding challenges.
Timing of support is important in the initiation and
maintenance of breastfeeding but also in the develop-
ment of maternal confidence. Learning the skills of
latching and positioning the baby early in the postpar-
tum period is critical to establishing breastfeeding
patterns and breast milk supply. Faced with challenges
such as engorgement, latching difficulties, fatigue and
perceived insufficient milk production, women without
support and resources are likely to give up[6,7,10].
Partners who are present during this period could offer
timely support and encouragement. Armed with infor-
mation and rudimentary skills they could be engaged in
targeted support activities. Timely partner intervention
may be crucial to the continuance of breastfeeding.
Our results indicate that active support measures such
as preparing baby and bringing beverages coupled with
positive verbal phrases encouraged and sustained maternal
confidence in breastfeeding. Health care professionals pro-
viding assistance in the prenatal and postpartum periods
have an opportunity to help partners recognize that
breastfeeding is best for babyas well as the effect of
encouraging words and deeds on mothersconfidence and
decision to continue breastfeeding. Strategies to actively
support breastfeeding have a greater impact on sustaining
mothersefforts. Verbal and nonverbal encouragement to
mothers from fathers was reported by Rempel and Rempel
to facilitate breastfeeding and was more likely to occur
when fathers had increased knowledge about
breastfeeding and used it to assist with breastfeeding chal-
lenges [33].
Involving fathers in breastfeeding will require in-
creased efforts on the part of health care professionals to
dispel the exclusivityof the mother/baby dyad. One of
these efforts will be to offer information to partners so
they can formulate knowledgeable solutions given prob-
lems they may witness. In 2006, Pisacane et al. found
that teaching fathers (intervention group) about fear of
milk insufficiency, transitional lactation crisis, return to
outside employment, and problems such as breast
engorgement, mastitis, sore and inverted nipples, and
breast refusaland preventive and management tech-
niques resulted in significant differences in successful
lactation and increasing breastfeeding rates compared to
the control group [11]. It should be noted that not all
partners may be interested in this level of involvement.
However, our results indicated that supportive partner
interaction, advice on how to be patient and to persevere
throughout breastfeeding challenges was the most useful
for women.
We found that responses to the HHLS were indistin-
guishable between our two groups termed active/positive
and ambivalent/negative. As one of the sub-scales mea-
sured maternal confidence and commitment, we would
have expected that maternal perception of active/positive
support from fathers may have positively affected mater-
nal confidence and this could have differentiated the
groups. It could be that the confidence in the ability to
breastfeed as measured by the BSES is more affected by
partner support than maternal perception of milk pro-
duction or the maternal assessment of infant satiety.
Key breastfeeding supports were identified by partici-
pants. Interestingly, for our sample, health care pro-
fessionals and mother/friends ranked almost equally but
we note that their information bases may be different.
Health care professionals offer evidence-based informa-
tion whereas mothers/friends may have their information
Mannion et al. International Breastfeeding Journal 2013, 8:4 Page 5 of 7
grounded in experience, folk lore, and television, internet
or media sources. Prenatal class information was also
identified as being helpful therefore relevant and accurate
breastfeeding content should be maintained.
Our research focused on maternal perception of
breastfeeding support not on the actions of partners.
Consequently, we cannot conclude that partners were
not providing instrumental, emotional, or other forms of
support, only maternal perception of that support. Infor-
mation could be provided to fathers to attend to how
mothers wish to be supported during the prenatal and
postpartum period and give examples of active and
positive supportive behaviors.
We used a convenience sample which is subject to selec-
tion bias and threatens the internal validity of our study.
Generalizability is limited by the small sample size of
our findings to other breastfeeding women. Another
limitation is that women reported their perceptions of
support at different times throughout the postpartum
period thus a womans initial perception of partner sup-
port may have changed depending whether breastfeeding
was maintained or stopped. Self-report is subject to
recall bias and some women may have forgotten their
initial perceptions of partner support. Verification of
emergent categories with women would have validated
the results.
Mothers reporting positive support from their partners
had higher confidence in breast milk production and
higher breastfeeding self-efficacy as measured by the
BSES. Our results concur with previous studies that
partners can influence a womans confidence in breast-
feeding [11,28,32]. More specifically, those fathers who
actively support and encourage women by helping pos-
ition the baby and bringing snacks and diapering, are
highly influential in a mothers perceptions of confidence
in breastfeeding. It is important that health care profes-
sionals appreciate the influence positive and active part-
ner support has upon maternal feelings of confidence in
breastfeeding and offer partners tips on common sup-
port strategies. In both prenatal classes and during post-
partum stay in hospital as well as postpartum visits,
health professionals can invite partners to become active
learners and highlight supportive functions that are
known to be meaningful to mothers. For some, learning
solutions to common breastfeeding challenges may offer
an opportunity for mothers to have an in-house re-
source. Future research could address knowledge gaps
partners may have, the effect of breastfeeding on sexual
intimacy for both parents and explore the disconnected-
ness partners have reported.
Competing interests
The authors declare that they have no competing interests.
CAM developed the design for the study and drafted the manuscript. AH
made substantial contribution to the acquisition of data and was involved in
manuscript revision. CAM, AH, SM and ST analyzed and interpreted the data
and were involved in manuscript revision. All authors read and approved the
final version.
CAM is an Associate Professor with the Faculty of Nursing, University of
Calgary. AH is a former student with the Faculty of Nursing, University of
Calgary. SM is a post doctoral fellow at the Child Development Centre,
Alberta Childrens Hospital. ST is a Professor, Departments of Pediatrics and
Community Health Sciences, Faculty of Medicine, University of Calgary
Health Scholar, Alberta Heritage Foundation for Medical Research Scientific
Director, Child Development Centre Alberta Childrens Hospital.
This research was supported by Nursing Research Endowment, Faculty of
Nursing, University of Calgary. The authors thank Debbie Mansell, Arsheen
Dhalla, Kristin Ruzicki, and Emmanuel Thompson for their assistance. We
would like to thank the mothers who shared their experiences and
perceptions with us.
Author details
University of Calgary, 2500 University Drive NW, Calgary AB T2N 1N4,
Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary,
Alberta T3B 6A8, Canada.
Received: 18 August 2012 Accepted: 5 May 2013
Published: 8 May 2013
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Mannion et al. International Breastfeeding Journal 2013, 8:4 Page 7 of 7
... This finding was consistent with other studies in Nepal that mothers who gained support from their husbands were 10 times more likely to breastfeed (23). Husbands' verbal support and active participation in breastfeeding activities makes mothers feel more capable and confident about breastfeeding (24). Husbands are highly influential in influencing mothers' decisions about breastfeeding their children and whether or not to continue breastfeeding (25). ...
... When mothers see their partner's support in the form of verbal encouragement and active participation in breastfeeding activities, they feel more capable and confident in their ability to breastfeed. Mothers who have partners who appear ambivalent, are motivated solely by 'what is best for the baby,' or provide negative feedback about breastfeeding have lower confidence in their ability to breastfeed (24). ...
... The help needed is not only verbal but also non-verbal, which is shown by concrete actions. More specifically, in previous studies, fathers who actively supported and encouraged mothers by helping position babies and carrying snacks and diapers, strongly influenced mothers' perceptions of trust in breastfeeding (24). ...
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Background: Indonesia is severely affected by the COVID-19 pandemic, particulary in the context of exclusive breastfeeding. Breastfeeding is the safest for babies in disaster situations, and the success of breastfeeding is a social and collective responsibility, as well as also a woman’s decision. The focus of this study is to explore the strengthening and weakening elements of breastfeeding experience during the COVID-19 pandemic. Methods: This is an exploratory qualitative study design, conducted in Yogyakarta Special Region Province, with nine lactating mothers who participated in the study. Interviews were audio-recorded, transcribed, translated and thematically analysed. Results: Strengthening elements in breastfeeding mothers during the pandemic were maternal affection to her baby, support system from family and community, and having adaptive coping strategy. The weakening elements were impaired comfort, insufficient milk supply, financial problem, parenting problem and indifferent husband. Conclusion: Breastfeeding a baby is appropriate even in a pandemic situation. Thus, to achieve good clinical practices that encourage breastfeeding, the support process should include a subjective and social component, and strengthen the support network of breastfeeding mothers in this COVID-19 pandemic situation. This will help to resolve the barrier in breastfeeding and the babies will receive their rights. Keywords: COVID-19 pandemic, elements, breastfeeding, strengthening, weakening
... supplemented to improve outcomes. Fathers' attitudes are identified as one of the principal determinants of breastfeeding decisions and experiences for women, and encouraging them to become part of a 'breastfeeding team' is an important way to encourage and include them (Wiessinger, 2009;Kenosi et al, 2011;Rempel and Rempel, 2011;Inoue et al, 2012;Mannion et al, 2013). However, this must be culturally appropriate in terms of male roles in society (Odeh Susin and Justo Giugliani, 2008). ...
... In international research, partner support has been shown to be predictive of maternal confidence in breastfeeding(Inoue et al, 2012;Mannion et al, 2013). ...
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The IPH support the Departments of Health on policy issues relevant to enhancing maternal and child health and reducing inequalities in child health outcomes. The IPH contribute to breastfeeding policy and practice across the island and completed an extensive review of the implementation of breastfeeding policy in the Republic of Ireland. This shaped the content of the 2017 action plan Breastfeeding in a Healthy Ireland . We contribute to the Research Subgroup of the group overseeing the implementation of Breastfeeding – A great start – A strategy for Northern Ireland 2013-2023. In addition, IPH contribute to the RoI Department of Health Working Group on a Folic Acid Policy which is examining policy options to reduce the incidence of neural tube defects in Ireland. Other policy team programmes of work also have a significant interface with maternal and child health, including our work on smoking and second-hand smoke and our work on obesity and alcohol.
... Maternal mental health constitutes a core factor related to face-to-face breastfeeding support, skin-to-skin contact after birth and partner's support, all interrelated factors connected to breastfeeding, one aspect of the gold standard infant care (102)(103)(104). There is evidence that most of these factors have been affected adversely by the COVID-19 pandemic. ...
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This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.
... For this reason, social and economic support from partners, and engagement from the district and Government to address the consequences of alcoholism in the community were identified as key needs. Indeed, research has shown that support from partners and family had, in fact, a positive effect on breastfeeding as mothers reported to be more confident and motivated [61]. Also, laws and regulations to support victims of abuse are needed at local level; the aim is to ensure an environment where women can safely nourish their children. ...
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Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.
Sub-optimal feeding practices among under-5 children are the major drivers of malnutrition. This study aims to assess the prevalence of malnutrition and the factors affecting exclusive breastfeeding, bottle feeding, and complementary feeding practices among under 5 children amid the COVID-19 pandemic as well as the economic and the political crises in Lebanon. A nationally representative stratified random sample of mother–child dyads (n = 511) was collected from households using a stratified cluster sampling design. The survey inquired about infant’s feeding and complementary feeding practices using a valid questionnaire. Anthropometric measurements of the mother and child were collected. Multivariate logistic regression was conducted to explore the determinants associated with under-5 children’s practices. The prevalence of underweight, stunting, wasting, overweight and obese children was 0.5%, 8.4%, 6.7%, 16.8% and 8.9%, respectively. In total, among under-5 children, the prevalence of ever breastfeeding, exclusive breastfeeding, and bottle feeding at birth was 95.1%, 59.1% and 25.8%, respectively. Half the children in this study started solid foods between 4 and 6 months. Regression analysis showed that supporting breastfeeding at hospital (aOR = 8.20, 95% CI (3.03–22.17)) and husband’s support (aOR = 3.07, 95% CI (1.9–4.92)) were associated with increased breastfeeding odds. However, mother’s occupation (aOR = 0.18, 95% CI (0.55–0.58)) was inversely associated with breastfeeding practices. Male children (aOR = 2.119, 95% CI (1.37–3.27), mothers diagnosed with COVID-19 (aOR = 0.58, 95% CI (0.35–0.95)), and bottle feeding at hospital (aOR = 0.5, 95% CI (0.32–0.77)) were more likely to induce early initiation of solid foods at 4 months of age. This study demonstrated non-negligible rates of malnutrition, low prevalence of exclusive breastfeeding, and high rates of early introduction of formula feeding and solid foods among Lebanese under-5-children amid escalating crises.
Breastfeeding is an important public health issue that significantly intersects with work, gender, and family relationships. Prior research has focused on partner dynamics in the breastfeeding family and specifically shown that male partners heavily influence women’s breastfeeding decisions and experiences. Much of this research emphasizes net gains of men’s involvement in breastfeeding. While acknowledging the importance of involved fathers early on, we argue for recognizing the dual potential for men’s involvement in breastfeeding to be both affirming and undermining to their breastfeeding partners. As part of a workplace case study, we conducted semi-structured, in-depth interviews with 32 women who were currently or recently breastfeeding. We identified four major themes: (1) encouraging/discouraging breastfeeding, (2) acknowledging/overlooking breastfeeding labor, (3) supporting/undermining breastfeeding decisions and goals, and (4) assisting with/avoiding domestic labor. Education directed at men should address the issue that not all intended support actions may be perceived as supportive by breastfeeding women and should provide concrete guidance on how men can be supportive, centering the needs of breastfeeding women.
Objective: To synthesize the findings on the effect of technology-mediated education intervention in the first year after birth on maternal health outcomes and to evaluate interventions for participant perspectives and health equity. Data sources: We conducted a systematic review of the literature using the electronic databases PubMed, Embase, and CINAHL for articles published between 2010 and 2020. The search strategy was developed by a health sciences librarian. Study selection: We included articles if the following criteria were met: they reported studies conducted in the United States or a resource-similar nation on the evaluation of a technology-mediated education intervention within the first year after birth and they included the assessment of at least one maternal health outcome. Data extraction: The lead author extracted data from the full-text articles and entered them into Microsoft Excel. We assessed the quality and risk of bias using the Cochrane Collaboration's tool for examining the potential risk of bias. Data synthesis: We identified 21 articles that met the inclusion criteria. Videos were the most commonly reported technology-mediated education intervention, followed by text messages, phone calls, and websites. Maternal health outcomes addressed in the included articles were mental health, weight loss, breastfeeding, general postpartum education, perineal care, and substance use. Technology-mediated education interventions positively affected mental health, weight loss, and breastfeeding outcomes. Conclusion: The current evidence suggests that technology-mediated education intervention is beneficial for the physical and mental health outcomes of women during the first year after birth. Future work may benefit from more attention to health equity and design in collaboration with women to gain a better understanding of the information needs and desired technology features.
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Background: Several lifelong maternal, child and societal health benefits have been associated with exclusive breastfeeding (EBF). However, despite all the potential advantages, EBF rates have been consistently low in developing countries, including South Africa. It has been suggested that the knowledge, attitudes and practices of male partners in relation to EBF are amongst the important factors that contribute to the success of EBF practices. Hence, the aim of this study was to determine the knowledge, attitudes and practices of men in Botshabelo, Free State province, South Africa, regarding EBF. Methods: This study was designed as a cross-sectional analytical study that utilised a structured questionnaire administered to 200 adult men attending the outpatient department of a district hospital, in the Free State province, South Africa. Results: The majority (n = 83; 41.5%) of participants had poor knowledge of EBF but reported positive attitudes (n = 153, 76.5%) and good practices (n = 151, 75.5%) towards EBF, respectively. Age, levels of education, employment status, marital status and whether the participant accompanied his partner to the antenatal clinic were associated with adequate knowledge, positive attitudes and good practices in relation to EBF (p 0.05). Conclusion: The study revealed a suboptimal level of knowledge on EBF in men in Botshabelo. Most men had positive attitudes and reported good practices in relation to EBF. Our findings highlight the need for targeted community-based intervention programmes directed to educating and promoting positive social and cultural change in relation to EBF amongst men in Botshabelo.
Women living in abusive relationships who choose to breastfeed their infants may do so for many reasons: bonding, health benefits for the infant and themselves, economics, and so on. Along with these benefits they are also choosing to engage in an activity that is often perceived as deeply gender performative. This study examines the gender performativity through breastfeeding of mothers living with intimate partner violence (IPV) and the ways in which these mothers use breastfeeding successfully (and unsuccessfully) to achieve what Butler (2004) terms a “livable life.” Semi-structured qualitative interviews were conducted with thirteen mothers who lived with abusive partners while breastfeeding. Content analysis was used to examine the women’s accounts for gender performativity around breastfeeding. Gender performativity was used by these mothers successfully and unsuccessfully to attempt to stem the violence and chaos in their relationships. Mothers attempted to fulfill traditional female roles to appease abusive partners, used breastfeeding to protect themselves and their infants, and also drew strength from family, friends and medical/support professionals by fulfilling the ‘good mother’ role through breastfeeding.
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This longitudinal study examined how male partners affect the breastfeeding decisions and behavior of first-time mothers. Based on the reasons model by Meichenbaum and Fong (1993), the breastfeeding reasons, intentions, and behavior of 317 first-time mothers were assessed prenatally and at six time points in the first year postpartum. In a prenatal assessment, men indicated their prescriptive beliefs about whether their partner should breastfeed at the same six time points. Men's prescriptive breastfeeding beliefs pre- dicted the strength of their partners' breastfeeding intentions, over and above the women's own breastfeeding reasons, and they predicted breastfeeding behavior over and above the women's intentions. These results demonstrate the influence wielded by intimate partners and highlight the importance of focusing on partners' beliefs when predicting and intervening in health behavior decisions.
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To explore male partner's perceptions of breastfeeding to inform the development of interventions to increase their support of breastfeeding. Qualitative grounded theory. Participants were recruited and interviewed in two Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics located Honolulu, Hawai‘i. Fourteen male partners of low-income pregnant women or new mothers. Male partner attitudes, knowledge, and feelings were collected through private interviews. Interviews were transcribed verbatim and data were analyzed using grounded theory methods. All men appreciated breastfeeding's health benefits, acknowledged that it was natural, and were empathetic to the efforts of their partners. The men also discussed not being involved in the breastfeeding decision, believing formula feeding was more convenient than breastfeeding, feeling left out of the infant-feeding process, and being uncomfortable with breastfeeding in public. Findings suggest that an intervention to increase male partner support of breastfeeding should include multiple components to enhance knowledge, to empower men to be more engaged in the breastfeeding decision, to provide specific tips on how men can be involved in breastfeeding, and to increase comfort with breastfeeding in public. A multicomponent framework such as the social cognitive theory could be useful in guiding the development of such an intervention.
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Objective. To examine the association of self-efficacy, perception of milk production, and lactating women's use of medication prescribed to increase breast milk in a cohort of 18-40-year-old mothers over six months. Methods. Mothers (n = 76) attending community clinics completed the Breastfeeding Self-Efficacy Scale and the Humenick/Hill Lactation Scale, a measure of perceived milk production, three times. Results. Domperidone, a dopamine antagonist, was used by 28% of participants. On average, those using domperidone had lower self-efficacy scores than those not using it (P < 0.05) and were more likely to have used formula (Pearson chi-square test statistic  = 6.87, df = 1, P < 0.05). Breastfeeding self efficacy and perception of milk production were positively correlated. Conclusion. Breastfeeding assessment conducted prior to prescription of galactogogues is recommended for mothers and healthy term babies. Following Baby-Friendly hospital protocols and increasing self-efficacy for lactating women may be most effective in sustaining breastfeeding. Risks and benefits of various galactogogues are discussed.
Background: In recent years closer attention has been paid to the role of fathers in both the decision about whether to breastfeed and in supporting a breastfeeding mother. This qualitative study explores couples’ decision making regarding infant feeding, parents’ views on the father’s role in relation to breastfeeding, and examines some dilemmas fathers face when supporting a breastfeeding partner. Methods: Eighteen men and women using maternity services at the Royal Sussex County Hospital were interviewed by telephone. Results: Fathers acknowledged that the decision to breastfeed should be made by the mother and a father’s role was to endorse his partner’s decision and provide practical and emotional support. Those who faced breastfeeding difficulties described the processes involved in deciding whether to continue. Conclusions: This small study draws upon the views of men and women living in the south-east of England in a city with high rates of breastfeeding initiation. Findings may not be generalizable to the wider population. However, in this setting new parents need information about breastfeeding and support to make informed decisions about duration and further input from health professionals when facing difficulties. Key points: • It has been established that paternal support has a positive impact on initiation and duration of breastfeeding • Participants in this study acknowledge the dominance of mothers in the decision to breastfeed • In their view the role of the father is to care for and support his breastfeeding partner • Fathers reported facing a dilemma supporting women who experience breastfeeding difficulties as they do not want to undermine her efforts but wish to protect her from the pain and exhaustion some women experience
The authors discuss the “insufficient milk syndrome” associated with the decline of breastfeeding in the urbanizing world and offer a biocultural model to demonstrate its complex transcultural etiology. Rejecting the common explanation of insufficient milk reports as rationalizations of women no longer interested in breastfeeding, the authors suggest that the syndrome stems from the spread of nonbiological breastfeeding patterns in industrializing, urbanizing societies. This paper describes the syndrome and its effects on infant feeding patterns, explains the biocultural model, and considers some possible interventions to affect its course.
Many new mothers discontinue breastfeeding prematurely. Researchers have shown that maternal confidence is an important factor in the continuation of breastfeeding. The purpose of this methodological study was to develop and conduct preliminary psychometric assessment of an instrument to measure confidence in new breastfeeding mothers. Using self-efficacy theory as a conceptual framework, the Breastfeeding Self-Efficacy Scale (BSES) was developed and content validity was judged by a panel of experts and through interviews with experienced breastfeeding mothers. Following a pilot test, the revised BSES was assessed with 130 in-hospital breastfeeding mothers for reliability and validity, including internal consistency, principal components factor analysis, comparison of contrasted groups, and correlations with measures of similar constructs. Support for predictive validity was demonstrated with positive correlations between BSES scores and infant feeding patterns at 6 weeks postpartum. Following further testing, this instrument may be used to identify new mothers with low breastfeeding confidence who are at high risk to prematurely discontinue breastfeeding. © 1999 John Wiley & Sons, Inc. Res Nurs Health 22:399–409, 1999
Insufficient breast milk is a major reason why mothers give up breastfeeding and may be related to low levels of maternal confidence. This study explored the relationship between parenting self-efficacy (PES) and perception of insufficient breast milk. Cross-sectional descriptive correlational study. Four private primary care pediatric practices in the northern United States. Sixty breastfeeding mothers of infants ages 1 to 11 weeks. Mothers were recruited during well-baby pediatric visits. They returned completed questionnaires by mail. Data were analyzed using descriptive statistics, t tests, and multiple regression analysis. The Perception of Insufficient Milk (PIM) questionnaire, an investigator-developed instrument. There was a significant correlation (r = .487, p < .01) between the self-efficacy and perceived insufficient milk scores. Regression analysis revealed that 23% of the variance in PIM was explained by PES, after maternal age, education, and parity had been taken into account. Although further research is needed to refine the measurement of perceived insufficient milk and differentiate breastfeeding self-efficacy from general parenting self-efficacy, nursing interventions to enhance self-efficacy may improve mothers' confidence in the adequacy of their milk supply.
Health visitors have a central role in delivering and leading on the new UK government targets on breastfeeding as part of the strategy to reduce health inequalities. This article explores fathers' views and proposes that health visitors are best placed to engage with fathers in supporting the initiation and continuance of breastfeeding. To conduct initial pilot scoping of fathers' views on breastfeeding in order to provide insights into possible interventions which could contribute to increasing rates of exclusive breastfeeding. Eight individual in-depth interviews were conducted with fathers (aged 28-47) from different socio-economic groupings living in Brighton and Hove (UK). Data were collected as part of a larger social marketing project focussing on increasing rates of exclusive breastfeeding in Brighton and Hove. Fathers were recruited through their partners whom had been interviewed previously about breastfeeding. Interviews were digitally recorded, transcribed, and analysed using a 'framework' approach. Data reveal that fathers are interested in breastfeeding and want to be involved more broadly in preparation for, and supporting of, breastfeeding. Fathers reported requiring more relevant and accessible information about the benefits of breastfeeding as well as details concerning some of the practical issues involved in supporting their partner's breastfeeding. Although in our study fathers reported wanting to be involved in supporting breastfeeding, it is likely that current discourses about men and fathers as well as more practical worries and concerns may prevent some health visitors and other health professionals from involving them in meaningful ways. Whilst our study is limited in its scope and more research is needed, our data indicates that fathers are potentially a missing part of the jigsaw in terms of breastfeeding support.