Date of Defense:
Methods: Primary qualitative and quantitative studies from peer-reviewed journals were sought using Ovid and PubMed. Forty-seven primary studies were reviewed and supplemented by governmental and professional publications. Barriers to breastfeeding were organized under macro-environmental, institutional, social environmental and attitudinal, behavioral and cultural themes.
Review: Certain sociodemographic characteristics decrease the likelihood of women successfully breastfeeding. Breastfeeding is also affected by existing trends in healthcare delivery, programs and policies. Many perceived barriers related to social norms, support and knowledge. Most states have yet to secure laws protecting and promoting breastfeeding in the workplace and employment continues to be negatively associated with breastfeeding. Formula marketing is detrimental to breastfeeding and supplemental use of formula is associated with shorter durations of breastfeeding.
Results: Many studies had small sample sizes, were prone to recall and selection biases and had narrow generalizability to other populations. The definition of breastfeeding and its measurement varied greatly, making comparisons between studies difficult. More randomized control trials testing interventions are needed. To be concordant with national breastfeeding goals, U.S. studies should report rates at six and twelve months postpartum.
Conclusions: Increasing breastfeeding support and promotion requires a myriad of interventions, education and policy changes. The Baby-Friendly Hospital Initiative and the World Health Organization’s Code of Marketing Breastmilk Substitutes offer sound guidelines to follow but conflict with current U.S. healthcare and the social-political climate.