Constraints to Exclusive Breastfeeding: Findings and Recommendations

1) Purpose: To raise awareness of low exclusive breastfeeding rates around the world as a serious public health concern. To educate public health professionals about factors that influence EBF rates using a conceptual framework that includes the impact of 1) healthcare systems and providers, 2) social, economic and political factors, and 3) media and marketing. Each factor is assessed for constraints that arise at specific points in time during the EBF decision-making and behavior continuum. To identify gaps and outline areas for potential change by timing and type of intervention. To recommend strategies for ameliorating constraints to EBF made within the context of the contextual model employed.

2) Data and Info Used: MEDLINE, PUBMED, ASSIA, and CINAHL were searched using broad-based terms in order to maximize results of the literature review. US National Immunization Surveys and Demographic and Health Surveys were reviewed to determine county-by-country breastfeeding rates and trends.

3) Methods used: The literature review included six components: 1) searching the published literature for EBF-specific publications, 2) assessing methodological validity, 3) assessing the applicability of the evidence to this model and for the US, 4) organizing evidence into the above-noted conceptual model by timing of the potential intervention, 5) extrapolating themes and possible recommendations, and 6) seeking review by those with experiential inputs.

Publically-available, country-level breastfeeding statistics were reviewed to contextualize research findings regarding particular countries.

4) Results: Optimal breastfeeding rates are impacted by myriad factors including, but not limited to healthcare systems and providers. Other key variables to consider include social, economic and political factors, and media and marketing of infant formula. Constraints within these realms present at specific points in time during the EBF decision-making and behavior continuum.

5) Recommendations: Barriers to EBF can be decreased, and EBF rates can increase when public health professionals develop appropriate types of interventions for intended use at particular time points. Ten policy and programmatic recommendations will be offered accordingly.