One of the most influential factors on the mother’s intention to practise exclusive breastfeeding is the sets of beliefs that underpin a behaviour. There are some intrinsic and
extrinsic factors that reflect the mothers’ behavioural beliefs related to exclusive
breastfeeding. In the current research all the research participants talked about having a positive attitude towards breastfeeding. All of the behavioural beliefs mentioned by the participants in my research were similar to the findings in other studies conducted in the USA, Africa and Asia ( Bai et al., 2010; Ismail et al., 2013; Naanyu, 2008; Swanson and Power, 2005). Perceptions of breastfeeding as a natural method of infant feeding, the health benefits of breastfeeding for the mother and baby, the financial benefits of breastfeeding, and difficulties preparing formula, for example, were reported by Swanson and Power (2005) as the main reasons for mothers choosing to breastfeed their babies.
Olivia, who breastfed exclusively for the full six months spoke favourably about the health benefits of breastfeeding for the baby labelling breast milk as “liquid gold”. She also recounted the other advantages of breastfeeding such as its naturalness, ease and availability. Probably because it’s just what I do and I don’t know anything else. To me it’s just so natural, it’s the way it is, it’s the liquid gold and it’s everything to a baby, so that is a huge reason. It’s easy, it’s always there - available. (Olivia, March 2014)
Olivia’s enthusiastic support for breastfeeding is consistent with research which shows
that mothers who have a good level of knowledge about the health benefits of breastfeeding compared to formula feeding are more likely to plan to breastfeed their babies (Alexy & Martin, 1994; Khoury et al., 2005; Meyerink & Marquis, 2002; Wambach, 1997).
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Both Ashley and Madelyn also mentioned that their educational background was the key influence on their decision to exclusively breastfeed their babies.
I kind of have a bit of educational background in it as well, so I know that it’s good for baby and that’s probably always influenced my decision just ‘cos I know that it’s the best, a really good option for baby. (Ashley, February 2014)
I think the key thing from my point of view was my existing knowledge about breastfeeding, which has come from multiple sources including my [educational background]. (Madelyn, October 2013)
Madelyn returned to work shortly after the birth of her son and continued to breastfeed exclusively for more than five months. After five months Madelyn started a small amount of solids while continuing breastfeeding as the main source of nutrition for her son.
Kate was another participant who exclusively breastfed her baby for the full six months. She identified that when she was pregnant the main factor that influenced her decision to breastfeed exclusively for six months was a recent contaminated infant formula scandal. This scandal confirmed her belief that breastfeeding is the only natural and safe method of infant feeding.
Just it’s a natural thing, and well, I don’t want to pay for formula as well [laughs], and also like you just see in the news about Fonterra and formula scares and things, and it was also why would I ever do that? So it was quite an easy decision to exclusively breastfeed. (Kate, January 2014)
In 2013, the New Zealand company “Fonterra”, which is one of the largest dairy
companies in the world, reported the presence of botulism in infant formula exported to countries such as China, Malaysia and Thailand (Mullany, 2013). It is notable that the consumption of even the small amount of botulism can cause severe poisoning and fatalities. China was the largest market for the New Zealand infant formula which was imported due to
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the parents’ concerns about the safety of Chinese infant formula (Mullany, 2013). The 2013 Fonterra incident was preceded by a 2008 contaminated infant formula incident that also involved a Chinese company in which Fonterra was a shareholder. In 2008, in China six babies died as a result of formula contaminated by melamine and at least 300,000 other Chinese children became sick (BBC, 2010). In the past melamine was used as a component in the process of making plastics, fertilisers and concrete. In the melamine scandal this product was added to watered-down milk in order to show a fake high protein content. When this milk was powdered and used to make infant formula it caused renal damage and kidney failure in a small number of babies (BBC, 2010).
Victoria and Abigail who exclusively breastfed their babies for five and four months respectively, also spoke about the health benefit of breastfeeding for the baby. They said that they chose exclusive breastfeeding as the best method of infant feeding due to its health benefits for the baby alongside other advantages. For example, both of them claimed that in comparison with bottle feeding, breastfeeding is much more practical method of infant feeding.
I think probably the main one was how good it is for them, and just all the information about all the antibodies and all that kind of thing. But I think a very close second is probably how cheap and convenient it is. You don’t have to muck around with bottles or buy formula, everywhere you go you’ve got your breasts with you, you don’t have to take anything. But the main reason is definitely the health one, but just the practicalities of it are much easier than formula feeding. (Victoria, February 2014)
Probably like just common understanding that it’s better for the baby and gives them more nutrients and stuff like that and immunity. And it’s just easier than using a bottle definitely at the beginning - I mean not having to heat a bottle and do all that sort of stuff just right there especially when they’re demand feeding and sometimes quite regularly. (Abigail, October 2013)
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Zoey and Nicole, identified the health benefits of breastfeeding for their babies as the main reason for exclusively breastfeeding their babies for six months. They also mentioned a range of other advantages of breastfeeding like naturalness, ease, and cost as well as the health and appearance benefits for the mother such as losing pre-pregnancy weight.
Probably the health benefits - yeah from an issue of health - and yeah so I think it has a lot of health benefits for the baby. But also well for me in losing weight and that kind of thing - but yeah definitely the health benefits for her [baby]. Also I think it’s just a lot easier than – yeah the main thing would be that it’s good for the baby. Yeah and then probably secondary to that it’s a lot easier than having to muck around with formula and cheaper as well you know? [Laughs]. (Zoey, December 2013)
To me, it’s the most natural thing, and the biggest thing is the allergy side of it. Yeah, it’s just a natural thing, but I was open to if I couldn’t then I’d have to look into other options. But it was just the most natural thing. (Nicole, May 2014)
The influential factors related to behavioural beliefs that are demonstrated by many studies are having experience of successful exclusive breastfeeding, being breastfed as a child, having friends or family members who are breastfeeding, level of education and being familiar with the health benefits of exclusive breastfeeding for the baby (Natan et al., 2015; Chung, Kim, & Nam, 2008; Scott, Binns, Oddy, & Graham, 2006; Swanson & Power, 2005).
Maya, Mackenzie and Sydney spoke about how their successful experience of breastfeeding with older children was the main reason for their antenatal intention to breastfeed exclusively again:
The fact that, it was very successful with my son, it was the main reason that I want to do with her, I found it quite easy with my son. (Maya, October 2013)
I just know it’s best to breastfeed the baby and if I can do it, which I obviously have been able to with all three of my children, why not? And I don’t want to pay for formula if I can breastfeed. (Mackenzie, June 2014)
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I like the whole bonding side of it which is really nice. Experiencing that with my son as well the first time you realise it is a very close thing that only you can do for your baby. And you just feel that you know you’re giving them the best and it’s perfect for them and you want that for your baby if you can. (Sydney, March 2014) As the current research participants mentioned in above interview extracts, having
breastfeeding experience was a positive influence on the mother’s behavioural beliefs.
Therefore, mothers who do not have experience of breastfeeding may face challenges during the difficult time of establishing breastfeeding. Likewise, a qualitative study in the Netherlands (Oosterhoff, Hutter, & Haisma, 2014), used the theory of planned behaviour to investigate why first time-mothers who had a strong antenatal intention to breastfeed, did not achieve this goal after the birth of their babies. They found that as their research participants were the first-time mothers, the lack of breastfeeding experience was the most influential factor that negatively interfered with their intention to breastfeed their babies.
In the current study a first-time mother, Brianna, who exclusively breastfed her baby for more than five months spoke about her passion about breastfeeding, at the time of the interview she was a full time employee on the paid maternity leave. Brianna was determined to breastfeed exclusively because most of her friends had not succeeded.
Probably talking to friends I think would be because a lot of the people that I know, particularly at work, didn’t breastfeed at all, and actually hearing that they didn’t made me want to more and made me quite determined to because I knew that it wasn’t as common probably as I think that it should be. Yeah I feel like hearing about people who it didn’t happen for made me really want to do everything I could to make it work for me. (Brianna, February 2014)
Brianna’s discussion of her motivation and confidence is consistent with the findings of an Australian study about the impact of psychosocial factors on exclusive breastfeeding (de
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Jager et al., 2015). The researchers examined psychological variables including maternal self-efficacy, body attitude, psychological adjustment, attitude towards pregnancy, intention, motivation and confidence with exclusive breastfeeding using a wide range of psychometric tools. The researchers found factors that influenced the six months exclusive postpartum behaviour were maternal breastfeeding self-efficacy, confidence to sustain breastfeeding until six months postpartum, psychological adjustment to motherhood and feeling obese.
They suggested that in order to improve women’s confidence with exclusive breastfeeding,
social support during pregnancy combined with individualised education about exclusive breastfeeding should be initiated.
Participants in this research identified the health benefits, naturalness, convenience, cost, prior knowledge and previous successful breastfeeding experiences as key factors that supported the intention, initiation and prolonged duration of exclusive breastfeeding. As a favourable attitude towards exclusive breastfeeding influences breastfeeding behaviour, in order to improve exclusive breastfeeding rates it is important to increase the mothers’ knowledge of the economic and health benefits of breastfeeding alongside other advantages such as convenience compared to formula feeding.