**2. Factors related to the breastfeeding initiation and duration**

In general, the factors that influence the success or abandonment of breastfeeding have been classified into sociodemographic, biophysical, and psychosocial factors. Several factors have been linked to the initiation and duration of breastfeeding, which can be classified as nonmodifiable factors (**Figure 1**) and modifiable factors (**Figure 2**).

Adolescent mothers express that the decision to breastfeed is taken before birth and that the opinions of their partner and family members about the breastfeeding process may affect its onset. Influences on breastfeeding include its impact on social and intimate relationships, the availability of social support, the physical demands of breastfeeding, knowledge of breastfeeding practices and their benefits, and the sensation of comfort perceived by the mother regarding breastfeeding [16]. In this age group, mothers who have a better prenatal attitude to initiate breastfeeding, and with higher confidence levels in pre and postnatal care, are sig-

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In this way, breastfeeding has a multifactorial behavior. In addition to sociodemographic factors, clinical factors, and habits, a wide range of social, psychological, and cultural factors of each woman determines the decision and ability to successfully initiate breastfeeding; operat-

If the focus is placed on an anthropological approach to breastfeeding, the cultural norms of a society have a powerful influence on decisions regarding health, such as the choice of an infant feeding method. Therefore, attitudes and beliefs about breastfeeding are important and

nificantly more likely to maintain breastfeeding 4 weeks after birth [17].

ing at different levels from the individual to society (**Figure 3**).

**Figure 1.** Nonmodifiable factors related to breastfeeding.

The main sociodemographic factors that influence the duration of breastfeeding are age, marital status, and income level. Therefore, successful long-term breastfeeding is less likely to occur in younger women with a low educational level, single women, and women with a lower income [12].

One review recently highlighted high impact factors such as smoking, mode of delivery, parity, separation of the mother-child dyad, maternal education, and maternal education on breastfeeding [13]. As an example, women who graduated from high school or higher educational institutions received education regarding breastfeeding, breastfeed within 1 hour after birth, and did not work had significantly higher rates of exclusive breastfeeding at 6 months. However, the breastfeeding rate in the first 6 months was significantly lower for women who lived with their parents and who were smokers [14]. Maternal age is directly associated with the duration of breastfeeding, observing that adolescents have lower breastfeeding rates, as well as a shorter duration [15].

Introductory Chapter: A Comprehensive Approach to the Process of Breastfeeding http://dx.doi.org/10.5772/intechopen.82177 3

**Figure 1.** Nonmodifiable factors related to breastfeeding.

medical contraindications to breastfeeding being rare [5]. Additionally, in their last policy statement regarding breastfeeding, they recognized that the decision to breastfeed should not be conceived by the mother, doctor, or society as a lifestyle option but as a basic and critical health decision that affects the welfare of the baby and the mother and therefore should be considered regardless of the parenting style or as a simple nutritional problem. They also emphasized that professionals must go beyond the maternal–infant binomial and incorporate new principles and concepts in daily activities to be true advocates and supporters of breast-

In lower income countries, breastfeeding is associated with a significant reduction in infant mortality and disease, and it is estimated that a high degree of protection, promotion, and support for breastfeeding can potentially prevent 1.3 million child deaths per year [8]. It has been estimated that if children under 1 year of age were breastfed for at least 4 months, 56.4% of hospital admissions for infection of nonperinatal origin could be prevented [9]. In addition, there is evidence that breastfeeding decreases the incidence and severity of digestive, respiratory, urinary, and middle ear infections, as well as atopic diseases; producing a lower incidence of sepsis and necrotizing enterocolitis in preterm infants [10]. In the long term, breastfeeding has beneficial effects on cardiovascular risk factors, reduces the risk of obesity during childhood, and improves cognitive development. Additionally, breastfeeding women have a lower risk of developing breast cancer, better spacing of births, and lower risk of dia-

betes and ovarian cancer compared to women who have never breastfed [11].

**2. Factors related to the breastfeeding initiation and duration**

modifiable factors (**Figure 1**) and modifiable factors (**Figure 2**).

In general, the factors that influence the success or abandonment of breastfeeding have been classified into sociodemographic, biophysical, and psychosocial factors. Several factors have been linked to the initiation and duration of breastfeeding, which can be classified as non-

The main sociodemographic factors that influence the duration of breastfeeding are age, marital status, and income level. Therefore, successful long-term breastfeeding is less likely to occur in younger women with a low educational level, single women, and women with a

One review recently highlighted high impact factors such as smoking, mode of delivery, parity, separation of the mother-child dyad, maternal education, and maternal education on breastfeeding [13]. As an example, women who graduated from high school or higher educational institutions received education regarding breastfeeding, breastfeed within 1 hour after birth, and did not work had significantly higher rates of exclusive breastfeeding at 6 months. However, the breastfeeding rate in the first 6 months was significantly lower for women who lived with their parents and who were smokers [14]. Maternal age is directly associated with the duration of breastfeeding, observing that adolescents have lower breastfeeding rates, as

feeding [6, 7].

2 Selected Topics in Breastfeeding

lower income [12].

well as a shorter duration [15].

Adolescent mothers express that the decision to breastfeed is taken before birth and that the opinions of their partner and family members about the breastfeeding process may affect its onset. Influences on breastfeeding include its impact on social and intimate relationships, the availability of social support, the physical demands of breastfeeding, knowledge of breastfeeding practices and their benefits, and the sensation of comfort perceived by the mother regarding breastfeeding [16]. In this age group, mothers who have a better prenatal attitude to initiate breastfeeding, and with higher confidence levels in pre and postnatal care, are significantly more likely to maintain breastfeeding 4 weeks after birth [17].

In this way, breastfeeding has a multifactorial behavior. In addition to sociodemographic factors, clinical factors, and habits, a wide range of social, psychological, and cultural factors of each woman determines the decision and ability to successfully initiate breastfeeding; operating at different levels from the individual to society (**Figure 3**).

If the focus is placed on an anthropological approach to breastfeeding, the cultural norms of a society have a powerful influence on decisions regarding health, such as the choice of an infant feeding method. Therefore, attitudes and beliefs about breastfeeding are important and

**Figure 2.** Modifiable factors related to breastfeeding.

should be considered in public breastfeeding campaigns [18]. In this sense, studies have been developed to understand the public's beliefs about breastfeeding policies.

own daughters to breastfeed successfully, as they believe that this may reflect their own skills to nourish their children [20]. It is then manifested that breastfeeding, besides being biological, is historical and social, with culture, beliefs, and taboos influencing its practice, interfering in the construction of sociocultural inheritance, and determining different meanings to breastfeeding for woman. Thus, the beliefs transmitted by relatives, medical guidelines, and the growth and development of the child are factors that may or may not stimulate

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Another socioanthropological aspect is that ethnicity is a determining factor for breastfeeding, as shown by a study conducted in Malaysian women, which found that Malay women with a higher education level and who received counseling regarding breastfeeding had a significantly more favorable attitude toward it, and that ethnicity was a significant determinant in the success of breastfeeding [22]. In Cameroon, 90% of women initiate breastfeeding but only 34% of these women breastfeed exclusively during the first 6 months. It is highlighted here that there are relevant issues related to breastfeeding practices, such as the preparation of women for breastfeeding exclusively, the cultural influences toward breastfeeding, and the

Another example, from a different culture, shows that France has low breastfeeding rates, which are considered a reflection of their cultural perception of motherhood, breastfeeding, and the body image [24]. Understanding the local beliefs and customs that influence breastfeeding can help professionals provide culturally appropriate advice. Additionally, developing studies on beliefs and practices linked to breastfeeding within different communities

breastfeeding [21].

perceived restrictions to breastfeeding [23].

**Figure 3.** Levels that influence the process of breastfeeding.

In the United States, breastfeeding policies in the workplace and breastfeeding rooms in public places are the most accepted policies, especially among African-Americans and lowincome populations. Additionally, the general population seems to approve breastfeeding in public, but less educated or older people (over 45 years) tend to do so less. Globally, there is relatively less public support for breastfeeding education in secondary schools [19]. There seem to be many beliefs and traditions surrounding breastfeeding, for example, in regard to the amount of breast milk a mother produces, which is a common concern and a major source of anxiety. The perception of insufficient breast milk is attributed to the mother's interpretation of the crying baby as a sign of hunger, as well as the resolution of breast engorgement, which the mother interprets as a sign of concern. Additionally, family members (particularly the woman's mother) are important sources of discouragement of breastfeeding; for example, it is believed that women are biologically incapable of breastfeeding.

The belief that the tendency to have insufficient milk production is inherited from mothers and mothers who have not breastfed their children may find it particularly difficult for their Introductory Chapter: A Comprehensive Approach to the Process of Breastfeeding http://dx.doi.org/10.5772/intechopen.82177 5

**Figure 3.** Levels that influence the process of breastfeeding.

should be considered in public breastfeeding campaigns [18]. In this sense, studies have been

In the United States, breastfeeding policies in the workplace and breastfeeding rooms in public places are the most accepted policies, especially among African-Americans and lowincome populations. Additionally, the general population seems to approve breastfeeding in public, but less educated or older people (over 45 years) tend to do so less. Globally, there is relatively less public support for breastfeeding education in secondary schools [19]. There seem to be many beliefs and traditions surrounding breastfeeding, for example, in regard to the amount of breast milk a mother produces, which is a common concern and a major source of anxiety. The perception of insufficient breast milk is attributed to the mother's interpretation of the crying baby as a sign of hunger, as well as the resolution of breast engorgement, which the mother interprets as a sign of concern. Additionally, family members (particularly the woman's mother) are important sources of discouragement of breastfeeding; for example,

The belief that the tendency to have insufficient milk production is inherited from mothers and mothers who have not breastfed their children may find it particularly difficult for their

developed to understand the public's beliefs about breastfeeding policies.

**Figure 2.** Modifiable factors related to breastfeeding.

4 Selected Topics in Breastfeeding

it is believed that women are biologically incapable of breastfeeding.

own daughters to breastfeed successfully, as they believe that this may reflect their own skills to nourish their children [20]. It is then manifested that breastfeeding, besides being biological, is historical and social, with culture, beliefs, and taboos influencing its practice, interfering in the construction of sociocultural inheritance, and determining different meanings to breastfeeding for woman. Thus, the beliefs transmitted by relatives, medical guidelines, and the growth and development of the child are factors that may or may not stimulate breastfeeding [21].

Another socioanthropological aspect is that ethnicity is a determining factor for breastfeeding, as shown by a study conducted in Malaysian women, which found that Malay women with a higher education level and who received counseling regarding breastfeeding had a significantly more favorable attitude toward it, and that ethnicity was a significant determinant in the success of breastfeeding [22]. In Cameroon, 90% of women initiate breastfeeding but only 34% of these women breastfeed exclusively during the first 6 months. It is highlighted here that there are relevant issues related to breastfeeding practices, such as the preparation of women for breastfeeding exclusively, the cultural influences toward breastfeeding, and the perceived restrictions to breastfeeding [23].

Another example, from a different culture, shows that France has low breastfeeding rates, which are considered a reflection of their cultural perception of motherhood, breastfeeding, and the body image [24]. Understanding the local beliefs and customs that influence breastfeeding can help professionals provide culturally appropriate advice. Additionally, developing studies on beliefs and practices linked to breastfeeding within different communities could help health professionals provide culturally sensitive care for their patients. This information could help clinicians to encourage women to initiate and maintain breastfeeding [20].

Therefore, it is essential to consider breastfeeding as a biological process that should be built socioculturally, where ideological, religious, cultural, and political convergences or divergences can be studied and interrelated. There is a need for integrated attention regarding the sociocultural context of the breastfeeding period, which should be broadened in order to support mothers and empower them to positively deal with adversity during this process. It is important to know what mothers think about breastfeeding in order to encourage the creation of practices to

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satisfactorily maintain this process as long as possible for both mothers and babies [25].

Faculty of Medicine, Institute of Nursing, Universidad Austral de Chile, Valdivia, Chile

[1] World Health Organization. Infant and Young Child Feeding. WHO 2018. Available from: http://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding.

[2] World Health Organization. Global Nutrition Targets 2025: Breastfeeding Policy Brief.

[3] United Nations Children's Fund (UNICEF). The State of the World's Children 2014 in

[4] United Nations Children's Fund (UNICEF). The State of the World's Children 2016. A

[5] Eidelman AI, Schanler RJ. American academy of pediatrics section on breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;**129**:e827-e841. DOI: 10.1542/

[6] Eidelman AI. The AAP's 2012 breastfeeding policy statement: Is there anything new?

[7] Eidelman AI. Breastfeeding and the use of human milk: An analysis of the American academy of pediatrics 2012 breastfeeding policy statement. Breastfeeding Medicine.

Breastfeeding Medicine. 2012;**7**:203-204. DOI: 10.1089/bfm.2012.9989

**Conflict of interest**

**Author details**

**References**

René Mauricio Barría P

Accessed: 28-09-2018

peds.2011-3552

The author has no conflict of interests to declare.

Address all correspondence to: rbarria@uach.cl

Geneva: World Health Organization; 2014

2012;**7**:323-324. DOI: 10.1089/bfm.2012.0067

Numbers: Every Child Counts. Nueva York: UNICEF; 2014

Fair Chance for Every Child. Nueva York: UNICEF; 2016
