There are numerous barriers and enablers to breastfeeding, which operate at a range of different levels, as outlined in Figure 2.5. Importantly, environmental factors and societal considerations have an impact on a mother’s commitment to breastfeed and ability to continue.
Source: Hector et al. (2005).
The Queensland Health Optimal Infant Nutrition: Evidence-based Guidelines (Queensland Health 2003) provide a detailed list of the factors that hinder the initiation and/or the duration of breastfeeding (see Appendix A).
Qualitative research commissioned by the Australian Government Department of Health and Ageing (Woolcott 2009) found that as babies grew older, some mothers gave up breastfeeding because breastfeeding in public was not felt to be the social norm. Breastfeeding mothers reported being confronted by negative comments from strangers. People were unclear about the right to breastfeed in public and whether they could be asked to leave a restaurant or café. Some people incorrectly believed that breastfeeding in public was illegal. A 2009 Newspoll commissioned by the Australian Lactation Consultants’ Association found that 26 per cent of respondents considered it was unacceptable to breastfeed a baby in a restaurant or café, 19 per cent thought it was unacceptable to breastfeed in a shopping centre (Newspoll 2009).
The workplace has an important environmental impact on breastfeeding rates. Analysis on the relationship between return to work and breastfeeding for mothers in Australia suggests a complex relationship, with other interplaying factors impacting on the decision to breastfeed, such as maternal and family characteristics (AIFS 2008). Employment flexibility and jobs that are less time intensive make it easier for mothers to continue breastfeeding. Full-time work was not necessarily a barrier as breastfeeding rates were not always lowest among those working full-time hours (AIFS 2008). Data on the percentage of women returning to work in the first year of an infant’s life is outlined in Figure 2.6.
Return to Work: Age of InfantThe Longitudinal Study of Australian Children (2006-07) suggests the following trends:
- when children were 3 months old - 11 per cent of mothers had returned to work;
- when children were 6 months old - 21 per cent of mothers had returned to work;
- when children were 9 months old - 31 per cent of mothers had returned to work; and
- when children were 12 monts old - 42 per cent had returned to work.
The parental leave environment may influence breastfeeding rates. OECD research has found that the return to work is one of the reasons why some mothers never start breastfeeding, or only do so for short durations. The incidence of exclusive breastfeeding and its duration tends to be higher/longer in countries with long periods of parental leave, such as the Scandinavian countries, Hungary and the Czech Republic. However, this relationship does not always hold. For instance, the United Kingdom and Ireland have more generous leave arrangements than Australia, but lower rates of breastfeeding duration (OECD 2009b).
Following an inquiry by the Productivity Commission, the Australian Government announced in May 2009 that it will fund a paid parental leave scheme, providing 18 weeks pay on the minimum wage, commencing on 1 January 2011. The Productivity Commission’s recommendation to fund the scheme took into consideration a range of factors including the health and wellbeing of children and parents and the need to allow sufficient time away from the workplace to establish breastfeeding.
Research has found that some population priority groups are less likely to breastfeed than others:
- Aboriginal and Torres Strait Islander mothers: In 2004–05, approximately 79 per cent of Indigenous infants from non-remote areas aged 0–3 years had been breastfed compared with 88 per cent of non-Indigenous infants. Breastfeeding status varied by remoteness, with a higher proportion of Aboriginal and Torres Strait Islander children aged under six months being breastfed in remote areas (85 per cent) than in non-remote areas (56 per cent). Seventy per cent of Indigenous children aged from birth to three years from households in the lowest Socio-Economic Indexes for Areas (SEIFA) quintile were breastfed compared with 90 per cent in the highest SEIFA quintile (AHMAC 2008, AIHW 2009).
- Less educated women of low socio-economic status: In 2001, almost two-thirds (64 per cent) of mothers with a post-school qualification were breastfeeding infants at six months of age, compared with 41 per cent of those with no post-school qualification (ABS 2007). Research also suggests that for each increase in SEIFA quintile, the odds of breastfeeding at six months increased by 26 per cent, with evidence suggesting this gap is widening over time (Amir and Donath 2008).
- Young mothers: The 2001 National Health Survey found that for mothers aged 30 years or over, 54 per cent were still breastfeeding their baby at six months of age, compared with 38 per cent for mothers aged 18–29 years. Mothers aged 30 years or over were also twice as likely to be breastfeeding their babies at 12 months of age (28 per cent) compared with mothers aged 18–29 years (14 per cent) (ABS 2003).
It has been reported that breastfeeding practices vary between different cultural groups in Australia. Some communities where breastfeeding is the cultural norm experience strong support from extended families and few difficulties with breastfeeding. In other cultures there is a tradition of providing rice milk or formula before the first breastfeed and weaning or introducing supplementary foods early. The Woolcott report found that some recent African arrivals had been given incorrect information that it was illegal to breastfeed in public in Australia (2009).