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3.2 The barriers

Barriers to breastfeeding can be divided into 3 main categories:

Mothers identified these barriers, with the top 3 being 1

Workbook Activity 3.2

Complete Activity 3.2 in your workbook.

Addressing societal barriers

Worldwide campaigns, eg. World Breastfeeding Week, a WABA initiative; the Global Strategy for Infant and Young Child Feeding, a WHO/UNICEF initiative, as well as national and local initiatives attempt to influence community attitudes.

National program to influence community attitudes.       The Ad Council, USA

National program to influence community attitudes. The Ad Council, USA

from San Diego County Breastfeeding Coalition

from San Diego County Breastfeeding Coalition

Acceptance of breastfeeding in public is a reflection of community attitudes.

Discomfort in public breastfeeding is reported by many women and is noted as a significant barrier. Targeting this area specifically, organizations have developed public service announcements for various media.

Some countries and States have had to go to the extreme step of legislating for a mother's right to breastfeed her baby wherever she and her baby are when her baby requires feeding.


What can you do to influence community attitudes?

Before you can address barriers that mothers will have to overcome, you will need to understand what they are. Surveying the mothers and their relatives and friends that you meet in your unit could give you a starting point. From there, a small but enthusiastic committee could brainstorm ideas for local and community activities to address these concerns.

Share your findings in the forum.

Health provider knowledge, skills and management

A common complaint from women is the amount of conflicting advice they receive from their health care providers. Also some of that advice may be detrimental to ongoing breastfeeding success.


Step 1 and Point 1

Step 1 of the Ten Steps to Successful Breastfeeding and Point 1 of the Seven Point Plan for Sustaining Breastfeeding in the Community both state:
Have a written breastfeeding policy that is routinely communicated to all staff

A regulatory policy, such as the policies implemented by health care institutions, limit the discretion of individuals or compel certain types of behavior. That is, you have a legal requirement imposed on you by your employer to follow the policy. It is not a personal decision whether you will follow or ignore certain aspects of a policy.

A policy that has been developed to support evidence-based, best-practice principles not only prevents conflicts in care, but is your protection should anything untoward occur.

Display the Policy in the most common languages spoken.

Display the Policy in the most common languages spoken.
© D.Fisher, IBCLC


The policy is to be displayed in all areas that serve mothers and babies. It should cover all Ten Steps to Successful Breastfeeding in hospitals or all of the Seven Point Plan.

Baby Friendly Step 2 and Point 2

Step 2 of the Ten Steps to Successful Breastfeeding and Point 2 of the Seven Point Plan for Sustaining Breastfeeding in the Community both state:
Train all health care staff in skills necessary to implement this breastfeeding policy
Congratulations on joining the ever-growing group of skilled and knowledgeable health professionals who protect, promote and support breastfeeding mothers and babies!

Education of health professionals using the curriculum developed for Step 2 of the Baby Friendly Hospitals Initiative produced staff who were significantly more knowledgeable about breastfeeding, had more positive attitudes and were more likely to employ correct practices for the promotion of exclusive breastfeeding.2,3 Another study showed that mothers who birthed in hospitals that had a high compliance to Baby Friendly Steps initiated breastfeeding in greater numbers and breastfed for longer than those in non-Baby Friendly hospitals.4

Support your colleagues

ALL of your colleagues want to do what is best for both mother and baby. Encourage those colleagues who are unsure of current, evidence-based practices to complete an educational program such as this one. It will help them to achieve their goal, and benefit mothers and babies.

Postnatal perceptions

Educating mothers about maintaining milk supply and normal newborn behaviour will be discussed as you work through this course.

Breastfeeding and separations

An increasing number of women must spend time away from a baby or child who is still in the age range prior to earliest age of weaning ... ie the first two years. Returning to the paid workforce is the most common reason for regular separation of mother and baby, and a common reason given for premature weaning.

Leaving her baby to go to work can be a highly stressful time for the mother. She will need to consider the physical and emotional effects of separation for long or short periods of time.

Continuing to provide breastmilk can

  • present many challenges,
  • help her to maintain an emotional connection to her baby, despite her physical absence,
  • help prevent the many acute illnesses associated with group child care,
  • make breastfeeding when they are reunited a very special and close time.

Your professional role is to

  • Educate her on the value of continuing to provide breastmilk for her baby, despite separation.
  • Discuss the issues she will need to address to be successful.
  • Provide her with contacts for peer-support services, to talk with other women in her situation.
  • Inform the mother of her right to breastfeed, and what workplace legislation will protect her right.

Do some action research

Ask your colleagues, friends and the mothers you meet who continued to breastfeed until their baby was at least 12 months old what they did during periods of separation. You are likely to get many unique ideas which you can share with pregnant women.

Workbook Activity 3.3

Complete Activity 3.3 in your workbook.

Breastfeeding in special circumstances

Most women will be healthy, having no special needs regarding breastfeeding, and will be able to breastfeed without difficulty.

When a referral is needed

In some of the circumstances described the mother will need the help of other health professionals, such as a psychologist, or a lactation consultant, or a doctor, and perhaps referral to a peer-support group. Does your Unit have a procedure in place to ensure the mother is aware of these other services and able to access them?

What should I remember?

  • The main barriers that mothers face when breastfeeding.
  • Methods to address these barriers.
  • The mothers that will require extra counseling or referral to other health care professionals to assist them to breastfeed successfully.

Notes

  1. # McIntyre E et al. (2001) Attitudes towards infant feeding among adults in a low socioeconomic community: what social support is there for breastfeeding?
  2. # Gupta A et al. (2002) Training in Baby Friendly Hospital Initiative
  3. # Owoaje ET et al. (2002) Previous BFHI training and nurses' knowledge, attitudes and practices regarding exclusive breastfeeding
  4. # Merten S et al. (2005) Do baby-friendly hospitals influence breastfeeding duration on a national level?