Johnson Angela, Kirk Rosalind, Rosenblum Katherine Lisa, Muzik Maria
Department of Psychiatry, University of Michigan , Ann Arbor, Michigan.
Breastfeed Med. 2015 Jan-Feb;10(1):45-62. doi: 10.1089/bfm.2014.0023. Epub 2014 Nov 25.
The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.
本文的目标是回顾一些关键干预措施和策略，这些措施和策略会影响母乳喂养的开始和持续时间，特别关注低收入非裔美国母亲在产后早期的母体心理脆弱性，并以社会生态视角作为指导框架。尽管美国在母乳喂养启动率方面取得了一定进展，但预计到2020年婴儿喂养方式与国家健康人群母乳喂养目标之间仍存在差距，尤其是在非裔美国人中。这些差异引发了人们的担忧，即社会处境不利的母亲和婴儿可能因心理健康较差以及患慢性健康疾病的易感性增加而面临更高的产后不良结局风险。母乳喂养可以成为一个保护因素，加强母婴关系，提高婴儿健康水平和恢复力。有证据表明，没有单一的干预措施能够充分解决母亲们面临的多种母乳喂养障碍。有效的干预策略需要采取多层次方法。社会生态视角强调，个体的知识、行为和态度是由个体女性与其朋友和家人以及更广泛的历史、社会、政治、经济、制度和社区环境之间的相互作用所塑造的，因此有效的母乳喂养干预措施必须反映所有这些方面。当前的母乳喂养干预措施相互脱节，无法充分满足所有非裔美国女性在母乳喂养方面的社会和心理需求。不良结果表明需要一种综合方法来应对母亲们在社会生态系统各层面所经历的相互关联的母乳喂养障碍的复杂性。
