Thomson Gill, Ingram Jenny, Clarke Joanne, Johnson Debbie, Jolly Kate
School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom.
Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Front Sociol. 2022 Jul 22;7:904773. doi: 10.3389/fsoc.2022.904773. eCollection 2022.
The early post-natal period is a critical period in women's infant feeding journeys, often marked by high levels of unintended breastfeeding cessation. Previous research has argued that infant feeding should be perceived within a complex system whereby factors operating at different ecological levels (i.e., individual, social/community networks, cultural/institutional) interact to affect individual behaviors. However, currently, more work needs to be done to implement an ecological approach in breastfeeding programs. We adopted a complex-systems lens approach to explore how multi-level factors-individual, mother-infant dyad, health service, family and social networks, and wider community infrastructure-interacted with women's motivations and experiences of breastfeeding. We undertook a secondary analysis of 24 women's interviews; all the women had a strong antenatal intention to breastfeed and were expecting their first baby. The interviews were collected during the UK-based Assets-based feeding help Before and After birth (ABA) feasibility trial when their infant was aged between 4 and 21 weeks. Categorical content analysis was used to explore the interrelationships between key factors and to identify different infant feeding typologies. Two different typologies emerged: "disappointed" ( = 7) and "by hook or by crook" ( = 17). "Disappointed" women had stopped breastfeeding early; women classified as "by hook or by crook" continued breastfeeding despite facing challenges. Sociodemographic, social, and service level differences between the typologies were noted. "Disappointed" women were more likely to be younger, White-British, to have considered mixed-feeding antenatally and experienced negative breastfeeding support from healthcare professionals and personal networks. Infants of "disappointed" women were more likely to have received unexpected "top-ups" and to be perceived as having infant feeding difficulties. Women classified as "by hook or by crook" were just as likely as "disappointed" women to experience birth-related complications, but demonstrated more proactive help-seeking behaviors, had positive experiences of personal/professional support and accessed wider support. While further research is needed to consolidate and/or refute the typologies, the ecological approach shifts the focus away from mothers' decisions to consider the multi-level factors that need to be in place to enable women to breastfeed successfully. Further work to encourage help-seeking behaviors and toward improving facilities, support, and services is needed.
产后早期是女性母乳喂养过程中的关键时期，这一时期往往以意外停止母乳喂养的高发生率为特征。以往的研究认为，应在一个复杂的系统中看待婴儿喂养问题，在这个系统中，不同生态层面（即个人、社会/社区网络、文化/机构）的因素相互作用，影响个体行为。然而，目前在母乳喂养项目中实施生态方法仍需开展更多工作。我们采用了一种复杂系统视角的方法，来探究多层次因素——个人、母婴二元组、卫生服务、家庭和社会网络以及更广泛的社区基础设施——如何与女性的母乳喂养动机和经历相互作用。我们对24名女性的访谈进行了二次分析；所有女性在产前都有强烈的母乳喂养意愿，且都怀有第一胎。这些访谈是在英国一项基于资产的出生前后喂养帮助（ABA）可行性试验期间收集的，当时她们的婴儿年龄在4至21周之间。采用分类内容分析法来探究关键因素之间的相互关系，并识别不同的婴儿喂养类型。出现了两种不同的类型：“失望型”（=7）和“千方百计型”（=17）。“失望型”女性早早停止了母乳喂养；被归类为“千方百计型”的女性尽管面临挑战仍继续母乳喂养。我们注意到了这两种类型在社会人口统计学、社会和服务层面上的差异。“失望型”女性更可能较年轻、是英国白人，产前考虑过混合喂养，并且在医护专业人员和个人社交网络方面获得过负面的母乳喂养支持。“失望型”女性的婴儿更可能接受过意外的“额外喂养”，并且被认为存在婴儿喂养困难。被归类为“千方百计型”的女性与“失望型”女性经历与分娩相关并发症的可能性相同，但表现出更积极的求助行为，有个人/专业支持的积极体验，并且获得了更广泛的支持。虽然需要进一步研究来巩固和/或反驳这些类型，但生态方法将关注点从母亲的决定上转移开，转而考虑为使女性能够成功进行母乳喂养而需要具备的多层次因素。需要开展进一步工作来鼓励求助行为，并改善设施、支持和服务。
