Health Education Regarding Breast Feeding 

Benefits of Breast Feeding

    Breast-feeding
continues to be the gold standard for feeding infants, as it provides
nutritional, immunological, cognitive, and psychological benefits for young
children.

    Recently, a burgeoning body of research in the immunological and
biochemical sciences has continued to identify the unique properties and
unreplaceable living tissue transferred to infants and children through
breast-feeding. 

Breast And Medical Issues

    These studies have made the connection between breast-feeding
and a decreased risk of illness and health problems in infants and children,
supporting its importance and necessity to the health of humans ( Heinig ,
2001). 

    Once seen as a personal lifestyle choice, documentation of the
superiority of breast-feeding to the health and well-being of infants,
children, and women, has led to the recognition that breast-feeding is a health
care behavior. 

    There continues to be a large discrepancy in the United States
between breast-feeding rates, especially according to income, education, race,
and ethnicity (Ahluwalia , Morrow, Hsia, & Grummer – Strawn , 2003). 

    When
breast-feeding is examined as a health care behavior, nurses have an
opportunity for health promotion and disease prevention among mother-child
dyads which can affect all of society. 

    The Healthy People 2010 (2000) national
health objectives target, 75% initiation of breast-feeding, 50% breast-feeding
at 6 months, and 25% breast-feeding children until 1 year of age.

Breast Feeding And Role Of Health Care Providers

    Breast-feeding
has an international and interdisciplinary focus. Many professionals from
various arenas of health care and the sciences are interested in lactation and
the field continues to grow; however, experts, especially lactation
consultants, are still underutilized. 

    Nurses have intimate contact with women
at key times to make a difference in their breast-feeding experiences. The
majority of nursing breast-feeding research relates to promotion, protection,
and support of breast-feeding.

Breast Feeding Ans Nursing Research

    Breast-feeding
researchers in nursing examined the policies and practices that impact
breast-feeding initiation. Nurse scientists continue to develop instruments to
assess breast-feeding (Dennis, 2002; Riordan, Bibb, Miller, & Rawlins,
2001). 

    More research is needed into nurses’ influence on the decision to
breast-feed and their roles in promoting and reinforcing women’s decision.
Researchers have demonstrated the importance of health care professionals’
recommendations to mothers (Ahluwalia et al., 2003). 

    Nurses need updated
education based on research to provide this support at critical times, and to
identify women at risk for complications carly on, so that interventions can be
initiated and referrals made in a timely fashion to preserve the breast-feeding
relationship. They need to be aware of new research on breast- feeding in areas
such as: breast reduction/ augmentation surgery, HIV status, medical
conditions, and drugs. 

    Careful assessment of the benefits and risks of not
breast-feeding should be in the forefront in nursing research.

Role Of Health Care Institutes Or Hospitals In Promotion Of Breast Feeding

    The
advent of the Breastfeeding-Friendly Hospital Initiative in 1997 in the United
States by United Nations Children’s Fund (UNICEF) encouraged the identification
of practices that impact breast-feeding duration. 

    Studies have demonstrated the
negative effect on breast-feeding initiation and duration of: labor
medications, vigorous sucking, foreing baby to breast, ineffective positioning,
early introduction of pacifiers, delayed feedings, routine separation of mother
and baby, failure of nurses to frequently assess 

    Breastfeeding encounters, use
of supplements, and provision of gift packs with promotional materials for
artificial infant milk (Auerbach, 2000). In contrast, a meta-analysis of over
35 studies demonstrated that breast-feeding educational programs had the
greatest single effect on initiation and short term duration of breast-feeding,
although support programs did increase both short and long-term duration (Guise
et al. al., 2003).

Duration of Breast Feeding 

    In a
thorough review of the literature from 1990-2000, Dennis (2002) examined
breast-feeding initiation and duration and concluded that mothers who weaned
prior to 6 months postpartum experienced perceived difficulties with
breast-feeding. 

    These studies identified those least likely to breast-feed as:
young, low income, ethnic minority, a supported, full-time employed women with
a negative attitude toward breast-feeding and low confidence in their ability
to breast-feed. 

    Partners and nonprofessionals were most supportive, hospital
routines were often detrimental to breast-feeding, and health care
professionals who lacked knowledge related to breast-feeding were seen as
negative sources of support providing inaccurate and inconsistent advice
(Dennis). 

    These results provide a target population for intervention and
indicate that even as knowledge has grown, the shift from knowledge to practice
is painful and takes time (Hong, Callister, & Schwartz, 2003).

    A
major population needing attention focused on breast-feeding are low-income
women, especially women of color within this group. African-American women have
among the lowest rates of breast-feeding in the United States (Ahluwalia et
al., 2003). 45% report ever breastfeeding (compared to 66% and 68% of Hispanic
and white women) (Bentley, Dee, & Jensen, 2003). 

    Reasons given by women for
not breast-feeding include: embarrassment, a lack of social acceptability of
breast-feeding (both public and private), work or school, the difficulty
keeping the infant close, and lack of support. 

Nursing Scientists Role In Promotion of Breast Feeding 

    Nurse
scientists are using different methodologies to study breast-feeding,
including: ethnographies

    , phenomenological studies, historical-cultural
approaches, and ecological perspectives. Theoretical frameworks used to explore
the health behavior of breast-feeding include the theory of planned behavior,
the health belief model, social cognitive theory using the concept of
self-efficacy, and the social ecological framework. 

    Nurses are exhibiting a
stronger role in publishing studies examining breast-feeding education,
support, and prenatal and postnatal interventions to support the mother and
infant, Researchers have demonstrated the importance of peer and social
support, the effect of hospital interventions.

    The need for comprehensive
breast feeding education and support, communication-related barriers,
socioeconomic issues, the effect of values and practice, and most importantly
the culturally relevant issues that influence breast feeding choices. 

    Clinical
issues being explored by nurse scientists include: biological benefits of
breast-feeding to the mother, breast-feeding and circumcision, HIV and
breast-feeding, lactation mastitis, and positioning and attachment. The
influence of the health care delivery system, community, and society/culture
cannot be ignored.

    Challenges
related to the study of breast-feeding include three major areas: the lack of
consistency in the definition of breast-feeding (eg, exclusivity), making
comparison of studies tedious if not impossible; the difficulty measuring
cross-cultural effects (lack of reliability and validity studies of major
breast-feeding instruments with various cultures); and the development of
prospective designs and randomized controlled trials.

Long Term Effects Of Breast Feeding 

    Although
breast-feeding is now recognized as a right of mothers, a health care behavior
contributing to the reduction of infant and maternal morbidity and mortality
rates, less expensive than artificial milk supplementation and m

    ore
environmentally friendly, the national breast-feeding goals are far from being
met. Federal funding for breast-feeding research in the United States
demonstrates an inconsistency with the national priorities for breast-feeding. 

    Only 13.7% ($5.6 million out of $40.4 million available) of federal research
funds from 1994 to 1996 were awarded to projects having an impact on the
Healthy People 2000 goals for increasing the incidence and duration of
breast-feeding. In contrast, 27 projects (7.5% or $4.1 million) involved the
use of human milk composition and technologies to improve artificial milks
(Brown, Bair, & Meier, 2003). 

    Nurses need to be at the forefront in
protecting, promoting, and supporting breast-feeding for the health of society.
This will require exploring the ways that cultural norms and structures at all
levels support or interfere with breast-feeding for all women and ways in which
nursing can make a difference.