The Global Breastfeeding study 2012

The global breastfeeding study was a survey among paediatric healthcare professionals worldwide. The purpose of this study was to monitor their general awareness of breastfeeding as a driver of public health, and to identify any factors that may limit breastfeeding rates and which could be addressed by the global breastfeeding summit 2012.

Invitations to take the survey were emailed directly to paediatricians, and complementary channels such as social media and website advertising were also used. For regional convenience,  the survey was translated into other languages. The survey was available for completion from July to November 2012.

 

Demographics (countries): around 2,266 responses from 106 countries. Among these, the 9 target countries for the global breastfeeding summit attracted 100-246 responses per country; 

Demographics (current jobs vs. target groups): The term ‘paediatric healthcare professional’ is wide. The core target group for EiP is general paediatricians, i.e. doctors who are often described as frontline physicians as they are the first medical doctors to see new patients in primary, secondary and tertiary care. Since general paediatricians are the most abundant members of the EiP network, it was expected to have the largest share of responders from this category. For this specific project, key complementary professionals were also targeted, particularly midwives, nurses, lactation consultants, and child birth educators. These groups were also responsive and their perspectives are important in future subgroup analyses for understanding and addressing potential weak links in the breastfeeding education and support. 

Most responders worked in a hospital setting, or in a national health network (data not shown).

 

 

 

Experience. The average number of years of experience was high across all countries. A doctor who has practiced for 15-20 years is likely to be 45-50 years old. This information is useful for medical educators as it may on the one hand indicate clinical seniority and thus credibility of submitted responses. On the other hand, it could indicate lack of research updates as older doctors may not have been close to clinical research environments for a long time. The indirect age indication on this slide can also serve as an indicator for what type of communication channels and formats may be most suitable for future educational campaigns.

 

National breastfeeding networks. The invitation to join a new breastfeeding network was overwhelmingly well received. As the figure here above indicates, the acceptance rates were overall extremely high, reaching 90% in several cases. Among the target countries, only UK scored slightly lower with a 79% acceptance (122 of 155 responses). 

National breastfeeding awareness. The question ‘How close is your country to achieving a national breastfeeding strategy that has already been widely agreed upon and it is now ready for implementation (or being implemented already)’ was intentionally asked as a wide question, as it seeks to monitor very basic awareness of national breastfeeding progression among the different target groups. The response scale was from 1-10, with three progression levels defined:
 

• 1= Doctors, policymakers and parents are aware of the medical importance of breastfeeding
• 5=Doctors, policymakers and parents understand and accept the national importance of this change
• 10= A breastfeeding strategy has been widely agreed and is ready for implementation (or being implemented already)

 

As a first step in such an inherently blunt analysis, the above figure shows self-perceived national average progression levels, for the summit participants to reflect upon and discuss. The national teams  may later request an optional national subgroup analysis if they wish to learn the perspectives of different groups of professionals in their country. The current slide reveals encouraging information: while target countries naturally differ in their breastfeeding maturation,  these results indicate that the basic awareness has already been established for the importance of breastfeeding both globally and in each of the target countries. Even more encouraging, key decision makers in 6 of 9 target countries – and globally on average - also understand and accept the national importance of change towards a national breastfeeding strategy. For these countries the next suitable step may thus be to strive for the development and agreement on a formal national breastfeeding strategy document.

Is the lack of sufficient breastfeeding of all infants  a public health problem in your country?

Breastfeeding as a public health problem. A predominant global view that insufficient breastfeeding is a public health problem. Reasons for this may vary. Some countries such as China and Spain may have other public health priorities which could overshadow the lack of breastfeeding. Furthermore, a definition of what qualifies as a public health problem needs to be addressed by the global breastfeeding summit, and also by the national teams. 

In your experience, what are the top reasons why mothers stop breastfeeding prematurely?  (Please rank from 0-5 where 0=not a problem, and 5=highly frequent problem)

3.1	Decreased milk supply
1.3	The child no longer wants to breastfeed
2.2	Breastfeeding takes  too much time
2.2	Breastfeeding became painful
2.9	The mother was not offered adequate breastfeeding education
2.5	The mother did not benefit from the received breastfeeding education
3.5	The mother had to return to work

Why mothers stop breastfeeding. Return to work was the highest ranked reason for stopping breastfeeding prematurely. On a scale 0-5, it reached an average of 3.5; well above the second-highest scoring problem with decreased milk supply. A statistical analysis was not performed here to compare them formally, but the very large n-numbers (1,700+) with nearly-invisible standard errors would typically point at significant differences with P levels well below 0.001 (i.e. a strong significance for the differences between the compared groups). As the third strongest reason, healthcare professionals worldwide ranked the lack of maternal breastfeeding education. Hence these results may encourage the following three actions for increased breastfeeding: Help the mothers avoid work while breastfeeding, help mothers overcome decreased milk supply, and provide adequate breastfeeding education to mothers.

What is the ideal vs. available and reimbursed breastfeeding support in your country? The two questions were asked sequentially, and their results were merged afterwards. The interesting thing to observe here is the gap between the bar value (ideal support) vs. the corresponding dot value (currently available and reimbursed support). A reasonable correlation between these two values was expected.

Critical gaps were identified by comparing the relative importance of a support versus its relative availability. For example, the first bar in the parent education category had the average importance 2.64/5.0 (=52.7%) and a relative availability 463/1680 (=29.3%). The gap is thus 53%-29% = 23.4%. 

Conclusions from the Global Breastfeeding Study 2012

Taken together, the results from the global breastfeeding study confirms a widespread awareness of and interest among paediatric healthcare professionals to support and increase breastfeeding rates in their countries. There is a predominant global view that insufficient breastfeeding is a public health problem. The results if this identify a lack of training on how to sustain breastfeeding and they also suggest a primary focus on supporting mothers who must return to work. This support could potentially be provided by new national support networks for continuous breastfeeding support.