Graduation Year

2014

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Community and Family Health

Major Professor

Carol Bryant

Keywords

duration, father, intention, partner, spouse, symbolic interaction

Abstract

The American Academy of Pediatrics recommends that babies be exclusively breastfed for the first six months of life, and continue to breastfeed throughout the first year of life and as long after as is mutually desired. Recent survey data suggests that initiation rates of breastfeeding are high; according to the CDC, 75.0 percent of children in the U.S. have been breastfed. Although initiation rates of breastfeeding are high, breastfeeding duration rates consistent are much lower; 33.0 percent of infants were exclusively breastfed at three months, and only 13.3 percent of infants were exclusively breastfed at six months. Additionally, only 22.4 percent of infants were still breastfeeding at twelve months.

Social and behavioral research has identified social support received from the infant's father to be one of the most important predictors of breastfeeding initiation and duration. Although several prior studies have identified paternal attitudes and support to be important influences of breastfeeding duration, few studies have been conducted to understand the specific forms of paternal support that are most important to mothers, and the forms of paternal support that are most predictive of breastfeeding duration. Also, to the author's knowledge, this was the first study to investigate negative forms of paternal support that may discourage breastfeeding.

This mixed-methods study sought to better understand the perceived forms of positive and negative paternal support for breastfeeding amongst a cohort of first-time parent couples. A longitudinal study design was utilized, in which each parent participated in an in-depth interview at four time points: prenatally, and at one, three, and six month post-partum. At each time point, mothers and fathers also completed a quantitative survey; breastfeeding intention was assessed at the prenatal period, and information about current breastfeeding status was collected at the post-natal time points. A final sample of fourteen parent couples was recruited from Champions for Children prenatal classes, and all interviews took place between June 2013 and February 2014.

The quantitative portion of this study found that at one month post-partum, mothers with higher prenatal breastfeeding intention scores were more likely to still be breastfeeding (85.7%), with the largest percentage of mothers still exclusively breastfeeding (50.0%); additionally, mothers with lower prenatal breastfeeding intention scores were more likely to be exclusively formula feeding (14.3%) (p = 0.03). In general, mothers with higher prenatal breastfeeding intention scores also identified more types of positive paternal support for breastfeeding; however, the only association found to be statistically significant was appraisal support (p=0.03).

For the qualitative portion of this study, expectant mothers and fathers identified forms of paternal support that they perceived to be either positively or negatively supportive of breastfeeding. More often than any other type of positive support, mothers and fathers mentioned a father providing instrumental support as helpful to sustain breastfeeding, and at the post-natal time points, almost every mother identified help with household chores as being the support they receive most often which helps them to sustain breastfeeding. Whereas mothers mentioned instrumental support most often when asked to identify forms of paternal support for breastfeeding, after delivery mothers indicated that emotional support was truly most valuable; almost every mother identified words of encouragement and motivation as being the support they receive from their partner that is most important, and which helps to sustain breastfeeding.

At the post-natal time-points very few mothers or fathers identified any forms of negative support actually received from their partner; mothers and fathers instead elaborated on examples of support that they perceived as negative for a mother to receive from her partner including failure to provide positive support, indifference to infant feeding method, a negative attitude towards breastfeeding or preference for formula, and negative or discouraging comments. At the post-natal time points, the majority of mothers perceived a father being verbally negative about breastfeeding as the worst form of negative support for breastfeeding.

This study primarily used qualitative methods to gather rich, in-depth personal accounts of first-time mothers' and first-time fathers' perceptions of paternal support for breastfeeding. This provided valuable insight and allowed for an emic perspective of the participants' personal experiences which led to a more in-depth understanding of the specific forms of paternal support most important to mothers. Unlike previous studies conducted to better understand paternal support for breastfeeding, this study utilized a longitudinal design which allowed for the collection of data at four time points, both pre- and post-natal. A longitudinal design strengthened this study as perceived forms of paternal support were compared at different time points, and shifts in perceptions over time amongst mothers and fathers were captured.

This study contributes new knowledge to the field of breastfeeding promotion regarding the specific forms of paternal support that mothers and fathers perceive as positive or negative of breastfeeding. It is imperative to improve our understanding of the precise forms of paternal support which are most positively associated with breastfeeding exclusivity and duration, so that future efforts to increase positive paternal support and decrease negative paternal support are most effective. The findings of this study can be used to help engage fathers in the breastfeeding process, including educating them on the specific ways that they can offer meaningful support to their breastfeeding partner.

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