The following article appeared in the January edition of the Network of
Australian Lactation Colleges Newsletter. It was reproduced from the Child
and Antenatal Nutrition Bulletin, Health Promotion Services, 
Health Department of Western Australia. I think that it covers the topic
well.

Breastfeeding:  Identifying a Role for Fathers


Research undertaken by Jane Scott, through the School of Public Health,
Curtin University of Technology, has explored factors that contribute to
mothers’ decisions about breastfeeding.  Jane writes about the importance
of fathers in supporting breastfeeding.

The factors that have been identified by investigators as being associated
with breastfeeding choice, or proposed as reasons for early weaning, can be
broadly categorised as demographic and socio-economic, psychosocial and
cultural,  biomedical, and health-service related (1).   To date, much of
the breastfeeding research has focused on the demographic factors
associated with breastfeeding.  For instance, higher rates of breastfeeding
have been consistently associated with married women of increased maternal
age and with at least 12 years of education (2,3).
However, it has been suggested that decisions about infant feeding are
influenced more by familial and social attitudes than by socio-demographic
factors (4,5).  Findings of the 1993 Perth Infant Feeding Survey conducted
by the School of Public Health at Curtin University support this argument. 
After controlling for potentially confounding socio-demographic factors,
this study found that psychosocial factors had the greatest independent
influence on the decision to breastfeed.  In particular, the father’s
stated preference for breastfeeding was found to be the most important
factor influencing a woman’s decision to breastfeed.

In traditional societies, breastfeeding women are supported by a doula. 
This person (frequently the mother of the new mother) supports the mother
emotionally, provides practical advice and guidance and helps her with
household duties, allowing her time to relax, establish her milk supply and
become adjusted to her infant’s needs (6).  An outcome of social changes in
modern societies is the loss of support for women to breastfeed, which
traditionally was provided by the doula.  When the extended family is
absent women may rely heavily on partners to support their breastfeeding
decision and to help with household responsibilities (7).  

Until recently, most research investigating factors influencing the
decision to breastfeed has focused on characteristics of the mother-infant
pair, with relatively little attention being paid to the role of the
father.  Earlier research demonstrating that married women were more likely
to breastfeed than single women suggests that the father plays some role in
the mother’s decision to breastfeed.  More recent research focusing on
fathers indicates that they participate in and influence the choice of
infant feeding method, and influence duration by acting as key supports or
deterrents to breastfeeding by the mother (8).  

In the Perth study, women whose partners expressed a definite preference
for breastfeeding were ten times more likely (OR = 10.18) to initiate
breastfeeding than women whose partners either preferred bottle-feeding or
were ambivalent about the method of feeding.  This result confirms, in a
different cultural setting, and extends the results of a smaller study by
Giugliani, et al (4).  They reported that the father’s opinion about
breastfeeding was the most important factor related to breastfeeding (OR =
32.8), regardless of maternal age, educational level, ethnic group and
marital status.

The level or amount of support provided by the father will depend on his
commitment to and expectations of breastfeeding(9).   Freed, et al (10)
proposed that variations in support for breastfeeding among fathers might
be explained by a lack of information or the harbouring of negative
cultural perceptions.  Previous studies have found that fathers of
bottle-fed children were more likely to believe that breastfeeding is bad
for the breasts, makes breasts ugly, interferes with sex and is painful,
and that prevention of sore and cracked nipples is not possible(10,11). 
When compared with fathers of breastfed infants, fathers of children who
were bottle-fed were generally unaware of the benefits of breastfeeding for
either their child (10,11) or their partner (11) and were comparatively
less aware of how a father can provide practical and psychological support
for breastfeeding(11). 
 
Implications for practice

The results of this and other studies highlight the need for including
fathers in breastfeeding discussions.  Classes which encourage both
partners to openly discuss their attitudes to breastfeeding would be
useful, as one study showed that women were unable to accurately predict
their partner’s attitudes and opinions regarding breastfeeding, despite
having reported that they had discussed infant feeding plans with their
partner(12).  A large number of women incorrectly predicted negative
responses from fathers, raising the possibility that the father’s negative
influence on breastfeeding is based on the mother’s inaccurate perceptions.
 Perception of a lack of spousal support may decrease enthusiasm for
breastfeeding among women who had planned to initiate lactation.

The amount of time spent on discussing the nutritive and protective
advantages of breastfeeding in antenatal classes needs to be expanded to
allow time for explanation of the supportive roles families can play for
the breastfeeding mother.  Fathers may feel left out of the breastfeeding
process.  Reinforcement of the value to breastfeeding mothers of practical
help with indirectly associated activities (such as occupying other
children and household chores) and emotional support during feeding should
be given to both parents before and after the birth.

Women everywhere doubt the adequacy of their breast milk both in terms of
quality and quantity.  This doubt makes mothers particularly susceptible to
the influence of family and friends who readily suggest that the quantity
and/or quality of the mother’s milk may be deficient in some way.

Giugliani, et al. (11) propose that a better understanding about such
issues as feeding behaviour of normal children and breastfeeding
physiology, would help father become more supportive when mothers feel
tired and insecure about the adequacy of their milk or during a transient
lactational crisis.  Classes which include father and confront the myths
and misconceptions surrounding breastfeeding may help to overcome obstacles
to the initiation of breastfeeding and to provide greater support for
nursing mothers (10).

References

Ford K, Labbok M.  Who is breastfeeding?  Implications of associated social
and biomedical variables for research on the consequences of method of
infant feeding.  Am J Clin Nutr 1990;52:451-456.

Grossman LK, Fitzsimmons SM, Larsen-Alexander JB, Sachs L, et al.  The
infant feeding decision in low and upper income women.  Clinical Pediatrics
1990;29:30-37.

Bee DE, Baranowski T, Rassin DK, Richardson J, et al.  Breast-feeding
initiation in a triethnic population.  Am J Dis Child 1991;145:306-309.

Giugliani ERJ, Caiaffa WT, Vogelhut J, Witter FR et al. Effect of
breastfeeding support from different sources on mothers’ decisions to
breastfeed.  J Hum Lact 1994;10:157-161.

Littman H, VanderBrug Medendorp S, Goldfar J.  The decision to breastfeed. 
The importance of fathers’ approval.  Clinical Pediatrics 1994;33:214-219.

Barron SP, Lane HW, Hannan TE, Struempler B, et al.  Factors influencing
duration of breastfeeding among low-income women.  J Am Diet Assoc
1988;88:1557-1561.

James DC, Jackson RT, Probart CK.  Factors associated with breast-feeding
prevalence and duration amongst international students.  J Am Diet Assoc
1994;94:194-196.

Jordan PL, Wall VR.  Supporting the father when an infant is breastfed.  J
Hum Lact 1993;9:1993.

Gamble D, Morse JM.  Fathers of breastfed infants: Postponing the types of
involvement.  International Journal of Gynaecology and Obstetrics 
1992;22:358-365.

Freed GL, Fraley JK, Schanler RJ.  Attitudes of expectant fathers regarding
breastfeeding.  Pediatrics 1992;90:224-227.

Giugliani ERJ, Bronner Y, Caiaffa WT, Vogelhut J, et al.  Are fathers
prepared to encourage their partners to breastfeed?  A study about fathers’
knowledge of breastfeeding.  Acta Paediatr 1994;83:1127-1131.

Freed GL, Fraley JK, Schanler RJ.  Accuracy of expectant mothers;
predictions of fathers’ attitudes regarding breastfeeding.  The Journal of
Family Practice 1993;37:148-152.

Laureen Lawlor-Smith
BMBS IBCLC
Editor NALC News
South Australia