Background
Factors | Consistent associations reported in the literature | Associations reported in the literature but not found consistently | ||
---|---|---|---|---|
Positive association – breastfeeding duration | Negative or no association – breastfeeding duration | Positive association – breastfeeding duration | Negative or no association – breastfeeding duration | |
Maternal & social factors
| Intention to breastfeed [5, 6-15] | Higher body mass index [27, 46, 47] | Having a previous child/children [21, 23] | Previous infant feeding method (no association) [9] |
Earlier timing of decision to breastfeed [7, 9, 16-18] | Having a previous baby increased planned duration [6] | Breastfeeding confidence (no association) [7] | ||
Increasing age [8, 9, 11-13, 15, 18-23] | The better the previous breastfeeding experience, the more positive association with subsequent breastfeeding duration [14, 23] | Lower income [48] | ||
Higher education [7, 9, 11, 14, 19, 21, 24-26] | Breastfeeding confidence [6, 8, 10, 14, 22, 32, 49] | A view that the feeding method makes no difference to the baby's health [42] | ||
Not smoking [19, 21, 23, 27-30] or smoking less [25] | Higher social class [50, 51] | More positive attitude to bottle feeding [11] | ||
Being married [21] or not being single [22] | Higher income [20] | Employment plans (no association) [9, 11, 12] | ||
Higher socioeconomic status [2] | Returning to work [22] | |||
Maternal attitude to infant feeding [24] or negative attitude to formula feeding [7] | Parity (no association) [20] | |||
Having been breastfed oneself [42] | Perception of lack of support for breastfeeding [6] | |||
Attendance at childbirth education classes [9] | ||||
Partner's perceived preference for breastfeeding [12, 22, 42, 52] | ||||
Breastfeeding knowledge [53] | ||||
Hospital practices & obstetric factors
| Early postnatal discharge (no association) [5, 23, 55, 56] | Earlier breastfeeding initiation [7,10, 18, 32, 57, 58] | Caesarean section [9] | |
Early postnatal discharge [59] | Rooming-in [12, 32, 60] | Birth type (no association) [7, 61] | ||
Commercial discharge packs (but effect more on exclusivity) [62] | Early skin-to-skin contact [63, 64] | Early infant to breast contact (no association) [12] | ||
Breastfeeding encouragement from a health professional [22] | Use of formula during the postnatal hospital stay [26, 65] (but not associated in earlier meta-analysis [64]) | |||
Other potential influences
| Introduction of solids with continued breastfeeding (no association) [66] | Mastitis [15] | Breastfeeding problems such as sore and cracked nipples (no association) [7] | |
Introduction of formula [10, 15, 58, 66] | Early breastfeeding problems [22] | |||
Inverted nipples [15] | ||||
Infant birth weight >2500 g [21] | Lower infant birth weight [23] | |||
Infant birth weight (no association) [9] | ||||
Male infant [12] | ||||
Admission to special care nursery [12] | ||||
Use of dummies (pacifiers) [15, 25, 26] | ||||
Use of dummies (pacifiers) (no association) [67] |
Methods
Results
Demographic characteristics | n |
%
(of 981)
| n |
%
(of 889)
|
---|---|---|---|---|
Lives with husband/partner | 864 |
88.0
| 788 |
88.6
|
Completed secondary school | 734 |
74.9
| 670 |
75.4
|
Pension/benefit main family income | 122 |
12.4
| 101 |
11.4
|
Smoked prior to pregnancy | 362 |
36.9
| 324 |
36.4
|
English first language | 813 |
82.9
| 744 |
83.4
|
Age at recruitment, years (mean, sd) | 28.3 |
(5.7)
| 28.3 |
(5.6)
|
Factor | No |
%
|
---|---|---|
Had
antenatal
intention to breastfeed 6 months or more
| 203 |
26.6
|
Had
postnatal
intention to breastfeed 6 months or more
| 511 |
66.9
|
Desire to breastfeed
| ||
Very strong desire to breastfeed | 595 |
77.9
|
Desire to breastfeed goes up and down | 120 |
15.7
|
Sometimes think bottle (formula) feeding preferable | 46 |
6.0
|
I think bottle (formula) feeding is preferable | 3 |
0.4
|
Confidence in breastfeeding ability
| ||
Feel confident in ability to breastfeed baby | 360 |
47.1
|
Breastfeeding difficult now but hope will get easier | 368 |
48.1
|
Not feeling confident in ability to breastfeed baby | 36 |
4.7
|
Partner's view of breastfeeding
| ||
My partner would prefer me to breastfeed | 498 |
65.2
|
My partner does not mind how I feed the baby | 22 |
2.9
|
My partner is supportive either way | 232 |
30.4
|
My partner would prefer me to formula feed | 8 |
1.2
|
Not sure | 4 |
0.5
|
Family's view of breastfeeding
| ||
My family would prefer me to breastfeed | 396 |
51.8
|
My family would prefer me to formula feed | 30 |
3.9
|
My family is supportive either way | 311 |
40.7
|
Not sure | 27 |
3.5
|
Was breastfed as a baby
| ||
Breastfed as a baby | 538 |
70.4
|
Not breastfed as baby | 190 |
24.9
|
Own breastfeeding history not known | 36 |
4.7
|
Smoking pre-pregnancy (number per day)
| ||
None | 487 |
63.7
|
1–9 | 110 |
14.4
|
10–19 | 100 |
13.1
|
20–29 | 57 |
7.5
|
30–39 | 4 |
0.5
|
> 40 | 2 |
0.3
|
Did not answer question | 4 |
0.5
|
Maternal body mass index
| ||
Underweight (< 20) | 105 |
13.7
|
Normal weight (20–25) | 477 |
62.4
|
Overweight (> 25 and < 30) | 104 |
13.6
|
Obese (>= 30) | 78 |
10.2
|
Baby admitted to special care
| 81 |
10.6
|
Gestation
| 702 |
91.9
|
Breastfed within 1 hour of birth
| 426 |
55.8
|
Received formula in hospital
| 217 |
28.4
|
Completed secondary education
| 589 |
77.1
|
Tertiary education
| ||
Not comp degree/diploma | 343 |
44.9
|
Completing degree/diploma | 58 |
7.6
|
Completed degree/diploma | 363 |
47.5
|
Family income (AUD)
| ||
<$20,000 | 102 |
13.4
|
$20–30,000 | 87 |
11.4
|
$30–40,000 | 116 |
15.2
|
$40–50,000 | 84 |
11.0
|
> $50,000 | 331 |
43.3
|
Income category not completed | 44 |
5.8
|
Region of birth
| ||
Australia | 535 |
70.0
|
Asia | 85 |
11.1
|
Other | 144 |
18.9
|
Employed/studying at 6 months postpartum
| 229 |
30.0
|
Attended childbirth education
| 619 |
81.0
|
Reported breastfeeding problems by day 2–4
| 455 |
59.6
|
Rated midwife home visit* extremely helpful for breastfeeding issues
| ||
Extremely helpful | 140 |
18.3
|
Very helpful | 301 |
39.4
|
A little helpful | 129 |
16.9
|
Not helpful | 53 |
6.9
|
Did not discuss/did not have home visit | 141 |
18.5
|
Attended breastfeeding clinic breastfeeding clinic in first few weeks
| ||
Had breastfeeding problems but did not attend clinic | 354 |
46.3
|
Had breastfeeding problems, did attend clinic | 142 |
18.6
|
Had no breastfeeding problems | 162 |
60.5
|
Anxiety or depression problem in first 6 months (self-report)
| 281 |
36.8
|
Relationship problems at all in first 6 months
| 101 |
13.2
|
Age at recruitment (mean, sd)
| 28.6 |
(5.57)
|
Factor | N * |
% **
| Odds Ratio | (95% Confidence Interval) | Adj*** Odds Ratio | (95% Confidence Interval) |
---|---|---|---|---|---|---|
Intention to breastfeed 6 months or more (asked at recruitment and 2–4 days after birth)
| ||||||
"Yes" at recruitment AND in hospital interview (ref) | 107 |
68.6
| 1 | 1 | ||
"No" at recruitment but "Yes" at in hospital interview | 205 |
57.8
| 0.63 | (0.42, 0.93) | 0.69 | (0.44, 1.07) |
"Yes" at recruitment but "No" at in hospital interview | 27 |
57.5
| 0.62 | (0.32, 1.21) | 0.84 | (0.39, 1.81) |
Never intended to breastfeed 6 months or more | 79 |
38.4
| 0.28 | (0.18, 0.44) | 0.41 | (0.25, 0.67) |
Desire to breastfeed
| ||||||
Other than very strong (ref) | 54 |
32.0
| 1 | 1 | ||
Very strong | 364 |
61.2
| 3.30 | (2.34, 4.64) | 2.18 | (1.45, 3.29) |
Confidence in breastfeeding ability
| ||||||
Other than confident (ref) | 202 |
50.0
| 1 | n/s | ||
Feels confident | 216 |
60.0
| 1.53 | (1.15, 2.02) | n/s | |
Partner's view of breastfeeding
| ||||||
Other than prefer breastfeed (ref) | 132 |
50.8
| 1 | n/s | ||
Prefers me to breastfeed | 283 |
56.8
| 1.52 | (1.15, 2.02) | n/s | |
Family's view of breastfeeding
| ||||||
Other than prefer breastfeed (ref) | 180 |
48.9
| 1 | n/s | ||
Prefer me to breastfeed | 238 |
60.1
| 1.95 | (1.49, 2.55) | n/s | |
Was breastfed as a baby
| ||||||
Not breastfed as baby (ref) | 83 |
43.7
| 1 | 1 | ||
Breastfed as a baby | 318 |
59.1
| 1.9 | (1.33, 2.60) | 1.73 | (1.19, 2.54) |
Breastfeeding history unknown | 17 |
47.2
| 1.15 | (0.56, 2.36) | 1.72 | (0.74, 4.03) |
Smoked pre-pregnancy
| ||||||
No (ref) | 291 |
59.8
| 1 | 1 | ||
1–19/day | 101 |
48.1
| 0.62 | (0.45, 0.86) | 1.04 | (0.70, 1.52) |
20 or more/day | 24 |
38.1
| 0.41 | (0.24, 0.71) | 0.47 | (0.26, 0.86) |
Did not answer question | 2 |
50.0
| 0.67 | (0.94, 4.82) | 1.59 | (0.19, 13.40) |
Maternal body mass index
| ||||||
Normal weight (20–25) (ref) | 272 |
57.0
| 1 | 1 | ||
Underweight (< 20) | 63 |
60.0
| 1.16 | (0.76, 1.76) | 1.15 | (0.70, 1.88) |
Overweight (> 25 and < 30) | 54 |
51.9
| 0.71 | (0.47, 1.06) | 0.70 | (0.43, 1.12) |
Obese (>= 30) | 29 |
37.2
| 0.39 | (0.25, 0.62) | 0.49 | (0.28, 0.85) |
Baby admitted to special care
| ||||||
No (ref) | 379 |
55.5
| 1 | n/s | ||
Yes | 39 |
48.2
| 0.74 | (0.47, 1.18) | n/s | |
Gestation
| ||||||
< 37 weeks (ref) | 31 |
50.0
| 1 | n/s | ||
37 weeks and over | 387 |
55.1
| 1.12 | (0.70, 1.79) | n/s | |
Breastfed within 1 hour of birth
| ||||||
Yes (ref) | 246 |
57.8
| 1 | n/s | ||
No | 172 |
50.9
| 0.71 | (0.54, 0.93) | n/s | |
Received formula in hospital
| ||||||
No (ref) | 328 |
60.0
| 1 | 1 | ||
Yes | 90 |
41.5
| 0.39 | (0.29, 0.53) | 0.43 | (0.30, 0.62) |
Education
| ||||||
Completed tertiary (ref) | 269 |
63.9
| 1 | n/s | ||
Completed secondary (but not tertiary) | 96 |
48.5
| 0.53 | (0.38, 0.75) | n/s | |
Did not complete secondary | 53 |
36.6
| 0.33 | (0.22, 0.48) | n/s | |
Family income (AUD)
| ||||||
<$20,000 (ref) | 43 |
42.2
| 1 | n/s | ||
$20–50,000 | 149 |
52.0
| 1.43 | (0.95, 2.12) | n/s | |
>$50,000 | 206 |
62.2
| 2.06 | (1.38, 3.09) | n/s | |
Income missing | 20 |
45.5
| 1.09 | (0.59, 2.02) | n/s | |
Region of birth
| ||||||
Australia (ref) | 269 |
50.3
| 1 | 1 | ||
Asia | 64 |
75.3
| 2.91 | (1.84, 4.62) | 2.90 | (1.57, 5.36) |
Other | 85 |
59.0
| 1.58 | (1.11, 2.24) | 1.53 | (0.99, 2.36) |
Employed/studying at 6 months
| ||||||
No (ref) | 306 |
57.2
| 1 | n/s | ||
Yes | 112 |
48.9
| 0.75 | (0.56, 0.99) | n/s | |
Attended childbirth education
| ||||||
Yes (ref) | 364 |
58.8
| 1 | 1 | ||
No | 54 |
37.2
| 0.45 | (0.32, 0.63) | 0.46 | (0.29, 0.71) |
Breastfeeding problems day 2–4
| ||||||
No (ref) | 178 |
57.6
| 1 | n/s | ||
Yes | 240 |
52.8
| 0.73 | (0.55, 0.96) | n/s | |
Rated midwife home visit extremely helpful for breastfeeding issues
| ||||||
No (ref) | 321 |
53.3
| 1 | n/s | ||
Yes | 85 |
60.7
| 1.36 | (0.93, 1.97) | n/s | |
Did not have home visit | 12 |
54.6
| 1.05 | (0.45, 2.47) | n/s | |
Attended breastfeeding clinic
| ||||||
Had breastfeeding problems but did not attend clinic (ref) | 177 |
50.0
| 1 | n/s | ||
Had breastfeeding problems, did attend clinic | 79 |
55.6
| 1.25 | (0.85, 1.85) | n/s | |
Had no bf problems | 162 |
60.5
| 1.53 | (1.11, 2.12) | n/s | |
Anxiety or depression problem in first 6 months (self-report)
| ||||||
No (ref) | 280 |
58.0
| 1 | 1 | ||
Yes | 138 |
49.1
| 0.78 | (0.59, 1.03) | 0.64 | (0.46, 0.90) |
Relationship problems at all in first 6 months
| ||||||
No (ref) | 378 |
57.0
| 1 | 1 | ||
Yes | 40 |
39.6
| 0.56 | (0.38, 0.84) | n/s | |
Age at recruitment (continuous variable used)#
| - | - | 0.48 # | (0.35, 1.84) | 1.58 # | (1.35, 1.86) |