Broadening the Lens: University Students and Breastfeeding Attitudes

Abstract

Dear Editor:

Breastfeeding is recommended as the optimal source of nutrition for infants and has proven benefits for both mother and child. Despite these well-known advantages, only 15% of women in Canada exclusively breastfeed their child to 6 months of age.¹ The national initiation rate, which captures women who breastfeed even for a short period of time, is much higher at 87.5%.¹ As with many national averages, this number represents marked geographical variation across the country, with higher rates in the western provinces such as British Columbia (97.3%) and Alberta (92.4%), whereas the eastern provinces demonstrate lower rates.² Newfoundland and Labrador (NL), the most easterly province in Canada, has the lowest breastfeeding initiation rate in the country, with an initiation rate of 62%.^1,3

In order to better understand factors that might contribute to NL's low breastfeeding initiation rate, a survey was distributed to 215 students at Memorial University, St. John's, NL, Canada. Young adults were chosen as survey subjects based on research that showed that most women make the breastfeeding decision prior to conception or, in some cases, as early as adolescence.⁴ The data from the survey revealed several interesting findings. First, the intention to breastfeed among these university students was 60%, a similar percentage to the number of women in NL who initiate breastfeeding. Second, knowledge among students about general breastfeeding benefits (such as breastmilk is better than formula) was greater than 80%, but they were considerably less informed about specific health benefits for the mother and infant (Table 1). Third, when compared with young women, young men were less informed overall on breastfeeding benefits.

Table 1.

Responses to World Health Organization Breastfeeding Knowledge Questions

Statement	n	True	False	Unsure
Breastfeeding is recommended by the WHO until 6 months without the addition of solid or other fluids.	215	50.2	4.2	45.6
Breastfeeding provides protection against diarrhea and respiratory tract infections of the baby.	215	50.2	4.7	45.1
Breastfeeding reduces risks of breast and ovarian cancer.	215	36.7	6.5	56.3
Breastfeeding is always painful for the new mother.	214	13.0	47.0	39.5
Breastmilk is the best source of nutrition for a newborn baby.	214	84.2	3.7	11.6
The ingredients in breastmilk and infant formula are identical.	214	1.4	76.3	21.9
It is healthy for babies to breastfeed for up to 2 years and beyond with the addition of appropriate solid foods.	215	19.1	37.2	43.7
People who were bottle fed perform better in intelligence tests than people who were breastfed.	215	6.0	54.9	39.1

Data are in percentages. Totals may not add to 100% because of rounding.

WHO, World Health Organization.

It is well known that cultural influences have a significant impact on breastfeeding rates. Norway, for example, enjoys a breastfeeding initiation rate of almost 100%, and the rate remains high (>50%) at 3 months. In Norwegian culture, women are expected to breastfeed, as it is seen as “trendy, good and positive.”⁵ NL, which has a “bottlefeeding” culture, does not have the same societal pressures to breastfeed, which may be reflected in the low initation rate, low exclusive breastfeeding rates, and the poor intention to breastfeed. Societal attitudes and behaviors toward breastfeeding in NL need to improve in order to positively affect the intentions of young adults to breastfeed.

The majority of students could correctly identify the most general of the World Health Organization (WHO) breastfeeding statements, such as “breast milk is the best nutritional source for the newborn” and “ingredients of breast milk differ from formula.”⁶ However, far fewer students could correctly identify the specific statements on breastfeeding, including the protective effects it offers to the mother and baby. Studies have demonstrated the effectiveness of educational interventions targeted toward teenagers and young adults in increasing knowledge after short teaching sessions.⁷ Informing students and young adults about the specific benefits of breastfeeding as well as on WHO breastfeeding facts and recommendations before they become parents may help increase the proportion of young people who decide to breastfeed, as they will be making better informed decisions.

When young men become fathers, they may play a significant role in the infant feeding decision. It is well known that women with male partners who are informed about the benefits of breastfeeding are more likely to breastfeed and to breastfeed for a longer duration.⁸ Therefore, it would be wise to provide educational opportunities for young men to learn about the benefits of breastfeeding. This could translate into breastfeeding support and encouragement for their partners, which in turn could impact breastfeeding initiation and exclusivity rates. Most students agreed that “a father's support is necessary for breastfeeding,” which demonstrated they were able to recognize the importance of the father's role in the breastfeeding picture. This finding, taken together with the fact that males have a lower knowledge level about breastfeeding (compared with young women), underscores the importance of educating young men on the benefits of breastfeeding.

Too often, breastfeeding “rates” are seen through the narrow lens of the maternal decision, and many promotional efforts focus exclusively on promoting breastfeeding to pregnant or postpartum woman. Widespread education of both young men and women to educate them on the specific benefits of breastfeeding has shown promise to help increase breastfeeding rates.

References

Public Health of Canada. What Mothers Say: The Canadian Maternal Experiences Survey. Ottawa: Public Health Agency of Canada, 2009.

Statistics Canada. Canadian Community Health Survey. 2011. www.statcan.gc.ca/pub/82-625-x/2010002/article/11269-eng.htm (accessed November 2012 ).

Newfoundland and Labrador Provincial Perinatal Program. NLPPP Resources and Publications. 2011. www.nlppp.ca/disclaimer.htm (accessed November 2012 ).

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World Health Organization. Global strategy for infant and young child feeding. 2003. www.who.int/features/qa/21/en/index/html (accessed November 2012 ).

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