Importance of Familial Opinions on Breastfeeding Practices: Differences Between Father,Mother,and Mother-in-Law

Abstract

Background:

Multiple types of individuals compose a mother's social support network. Women may value opinions of individuals' within their support network differently. Our study examined the relationship between breastfeeding opinions from individuals within the social support network and breastfeeding initiation and duration.

Materials and Methods:

Data from the Infant Feeding Practices Survey II were analyzed. The importance of individuals' opinions on a mother's breastfeeding decision was investigated for the baby's father, the participant's mother and mother-in-law, the infant's pediatrician, and the participant's obstetrician. The main outcomes were breastfeeding initiation (yes; no) and breastfeeding duration (weeks). Logistic regression provided the odds of never breastfeeding, while Cox proportional hazard models were used to assess the risk of breastfeeding cessation.

Results:

Women who stated that the father's opinion was not at all important were more likely to never breastfeed and prematurely cease breastfeeding compared to women who stated that the father's opinion was very important for their breastfeeding decisions. Conversely, women had lower odds of never breastfeeding and a decreased risk of breastfeeding cessation if they reported that the mother-in-law's opinion was not at all important or not very important compared to women who reported that the mother-in-law was very important. No statistically significant relationship was found between the participant's mother and breastfeeding initiation and cessation.

Conclusion:

This study found a hierarchical association between individuals in a social support network and breastfeeding initiation and duration. Inverse relationships were found between the importance of fathers' and mother-in-laws' opinions. Interventions aimed at increasing breastfeeding initiation, and duration rates should include a wider range of individuals within a social support network.

Introduction

The United States has one of the lowest breastfeeding rates in the world.¹ In 2015, only one in five (22.3%) mothers exclusively breastfed for 6 months.² Increasing breastfeeding rates is a key strategy to improve maternal and child health. The nutrients and antibodies found in breast milk provide long-lasting protection against chronic and short-term ailments for the child,^3–7 including upper and lower respiratory tract infections, otitis media,⁸ type 1 and type 2 diabetes mellitus, and obesity.⁹ Similarly, mothers who breastfeed are at a decreased risk of breast¹⁰ and ovarian cancer¹¹ and are more likely to return to prepregnancy weight quickly.¹²

Despite the benefits of breastfeeding, research shows that thus far mothers in the United States received inadequate social support. The Centers for Disease Control and Prevention (CDC) stated that the low breastfeeding rates suggest that support from health care providers, family members, and employers is not adequate for mothers.² A lack of support or opposition of breastfeeding within a mother's social network is a major barrier to both initiation and continuation of breastfeeding.¹³ One individual in the mother's network that is often cited as the most influential for breastfeeding outcomes is the infant's father.^14,15 Results from a prospective cohort study indicated that mothers can be heavily encouraged or dissuaded from breastfeeding by the father.¹⁵ In addition, a cross-sectional study stated that a father's encouraging attitude was the most important form of support for breastfeeding mothers.¹⁴

Current research investigating other individuals in a mother's social support network, such as grandparents, is scant. This is a critical gap in current literature as previous research indicated that other individuals in a women's support system could be as equally important as fathers.^16–19 For example, a community-based study reported that support from the infant's maternal grandmother would have influenced bottle-feeding mothers to breastfeed.¹⁶ Moreover, an evaluation of a voluntary breastfeeding support service in Northwest England reported that including grandmothers in the community-based program made a significant positive impact in the support mothers received.¹⁷ Findings from these studies suggested that in addition to fathers, grandmothers may play an important role in breastfeeding success.

Physicians are also an essential component of a mother's social support network that has been vastly ignored. Physicians have a unique opportunity to provide breastfeeding education and support that may aid mothers in breastfeeding. However, less than a quarter of women report receiving breastfeeding guidance from their obstetrician.²⁰ Furthermore, significant deficits in physicians' knowledge and abilities to provide breastfeeding support have been documented,^21–23which may undermine the relationship between patients and providers.

This study investigates a mother's extended social support network in an attempt to understand the influence of major individuals (fathers, grandmothers, and physicians) who provide social support for breastfeeding. The current study was guided by an adapted social-ecologic model, which has been used in previous breastfeeding research.²⁴ This model is based on evidence stating that no single factor can explain an outcome.²⁵ Core areas of the adapted model include the following: individual, interpersonal, community/environment, organizational, and policy. Utilizing aspects of the social-ecological model, this study investigates the relationship between the importance of breastfeeding opinions from the infant's family members and health care providers and breastfeeding initiation and duration.

Materials and Methods

Data from the Infant Feeding Practices Survey (IFPS) II were analyzed. The data were collected by the Food and Drug Administration and CDC in the United States from May 2005 to June 2007, with a 6-year follow-up in 2012. The IFPS II collects longitudinal data on a variety of information, including infant feeding and maternal perceptions. It used a standardized data collection protocol that minimized the potential for information bias. Furthermore, all survey questions were extensively tested and validated.^26,27 Additional information on IFPS II methodology can be found elsewhere.²⁸

The main exposure, the importance of individuals' opinions on mother's breastfeeding decisions, was based on the survey item, “How important are the following people's opinions in your decision about how to feed your baby?.” The survey item asks about the baby's father, the participant's mother, the participant's mother-in-law, the participant's obstetrician or other doctor, and the infant's pediatrician or other doctor. Participants could answer “not at all important,” “not very important,” “somewhat important,” “very important,” or “no one in this category.” Each individual was coded as a separate variable, and responses were considered ordinal. Breastfeeding initiation, breastfeeding duration, and exclusive breastfeeding duration were the main outcomes of interest. Breastfeeding initiation (yes; no) was based on the prompt, “Did you ever breastfeed this baby (or feed this baby your pumped milk)?.” This study only included women who initiated breastfeeding for the secondary outcome variable, breastfeeding duration. To determine breastfeeding duration, participants responded to questions reporting the number of weeks the infant was breastfed. To differentiate between “breastfeeding duration” and “exclusive breastfeeding duration,” IFPS II created variables based on questionnaire prompts regarding exclusive breastfeeding during the hospital stay and in the postpartum period. Additional information on the operational definition of “breastfeeding duration” and “exclusive breastfeeding duration” can be found elsewhere.²⁹

A variety of covariates identified in the literature were assessed as potential confounders.^3,30,31 These covariates included marital status (married; not married), maternal race (Non-Hispanic White; Non-Hispanic Black; Hispanic; Non-Hispanic other), maternal age (continuous), maternal education (less than high school; high school graduate; 1–3 years of college; college graduate), household income (<$20,000; $20,000–49,999; >$50,000), prenatal health insurance or health care plan (yes; no), prenatal participation in the Special Supplemental Nutrition Program from the Women, Infants, and Children (WIC) program (yes; no), prenatal care provider (obstetrician; family/other physician; midwife/nurse-midwife), and breastfeeding intention (breastfeed only; formula feed only; both breast and formula feed).

Women were excluded if they reported “no one in this category” for the father, mother-in-law, mother, obstetrician, or pediatrician. The study analysis included participants who had complete information on the outcome and exposure variables (N = 2,430). Descriptive statistics, including frequencies and percentages, was generated to assess the distribution of characteristics in the study sample. Breastfeeding intention and marital status were statistically significant effect modifiers for breastfeeding initiation and duration; therefore, they were not considered as potential confounders.^32,33 Furthermore, the Pearson correlation coefficient showed a high correlation (r = 0.84) between the infant's physician and mother's physician; therefore, only the participant's obstetrician was included in the breastfeeding initiation model and only the infant's pediatrician was included in the breastfeeding duration model.³⁴

To assess the relationship between individuals within a mother's social support network and breastfeeding initiation, logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). To assess the relationship between individuals within a mother's social support and breastfeeding duration and exclusive breastfeeding duration, hazard ratios (HRs) and 95% confidence limits (CLs) were obtained using Cox proportional hazard models. The proportional hazard assumption was verified graphically and with a time-dependent interaction. Potential confounders that changed the crude estimations by 10% were included in a parsimonious model.³⁵ A fully adjusted model was also produced. All descriptive, logistic regression, and survival analyses were conducted using SAS software (SAS, Version 9.4; SAS Institute Inc., Cary, NC).

Results

The mean age of participants was ∼29 years (standard deviation = 5.3). The majority of women were married (82.3%), non-Hispanic White (85.5%), and intended to breastfeed (62.2%). The majority of women who breastfed at least 6 months were a college graduate (53.7%), intended to breastfeed (85.5%), and stated that the infant's father was very important in their decision to breastfeed (73.5%). Breastfeeding duration was associated with age, marital status, race, education, income, prenatal health insurance plan, prenatal WIC participation, and breastfeeding intention (Table 1).

Table 1.

Distribution of Maternal Characteristics by Breastfeeding Duration

Characteristic	Total	Never breastfed	Breastfed <6 month	Breastfed ≥6 month	p^a
Characteristic	N = 2,430	n = 346	n = 1,062	n = 1,022
Age^b	28.9 (5.3)	28.8 (5.3)	27.8 (5.4)	30.0 (4.9)	<0.0001
Marital status					<0.0001
Not married	17.7	23.5	24.9	8.9
Maternal race					<0.0001
White, NH	85.5	90.2	81.0	88.6
Black, NH	3.9	5.0	5.3	2.2
Hispanic	6.0	3.3	8.1	4.9
Other	4.5	1.5	5.7	4.4
Maternal education					<0.0001
Less than high school	2.9	5.7	3.3	1.6
High school	16.0	27.4	17.8	10.8
1–3 years of college	39.9	38.8	46.7	33.8
College graduate	41.2	28.1	32.2	53.7
Income					<0.0001
< $20,000	12.2	16.5	14.3	8.5
$20,000–$49,999	42.6	43.1	43.2	41.8
≥ $50,000	45.2	40.5	42.5	49.7
Health insurance					0.4597
No	4.3	3.8	4.9	3.9
Prenatal WIC					<0.0001
Yes	27.8	41.2	32.2	18.7
Breastfeeding intention					<0.0001
Breastfeed only	62.2	2.44	58.5	85.5
Formula feed only	13.5	82.3	4.6	0.00
Both breast and formula feed	24.3	15.2	36.9	14.5
Importance of baby's father					<0.0001
Not at all	6.0	11.3	6.2	3.9
Not very	3.5	4.9	3.6	3.0
Somewhat	20.1	29.5	17.6	19.6
Very	70.4	54.3	72.6	73.5
Importance of participant's mother					<0.0001
Not at all	16.5	20.8	14.1	17.6
Not very	21.1	21.7	18.8	23.3
Somewhat	39.8	38.2	39.9	40.1
Very	22.6	19.4	27.1	19.0
Importance of participant's mother-in-law					<0.0001
Not at all	30.5	33.0	28.8	31.4
Not very	30.3	28.6	27.5	33.9
Somewhat	30.8	29.5	31.8	29.2
Very	8.8	9.0	11.9	5.6
Importance of participant's obstetrician/other doctor					<0.0001
Not at all	9.1	12.7	7.0	10.0
Not very	11.1	11.6	9.8	12.3
Somewhat	42.9	46.8	39.3	45.3
Very	37.0	28.9	44.0	32.4
Importance of infant's pediatrician/other doctor					<0.0001
Not at all	7.2	10.4	5.7	7.8
Not very	6.5	8.4	5.7	6.7
Somewhat	39.6	46.2	35.7	41.5
Very	46.6	35.0	52.9	44.0

Not all percentages sum to 100% due to rounding.

Analysis for categorical variables was conducted using the chi-squared test, while continuous variables were tested using a t test.

Mean with standard deviation.

NH, Non-Hispanic; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.

Table 2 displays crude and adjusted results from the logistic regression analysis assessing the importance of individuals within a mother's social support network and breastfeeding initiation. The parsimonious model controlled for maternal education and prenatal WIC participation. Compared to women who stated that the father's opinion was very important for their breastfeeding decisions, women who stated that the father was not at all important or somewhat important were 2.5 times (OR = 2.51; 95% CI = 1.47–4.27) and 1.8 times (OR = 1.80; 95% CI = 1.33–2.45) more likely to never breastfeed, respectively. Similarly, women who reported that the obstetrician was somewhat important for their breastfeeding decision were 1.5 times (OR = 1.49; 95% CI = 1.09–2.05) more likely to never breastfeed compared to women who reported that the obstetrician was very important. Conversely, women had lower odds of never breastfeeding if they reported that the mother-in-law was not at all important (OR = 0.45; 95% CI = 0.24–0.83) or not very important (OR = 0.52; 95% CI = 0.28–0.96) compared to women who reported that the mother-in-law was very important. The importance of the participant's mother did not show a statistically significant relationship with breastfeeding initiation. The fully adjusted model controlled for maternal education, age, income, insurance status, prenatal care provider, and prenatal WIC participation. After controlling for all potential confounders, the majority of estimates remained statistically significant but were attenuated; however, the importance of the participant's mother-in-law was not statistically significant.

Table 2.

Association Between the Importance of Individuals Within the Social Support Network and Breastfeeding Noninitiation

OR ^a [95% CI]
	Unadjusted	Parsimonious model ^b	Fully adjusted model ^c
Importance of baby's father
Not at all	3.14 (1.93–5.12)^f	2.51 (1.47–4.27)^e	2.20 (1.27–3.83)^e
Not very	2.02 (1.14–3.60)^d	1.40 (0.73–2.67)	1.38 (0.71–2.68)
Somewhat	2.14 (1.62–2.83)^f	1.80 (1.33–2.45)^e	1.72 (1.25–2.37)^e
Very	Reference
Importance of participant's mother
Not at all	1.16 (0.69–1.93)	1.34 (0.76–2.34)	1.17 (0.66–2.08)
Not very	1.11 (0.69–1.77)	1.28 (0.77–2.13)	1.11 (0.66–1.89)
Somewhat	1.02 (0.69–1.52)	1.12 (0.72–1.74)	0.98 (0.62–1.53)
Very	Reference
Importance of participant's mother-in-law
Not at all	0.48 (0.27–0.85)^d	0.45 (0.24–0.83)^d	0.56 (0.29–1.07)
Not very	0.54 (0.31–0.95)^d	0.52 (0.28–0.96)^d	0.63 (0.33–1.20)
Somewhat	0.66 (0.39–1.13)	0.56 (0.31–1.00)	0.67 (0.36–1.25)
Very	Reference
Importance of participant's obstetrician/other doctor
Not at all	1.51 (0.91–2.48)	1.54 (0.91–2.63)	1.66 (0.95–2.89)
Not very	1.37 (0.88–2.13)	1.48 (0.93–2.38)	1.46 (0.90–2.39)
Somewhat	1.47 (1.10–1.97)^e	1.49 (1.09–2.05)^d	1.48 (1.06–2.06)^d
Very	Reference

Compared to women who initiated breastfeeding.

Adjusted for maternal education and prenatal WIC participation.

Adjusted for maternal education, age, income, insurance status, prenatal care provider, and prenatal WIC participation.

p ≤ 0.05; ^ep ≤ 0.01; ^fp < 0.001.

CI, confidence interval; OR, odds ratio.

Table 3 shows results from the Cox proportional hazard model investigating the relationship between individuals within a mother's social support network and breastfeeding duration. After adjusting for maternal race, education, and age in the parsimonious model, women who reported that the father was not at all important had a 43% higher risk (HR = 1.43; 95% CL = 1.13–1.81) of breastfeeding cessation compared to women who reported that the father was very important. Conversely, women who reported that the mother-in-law was not at all important, not very important, or somewhat important had a decreased risk of breastfeeding cessation compared to women who reported that the mother-in-law was very important. Similarly, women who reported that the infant's pediatrician or other doctor was not at all important or somewhat important had a lower risk of breastfeeding cessation. No statistically significant relationship was found for the participant's mother. The fully adjusted model controlled for maternal education, age, income, insurance status, prenatal care provider, and prenatal WIC participation. After controlling for all potential confounders, estimates had no or little variation from the parsimonious model and remained statistically significant.

Table 3.

Proportional Hazards of Breastfeeding Duration by the Importance of Individuals Within the Social Support Network

HR [95% CL]
	Unadjusted	Parsimonious model ^a	Fully adjusted model ^b
Importance of baby's father
Not at all	1.67 (1.33–2.09)^e	1.43 (1.13–1.81)^d	1.41 (1.11–1.79)^d
Not very	1.09 (0.85–1.41)	1.03 (0.79–1.34)	1.06 (0.82–1.38)
Somewhat	0.997 (0.89–1.12)	0.97 (0.86–1.09)	0.96 (0.85–1.09)
Very	Reference
Importance of participant's mother
Not at all	0.80 (0.67–0.97)	0.94 (0.77–1.14)	0.95 (0.78–1.16)
Not very	0.95 (0.81–1.12)	1.10 (0.93–1.30)	1.11 (0.94–1.32)
Somewhat	0.97 (0.85–1.11)	1.06 (0.92–1.21)	1.08 (0.94–1.24)
Very	Reference
Importance of participant's mother-in-law
Not at all	0.77 (0.63–0.94)^d	0.78 (0.62–0.96)^c	0.78 (0.62–0.97)^c
Not very	0.72 (0.59–0.88)^d	0.76 (0.61–0.94)^c	0.76 (0.61–0.94)^c
Somewhat	0.77 (0.64–0.93)^d	0.79 (0.64–0.97)^c	0.79 (0.64–0.97)^c
Very	Reference
Importance of infant's pediatrician/other doctor
Not at all	0.71 (0.58–0.86)^d	0.67 (0.55–0.83)^d	0.66 (0.54–0.82)^d
Not very	0.86 (0.71–1.04)	0.87 (0.71–1.07)	0.86 (0.70–1.05)
Somewhat	0.86 (0.78–0.95)^d	0.84 (0.76–0.94)^d	0.84 (0.76–0.93)^d
Very	Reference

Bold estimates signifcant.

Adjusted for maternal race, education, and age.

Adjusted for maternal education, age, income, insurance status, prenatal care provider, and prenatal WIC participation.

p ≤ 0.05; ^dp ≤ 0.01; ^ep < 0.001.

CL, confidence limit; HR, hazard ratio.

Table 4 shows results from the Cox proportional hazard model investigating the relationship between individuals within a mother's social support network and exclusive breastfeeding duration. After adjusting for maternal age and prenatal health insurance status in the parsimonious model, women who reported that the father was not at all important had 56% higher risk (HR = 1.56; 95% CL = 1.12–2.18) of discontinuing exclusive breastfeeding compared to women who reported that the father was very important. Conversely, women who reported that the infant's pediatrician or other doctor was not at all important, not very important, or somewhat important had a lower risk of breastfeeding cessation compared to women who reported that the pediatrician was very important. No statistically significant relationship was found for the participant's mother or mother-in-law. The fully adjusted model controlling for maternal education, age, income, insurance status, prenatal care provider, and prenatal WIC participation resulted in attenuated estimates; however, all relationships from the parsimonious model remained statistically significant.

Table 4.

Proportional Hazards of Exclusive Breastfeeding Duration by the Importance of Individuals Within the Social Support Network

HR [95% CL]
	Unadjusted	Parsimonious model ^a	Fully adjusted model ^b
Importance of baby's father
Not at all	1.66 (1.19–2.31)^d	1.56 (1.12–2.18)^d	1.44 (1.02–2.03)^c
Not very	1.01 (0.70–1.45)	1.02 (0.71–1.47)	0.91 (0.61–1.32)
Somewhat	1.15 (0.98–1.36)	1.14 (0.97–1.34)	1.08 (0.91–1.28)
Very	Reference
Importance of participant's mother
Not at all	1.03 (0.80–1.34)	1.08 (0.83–1.39)	1.10 (0.84–1.44)
Not very	1.19 (0.95–1.49)	1.22 (0.97–1.54)	1.28 (1.00–1.62)
Somewhat	1.11 (0.91–1.34)	1.11 (0.92–1.35)	1.15 (0.95–1.41)
Very	Reference
Importance of participant's mother-in-law
Not at all	0.97 (0.71–1.34)	1.00 (0.73–1.37)	1.04 (0.74–1.45)
Not very	0.89 (0.65–1.22)	0.91 (0.66–1.24)	0.92 (0.66–1.29)
Somewhat	1.05 (0.77–1.42)	1.08 (0.80–1.46)	1.07 (0.78–1.48)
Very	Reference
Importance of infant's pediatrician/other doctor
Not at all	0.63 (0.48–0.82)^d	0.63 (0.48–0.82)^d	0.62 (0.47–0.81)^d
Not very	0.72 (0.56–0.93)^c	0.73 (0.57–0.95)^c	0.74 (0.57–0.97)^c
Somewhat	0.78 (0.68–0.89)^d	0.77 (0.68–0.89)^d	0.78 (0.67–0.89)^d
Very	Reference

Bold estimates signifcant.

Adjusted for maternal age and insurance status.

Adjusted for maternal education, age, income, insurance status, prenatal care provider, and prenatal WIC participation.

p ≤ 0.05; ^dp ≤ 0.01.

Discussion

Research has demonstrated that social support is integral for breastfeeding outcomes; however, most studies were predominately conducted outside the United States,^36–39 or they failed to examine multiple individuals within a social network that provide breastfeeding support. Our results suggest a hierarchical association between individuals within a women's social support network and breastfeeding initiation and duration.

The current study found that participants who did not think the father's opinion was very important had increased odds of never breastfeeding and an increased risk of breastfeeding cessation. These results are corroborated with previous research investigating the role of fathers in breastfeeding outcomes. For example, a cross-sectional study showed that a primary reason for infant formula bottle-feeding over breastfeeding was the mother's perception of the father's feeding preference.¹⁶ Furthermore, research has found that mothers receiving breastfeeding support from their partners in the early postpartum period were more likely to initiate breastfeeding and have a longer breastfeeding duration.⁴⁰

Conversely, this study found that regardless of the level of importance that the mother-in-law's opinion had on a mother's breastfeeding decision, the odds of never breastfeeding and the risk for breastfeeding cessation decreased. This suggests that participants may not value the mother-in-law's opinion—which could be explained through the culture of integrating with the “in-laws” in the United States. In today's society, popular culture depicts a relationship with the mother-in-law as problematic and strenuous.⁴¹ Furthermore, research investigating family communication found that the majority of female participants' complaints were regarding the mother-in-law.⁴² However, previous literature stated that the mother- and daughter-in-law relationship provides a high level of social support.^43,44 The parsimonious logistic regression model showed a statistically significant relationship between the mother-in-law and breastfeeding initiation; however, the estimate was not statistically significant in the fully adjusted model. This may be explained through the loss in efficiency of the logistic regression model when controlling for additional variables or accounting for the additional covariates explained in the association. In addition, the estimate from the fully adjusted Cox proportional hazards model remained statistically significant for breastfeeding duration.

Results from this study also found that mothers had higher odds of never breastfeeding if they reported that an obstetrician's opinion was not very or somewhat important for their breastfeeding decision. Despite physicians' immediate and intimate interaction with mothers after delivery, the amount of time spent with the patient discussing and supporting breastfeeding initiation may be insufficient. Repeatedly, clinicians report inadequate time to properly educate and support women during their patient encounters.⁴⁵ Furthermore, clinicians may feel unprepared to resolve problems that are often cited as a barrier to breastfeeding initiation,⁴⁵ such as infant latching.⁴⁶ In contrast, this study found that regardless of the reported importance of the pediatricians' opinion, having a pediatrician lowered the risk of breastfeeding cessation. This could also be explained through health seeking behaviors, as women may ask probing questions to their pediatrician⁴⁷—which could lead to a longer breastfeeding duration. A cross-sectional study among women who lived in a Midwestern state reported that if physicians informed women about the numerous maternal and child health benefits, they were more likely to breastfeed.⁴⁷

To the authors' knowledge, this is the first U.S. based study to concurrently investigate multiple individuals within a women's social support network for breastfeeding initiation and duration. Utilizing the prospective, longitudinal IFPS II dataset allowed temporality to be established. However, IFPS II does not have an exhaustive list of all individuals that could provide support to the mother, such as friends, siblings, or extended family members (e.g., the mother's father, aunt, uncle, and cousins). The current study excluded mothers who did not have a full social network to reduce potential residual confounding that may result from psychological underpinnings related to the absence of essential people in the social support network. Breastfeeding initiation and duration is self-reported, which is prone to social desirability and recall bias. Finally, some potential confounding factors that could affect estimates, including self-efficacy, alcohol/substance use, and the breastfeeding opinions of individuals within the social network, were not available in the dataset and could not be assessed.

Conclusion

Results from this study highlight an important aspect of breastfeeding support. Specifically, this study found that multiple individuals play an integral role in breastfeeding initiation and duration. However, the strength and direction of associations varied based on the individual providing support, suggesting a hierarchical relationship between individuals within a social support network and breastfeeding initiation and duration. Interventions aimed at increasing breastfeeding initiation and duration rates should include a wider range of individuals within a social support network. Current public health efforts should also take into consideration the differing effects individuals may have on mothers' breastfeeding choices. Additional research should examine the relationship of the number of people within a mother's social support network and breastfeeding duration. Future studies should also investigate if the presence or absence of each individual within a social support network increases breastfeeding duration. Finally, additional research is needed to corroborate the idea of a hierarchical structure of individuals within social support networks.

Footnotes

Disclosure Statement

No competing financial interests exist.

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