The Role of Family on Breastfeeding: A Scoping Review

Jusrawati Jusrawati, Endang Koni Suryaningsih*

Faculty of Health Sciences, Universitas Aisyiyah Yogyakarta, 55592 Yogyakarta, Indonesia

*Corresponding Author's Email: koni@unisayogya.ac.id

ABSTRACT

Background: The role of the family in the breastfeeding process affects the success rate of breastfeeding, such as the closest family, namely the spouse and grandmother. Objective: To classify the scientific evidence related to the role of the family at large and the factors that may hinder the role of the family. Methods: This scoping review referred to Arksey and O'Malley's framework for exploring family roles in breastfeeding and used the PRISMA-ScR checklist. Articles were searched in three databases: PubMed, ProQuest, EBSCO, and Science Direct. Themes were identified by applying inclusion and exclusion criteria, performing a critical appraisal, data charting, reporting, and discussing the results. Results: A search of 2,292 articles found studies that were consistent with the findings that family support in breastfeeding, the role, attitude, and knowledge of parents, the presence of supplementary feeding, and partner violence in breastfeeding occurred in breastfeeding practices. Conclusion: This review describes the role of the family in breastfeeding and shows that the family plays an essential role in breastfeeding practices. The findings can make researchers and practitioners aware that various supporting factors and barriers influence breastfeeding. Future research is expected to evaluate the role of the family in breastfeeding.

Keywords: Breastfeeding; Family; Review; Role

INTRODUCTION

Breastfeeding is giving breast milk to newborns for at least six months, aiming to improve the immune system, fulfil nutritional needs, and reduce mortality in children (Bueno-Gutiérrez, Castillo & Mondragón, 2021). Breastfeeding also increases the positive relationship between mother and baby (Sandhi et al., 2020). Currently, breastfeeding practice is low in some countries as mothers stop breastfeeding their babies before six months old (van Dellen et al., 2019). WHO recommends breastfeeding for six months at least and can be continued until 24 months (World Health Organization, n.d.). Baseline data show that breastfeeding practice reached 38% in 2012. However, the global breastfeeding target for 2025 is above 50%. Based on an analysis, children under five who are not optimally breastfed contributed 11.69%, or equivalently, to 804,000 child deaths in 2011 (World Health Organization, 2012).

Less optimal breastfeeding after childbirth can be influenced by factors such as a husband's lack of support. Family support, including parents and grandmothers, can affect breastfeeding (Ayalew, 2020). Many assume that family support is not essential when breastfeeding, causing separation for some couples (Nilsson et al., 2022). The breastfeeding process requires a calm environment, especially the husband's role in the breastfeeding process, to avoid stress (Hernández-Cordero et al., 2020).

Most mothers, when breastfeeding their babies, are not optimal because of several interventions from the family. Breastfeeding can be helped by formula milk (Uddin et al., 2022). Therefore, support from the family in breastfeeding practices will reduce anxiety or extreme attitudes (Abdulahi et al., 2021). While the majority of fathers or grandmothers mostly breastfeed, their babies use a spoon or bottle when the mother feels exhausted while breastfeeding (Sultana et al., 2022).

Achieving optimal breastfeeding status requires prospective parents to be given education and the knowledge that family involvement starts from pregnant women through childbirth and breastfeeding (Suryaningsih et al., 2020). Previous studies showed the success of breastfeeding practices due to support and motivation from husbands and families, which can create confidence in mothers when breastfeeding (Fadjriah et al., 2021). Another thing that can affect breastfeeding is the existence of gadgets in this day and age. Hence, mothers and husbands want to be more practical by looking for alternatives to breastfeeding their babies (Dinour & Pole, 2022). Based on previous research in the Chinese region, it was revealed that urban areas breastfeed their babies less than rural areas because of the role of parents who are more involved with their activities (Liu et al., 2022).

The previous study focused more on the specific role of the family, namely low breastfeeding due to stress caused by a lack of support from the family, formula feeding due to family intervention, and the knowledge and education of parents and families about the importance of breastfeeding. The main objective of this study was to identify and evaluate the overall theory and physiology of research on the role of family in breastfeeding. Therefore, we were interested in using the scoping review method based on existing research knowledge gaps (Munn et al., 2018).

METHODOLOGY

This literature review includes five critical phases of the framework based on Arksey and O'Malley, namely (1) Identifying the research objectives; (2) Identifying the types of relevant studies; (3) selecting studies; (4) mapping data; and (5) compiling, summarizing, and reporting the results (Arksey & O’Malley, 2005). The databases used in this search are PubMed, ProQuest, EBSCO, and Science Direct. Literature that covers the role of the family in breastfeeding and includes relevant inclusion criteria will be identified through further study. The search strategy was a Boolean "OR/AND" method with medical subject headings (MeSH) through word splitting with "*" and keywords or synonyms with various combinations that were combined in one search related to the role of the family in breastfeeding. The top search terms were breastfeeding, breastfed, breast milk, breastfeeding, father, mother, grandmother, family, function, and involvement. The search strategy can be seen in Table 1.

Table 1: Search Strategy

Article Selection Criteria

The inclusion criteria used to select relevant articles are: (1) English articles: researchers use English articles to make it easier to understand; (2) Articles that discuss the role of the family towards the breastfeeding process as well as support and obstacles to the role of the family towards the breastfeeding process, (3) Articles published in 2013–2022, (4) Free full-text articles: articles that are open access, (5) Research Studies: research with qualitative, quantitative, and systematic reviews Exclusion criteria in this literature are: (1) Theses, dissertations, and books; (2) Articles that are reviews of research; (3) Opinion articles.

Search Results

Search results identified 2,291 titles; 157 markers were eligible for inclusion, and duplicates were removed. Eighty-five articles were screened by title or abstract, and 64 articles were excluded as they did not address the role of the family in breastfeeding. Thus, 21 full-text and eligible articles were analysed and reviewed together. Seven papers were inaccessible and not included in the review, resulting in 12 that met the inclusion criteria. Figure 1 (Prisma Flowchart) shows the article selection process.

Source: Diadaptasi dari Mother et al. (2009) [Tricco A. et al., 2018]

Figure 1: Prisma Flowchart (flow diagram)

Data Charting

The researcher entered relevant articles into a table (Data Charting), which was then continued with data recording to collect all relevant articles.

Table 2: Data Charting

Quality Appraisal

The authors used the Joanna Briggs Institute (JBI) study quality assessment tool for cross- sectional, cohort studies, and randomized controlled trials (RCTs) (Barker, 2023). The JBI checklist for cross-sectional research consists of eight questions. The JBI checklist for cohort studies contained 11 questions with an overall appraisal of Randomized controlled trials (RCTs) with 13 questions, all yes, and answers. Assessment of qualitative studies of four selected articles using ten questions—only two with overall solutions, yes, but the general appraisal is included. In the systematic review study, 11 questions about the quality of the article are included.

Synthesis

The authors conducted a literature review on articles obtained independently, resulting in pieces that were determined to be quantitative studies, qualitative studies, and systematic reviews. In quantitative research articles, research designs were cross-sectional, Randomized Controlled Trials, and Cohort Studies. Research articles on qualitative studies use methods such as focus group discussions (FGDs) and semi-structured and in-depth interviews. At the same time, the systematic review study was continued by conducting a meta-analysis. The summary in this scoping review describes the scope of evidence but does not describe the quality of the research. Ethical approval is not required for this scoping review.

RESULTS

Characteristics of the Study

The study characteristics were obtained based on the articles selected in the scoping review, namely research design, country, and year of publication.

Method and Design

In the final stage of the scoping review, 12 articles were obtained with Quantitative, Qualitative, and systematic review research (refer to figure 2).

Figure 2: Articles by Method

Year

Of the 12 pieces of literature that have been selected, they are from 2013 to 2022 article publications; except in 2014, there were no criteria in the selection of articles (refer to figure 3).

Figure 3: Articles by Publication Year

Country

The results of the selection of articles obtained were 12 from each country (see figure 4 below).

Figure 4: Articles by Country

Father and Grandmother Support Breastfeeding

The theory of this review is that the role of the family after the mother has given birth, especially the husband who will transition to fatherhood, plays an important role (Johansson et al., 2022). Fathers' support for breastfeeding is a significant factor in successful breastfeeding (Panahi et al., 2022). Many fathers express that mothers feel more comfortable breastfeeding their babies after returning home postpartum (Saade et al., 2022). Therefore, increased breastfeeding is improved in this case because it is inseparable from the support of a father (Bisi-Onyemaechi et al., 2017).

The family, especially the grandmother, provides support, such as information on their previous experience breastfeeding their children (Ahmadi et al., 2016). A mother's identity after giving birth is that breastfeeding is a process of her life (Rasoli et al., 2020). Grandmothers advocate that breastfeeding alone is not enough, so it is necessary to provide additional food as soon as possible (Winifred Nwabuaku & Perpetua Onyinye, 2020). Breastfeeding counseling is needed for breastfeeding mothers and other family members (grandmothers) (Nguyen et al., 2016). The family's love and support strengthen the mother's desire to breastfeed because they can build and have a loving relationship with her (Bich et al., 2019). Self-efficacy theory helps mothers delay breastfeeding early (You et al., 2020). Mothers are fully responsible for breastfeeding babies for at least six months with support from their family and environment (Mesters, Gijsbers & Bartholomew, 2018). Thus, breastfeeding practices can improve the quality of life of children in the future (Nguyen et al., 2014).

The Role of Parents in Breastfeeding Practices

It is essential to provide counseling or education to prospective parents since breastfeeding has various benefits, especially for the baby. Of course, every partner should be involved in this process (Rahayu, 2017). Other things cause mothers and fathers not to breastfeed because they feel they do not have time, have different jobs, and breastfeed in the open so that the obligations that should be carried out are not carried out (Hauck et al., 2020). Breastfeeding behavior requires health professionals in charge of health care centers to educate couples who have just become parents (Ismail, Muda & Bakar, 2016).

Parents' Knowledge, Attitude, and Perception Towards Breastfeeding

The existence of an exclusive breastfeeding program in a specific area is expected to have a practical impact on increasing parents' knowledge about breastfeeding (Nisa, Damayanti & Anggraini, 2020). The low interest of parents in providing breast milk to their babies causes poor nutrition in children, which will have an effect in the future (Claesson et al., 2018). Many parents, especially mothers, say formula feeding is considered a practical and preferred method because it does not require a long time to breastfeed their babies (Asiodu et al., 2017). The success of breastfeeding is closely related to the attitude and knowledge of the mother and father as the primary support system in this process (Demirci et al., 2018).

In general, the perception is that fathers are also involved in breastfeeding, which should show a positive attitude even though it is challenging to implement in everyday life. Therefore, the father's supportive attitude positively impacts the mother's psychological state while breastfeeding (Crippa et al., 2021). Father's participation is a form of support for mothers to be happier because of their partners' support (Zakar et al., 2018).

Supplementary Feeding

Supplementary feeding, such as formula milk, is one of the barriers mothers and fathers face in breastfeeding because, with formula milk, mothers feel that they can help in certain situations if they cannot provide breast milk. This triggers concerns because not all infant bodies can receive formula, and each procedure has different content derived from cow's milk and soy milk (Mesters, Gijsbers & Bartholomew, 2018).

Working mothers who, ideally between the ages of 0 and 6 months, should exclusively breastfeed due to the baby's imperfect digestive system, introduce solid food early. The most influential factor is the closest or older family that gives other food, such as bananas, which can be done when the baby is not even six months old (Sağlam et al., 2018).

Partner Violence in Breastfeeding

Women who tend to experience physical violence from their partners will experience more serious mental disorders, affecting their daily activities and possibly abandoning their duty to breastfeed their babies (Moraes et al., 2011). Mothers who suffer psychologically from partner violence are more likely to stop exclusive breastfeeding before six months (Kjerulff Madsen et al., 2019).

DISCUSSION

This scoping review aimed to identify the role of the family in breastfeeding and the barriers faced during breastfeeding. This study found essential family functions and barriers to breastfeeding that may affect breastfeeding practices. The review found that family support for breastfeeding, parental roles, attitudes, knowledge, the presence of supplementary feeding, and partner violence in breastfeeding occurred in breastfeeding practices.

Breastfeeding support significantly influences mothers because it will encourage positive thoughts and increase milk production (Gerhardsson et al., 2023). Existing research shows that support is an appreciation for breastfeeding mothers for going through many processes, from pregnancy and labour to breastfeeding (Mannion, 2013). Couples who attend or participate in breastfeeding practice counselling classes are appreciated for their readiness to become current and future parents (Gebremariam et al., 2021). Although there is support from health professionals that breastfeeding education is essential, the direct presence of the couple to practice breastfeeding shows a real sense of love for the child (Mannion, 2013). A thorough understanding on religious recommendation and cultural influence would benefit in the reconstruction of breastfeeding promotion and education program.

Family involvement in supplementary feeding makes breastfeeding less than optimal for infants, affecting healthy development and future growth (Martin, Ling & Blackburn, 2016). The impact of partner violence on breastfeeding is associated with a lower likelihood of breastfeeding (Walters et al., 2021).

CONCLUSION

This study incorporates family involvement in breastfeeding, drawing upon relevant theories and philosophies with the ultimate goal of enhancing the breastfeeding experience. Family participation in breastfeeding is constructive for mothers when breastfeeding their babies because direct and indirect support can reduce the physical and psychological burden on mothers. This study found that breastfeeding requires family support, roles, attitudes, and parents' knowledge. This study also found several barriers that can occur in breastfeeding, namely the provision of additional food and intimate partner violence in breastfeeding.

This scoping review is expected to include more searches on databases that can be accessed to support the needs of further research comprehensively and to determine the role of the family in the breastfeeding process.

Conflict of Interest

The authors declare that there is no conflict of interest in this research.

ACKNOWLEDGMENT

The author would like to thank all those involved in this research, including the supervisor and the Master of Midwifery Study Program 'Aisyiyah Yogyakarta and Kemenristek DIKTI, for providing various study materials for this research.

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