Introduction: Despite good quality evidence (Victora et al, 2016) and recommendations, the duration of breastfeeding varies around the world. In developed nations breastfeeding beyond infancy is unusual and hard to measure. In the UK the numbers of women who breastfeed beyond twelve months are likely to be very small.
There is limited understanding of how women experience continuing to breastfeed once it becomes uncommon. Research undertaken in the latter part of the twentieth-century in North America is still referred to in more recent work; findings are similar. These include the experience of breastfeeding long-term as stigmatising, lack of support from family members, distrust of health professionals and pressure to wean. A ‘concept analysis’ (Brockway and Venturato, 2016) examined some of these issues but had a different focus to the work reported here.
We are interested in whether the experience of women breastfeeding long-term in the twenty-first century, as reported in published qualitative research, is different to that in the earlier literature. Although breastfeeding long-term continues to be unusual, there are many ways in which it has become more visible, including on social media. This review is driven by our interest in finding out whether this has been reflected in the academic literature.
Methods: We will report this work in line with the PRISMA and ENTREQ checklists where appropriate (Moher et al, 2009; Tong et al, 2012). This is a synthesis of qualitative data from primary research studies, broadly following the process used in meta-ethnography for searching for/selecting studies, and providing a synthesis of findings.
We will include papers that report qualitative studies exploring the experience of breastfeeding for longer than twelve months, or those which use study designs aimed at understanding and describing experiences. A range of terms are used, including extended, long-term, full-term, natural term; we will search for papers which use any of these as well as other variants. We are interested in the experience of women in the twenty-first century and so will search for literature published post-2000. Only English language papers will be included. We will exclude those that are predominantly about the experience of early breastfeeding or only about breastfeeding infants under 12 months of age. Our focus is on published primary data so we will also exclude reports of personal experiences published on blogs, websites and in publications from breastfeeding support organisations.
We have designed a search strategy which aims to identify all relevant primary research on this topic published in peer-reviewed journals. The electronic databases Maternity & Infant Care (MIDIRS), CINAHL Plus, BND (British Nursing Database) and PsychInfo will be searched from 2000 to December 2018. These databases have been selected as being most likely to identify relevant papers to address the review topic. Truncation will be used to capture all variations of terms and words combined using Boolean operators AND and OR.
Results and conclusions: The review is currently underway; in this presentation we will report both the process and the results (in relation to the development of second and third-order constructs derived from our analysis). We will draw conclusions to identify if the experience of long-term breastfeeding in the twenty-first century is being described differently than in older published literature, and reflect on any implications.
Brockway, M. and Venturato, L. (2016) Breastfeeding beyond infancy: A concept analysis. Journal of Advanced Nursing, 72(9):2003-15.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med, 6(7): e1000097
Tong, A, Flemming, K., McInnes, E., Oliver, S., Craig, J. (2012) Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Medical Research Methodology,12(1):181.
Victora, C.G, Bahl, R. Barros , A.J.D., Franca, G.V.A, Horton, S., Krasevec, J., Murch, S., Sankar, M.J., Walker, N., Rollins, N.C. on behalf of the Lancet Breastfeeding Series Group (2016). Breastfeeding in the 21st Century: epidemiology, mechanisms and life-long effect. Lancet, 387(10017): 403-504.
Dowling, S., & Cooper, T. (2019, June). What do we know about the experiences of women in the twenty-first century who breastfeed beyond 12 months of age? A systematic review of qualitative evidence. Paper presented at Nutrition and Nurture in Infancy and Childhood: Bio-cultural Perspectives