The duration of breastfeeding varies around the world; in developed nations breastfeeding beyond infancy is unusual and hard to measure, with the numbers in the UK likely to be very small. There is limited understanding of how women experience breastfeeding once it becomes uncommon. Research undertaken in the latter part of the twentieth-century is still referred to in more recent work; findings are similar. These include experiencing breastfeeding long-term as stigmatising, lack of support from family members, distrust of health professionals and pressure to wean. We were interested in whether the experience in the twenty-first century, as reported in 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 was driven by our interest in finding out whether this has been reflected in the academic literature.
We carried out a synthesis of qualitative data from primary studies, following accepted processes for searching for/selecting articles and synthesising findings. The review protocol was registered with Prospero in March 2019 (CRD4201912703). Our finalised research question was ‘What do we know about the experience of women in the twenty-first century who breastfeed beyond twelve months of age?’ and this drove the search strategy and subsequent analysis of papers.
The search strategy aimed to identify all relevant primary research using the electronic databases Maternity & Infant Care (MIDIRS), CINAHL Plus, BND (British Nursing Database) and PsychInfo (searched from 2000 to February 2019 with Scopus used for follow-up citation searching). Three concepts were identified; truncation captured all variations of terms and words were combined using Boolean operators AND and OR. Adjacency operators were used to restrict the appearance of search terms in different concepts to within two words (N2) and improve the relevance of results. Personal connections and networking at conferences were also used to find out about other work in the process of publication.
We included English language articles that reported studies exploring the experience of breastfeeding for longer than twelve months, using study designs aimed at understanding and describing experiences and any terms commonly used to describe breastfeeding duration (extended, long-term, full-term, prolonged, sustained, and variants), based on research/published since 2000. We excluded articles published prior to 2000, those which used quantitative methods and that were predominantly about the experience of early breastfeeding/only about breastfeeding infants under 12 months of age. We also excluded reports of personal experiences published on blogs, websites and in publications from breastfeeding support organisations.
We used Covidence to import references and for title, abstract and full-text screening. Both reviewers screened papers separately and any conflicts were resolved through discussion. From an initial 346 papers, 12 were included in the review (7 published, 5 in press). Two other studies were originally included but discarded after further discussion as not fully meeting the inclusion criteria. Data (including study aims, methods and findings) was extracted from all 12. The Critical Appraisal Skills Programme (CASP) tool for qualitative research was used to identify any quality issues (no papers were excluded on these grounds).
Thematic synthesis was carried out as outlined by Thomas and Harden (2008), with ‘findings’ or ‘results’ text extracted from each paper and imported into NVivo for line-by-line coding, the organization of these codes into ‘descriptive’ themes and the development of ‘analytical’ themes (the ‘third order interpretations’ in meta ethnography). Finally themes were compared with the earlier literature in order to think about whether the experience of breastfeeding in the twenty-first century was described differently. Six analytical themes described the experience in ways that both related to the pre-21st century findings and further developed them in important ways. Four themes represented new findings, including that long-term breastfeeding is not always positive, that it can unite and cause tension (including in relation to mothering) and the importance of online support.
In conclusion, in many ways the experience of breastfeeding long-term is very similar to the experience as reported in the earlier literature. The difficulties, social media use, and identity are described more in the work we reviewed. Importantly also, our review includes papers which reflect research about the experience of long-term breastfeeding in the UK whereas most of the pre-2000 work was from the US, Canada and Australia.
Thomas, J. and Harden, A. (2008) Methods for the thematic synthesis of qualitative
BMC Medical Research Methodology, 8:45
Dowling, S., & Cooper, T. (2019, November). What do we know from current evidence about the experience of women who breastfeed beyond twelve months of age? A systematic review of qualitative evidence