Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature

Abstract

BackgroundBreastfeeding provides numerous health benefits for mothers and infants, but worldwide breastfeeding rates fall below recommendations. As part of efforts to increase breastfeeding initiation and duration, the World Health Organization and UNICEF UK recommend educational interventions to increase awareness and positive attitudes towards breastfeeding beginning during the school years. Breastfeeding education in the school setting offers the opportunity to improve the knowledge base, address misconceptions, and positively influence beliefs and attitudes for students from a wide range of socioeconomic and cultural backgrounds. The purpose of this paper is to present a comprehensive narrative review of the literature regarding student and teacher (stakeholder) views of breastfeeding and breastfeeding education programs in schools to inform future research in the area.MethodsArticles were located through a systematic search of online databases and journals using the following keywords in various combinations: (1) breastfeeding, lactation, breast-feeding, “bottle feeding”, “infant feeding” (2) student, educator, teacher, “school administrator” and (3) schools, “secondary education”, “primary education”, “K-12”, “high school”, “middle school”, “elementary school”, education, adolescents, curriculum, and a manual search of article references. Studies were screened for inclusion against specific criteria and included papers were assessed using the Mixed Methods Appraisal Tool (MMAT).ResultsThis review suggests that adolescents have a deficit in breastfeeding knowledge and express negative conceptions about breastfeeding. Breastfeeding is being discussed in some school environments, but the extent of lessons and the specific messages that teachers communicate have not been explored. Students appear to be interested in receiving more information about breastfeeding, especially if delivered by health professionals or breastfeeding mothers. The majority of teachers are supportive of incorporating breastfeeding education in family and consumer sciences, sexual education, and health classes; however, time constraints and limited knowledge of infant feeding recommendations may be barriers to implementation of appropriate lesson plans.ConclusionsStudents generally support and are receptive to breastfeeding education; however, research on educator attitudes, knowledge, and experiences are necessary for appropriate implementation of breastfeeding education in varying school settings around the world.

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools

“…Similar to findings in several countries around the world (Singletary et al, ), we are the first to show in Lebanon that intention among adolescents is significantly associated with attitude towards breastfeeding. In both males and females, intention was stronger when positive beliefs about the beneficial health outcomes of breastfeeding were stronger.…”

“…In addition to attitudinal beliefs, and similar to other studies (Singletary et al, ), we found students' families to be influential on their intentions. Adolescents are more likely to support breastfeeding if they believed their families would approve.…”

“…Finally, we measured intention and its drivers cross‐sectionally and broadly (likelihood to breastfeed/support partner to breastfeed in the future) without including breastfeeding‐specific nuances such as intention related to breastfeeding exclusivity and duration. We had speculated based on other work (Singletary et al, ) that students in our cohort will not have the adequate background knowledge to even reflect on their own intentions related to exclusivity and duration. Our research would benefit from a deeper and also longitudinal exploration of intention and its drivers as attitudes and beliefs may shift over time.…”

“…One of the strategies that holds promise for overcoming these barriers, helping normalize breastfeeding, and thereby increasing breastfeeding initiation, exclusivity, and duration in the long‐term, is school‐based breastfeeding education (SBBE). Intervening early on with children and adolescents may prime them to make informed decisions related to infant feeding as parents in the future and to become positive change agents in their communities even if they do not become parents themselves (Glaser, Roberts, Grosskopf, & Basch, ; Singletary, ; Singletary, Chetwynd, Goodell, & Fogleman, ; Stockley, ). Despite being advocated for by the WHO/United Nations Children's Fund (UNICEF) and several other health agencies for more than 15 years now (Li, Benton‐davis, & Grummer‐Strawn, ; Royal College of Paediatrics and Child Health, ; WHO, ), sustained implementation of theory‐driven and evidence‐based SBBE, beyond mere knowledge dissemination, is yet to be achieved in school systems globally.…”

“…Individual‐level barriers to breastfeeding include negative beliefs, insufficient knowledge, and misconceptions among adult mothers, their family members, and physicians (Akik, Ghattas, Filteau, & Knai, ; Moukarzel et al, ; Nabulsi, ; Osman, El Zein, & Wick, ). Among the youth, several studies, mainly in developed countries, have reported that students at various ages may have insufficient knowledge about infant feeding recommendations and may hold negative attitudes about breastfeeding (Glaser et al, ; Singletary et al, ). There are no data currently available on Lebanese children and adolescents during their Pre‐K‐12 education: from first grade at around 5 years of age to 12th grade at around 17 years of age.…”