The influence of grandmothers on breastfeeding rates: a systematic review

Abstract

BackgroundExclusive breastfeeding for the first six months of an infant’s life has enormous potential to reduce mortality and morbidity. The older generation, particularly the infant’s grandmothers, play a central role in various aspects of pregnancy and child rearing decision-making within the family unit. This is particularly true in low- and middle-income countries where older women are seen as owners of traditional knowledge. Despite this, most health programs target the individual person most directly involved in the target behaviour – usually new mothers – without a commensurate understanding of who else influences those decisions. In this systematic review we aim to quantify the impact of the grandmother on influencing a mother’s breastfeeding practices.MethodsWe conducted a systematic review using Web of Science, Scopus, and Medline databases using search terms for grandmother and breastfeeding. Eligible studies reported on the duration of exclusive breastfeeding and included estimates of effect of a grandmother’s influence including whether or not the grandmother lived with the infant’s family, the grandmother’s education, and the grandmother’s attitudes towards and prior experience with breastfeeding.ResultsWe identified 568 articles and, after review, 13 articles were assessed as meeting the selection criteria. They were conducted in both developed and developing countries and included cross-sectional surveys, prospective cohort studies and one randomised controlled trial. Eight studies examined the effects of attitudes or experiences of older generations with respect to breastfeeding and five of the eight found a significant positive impact on breastfeeding when grandmothers of the infants had had their own breastfeeding experience or were positively inclined towards breastfeeding, resulting in effects of between 1.6 to 12.4 times more likely to exclusively breastfeed or refrain from introducing solid foods. A Chinese study however found that highly educated grandmothers were associated with decreased exclusive breastfeeding. The majority of the studies were assessed to be of weak or moderate quality.ConclusionsThis review found evidence that demonstrates that grandmothers have the capacity to influence exclusive breastfeeding. Programs that seek to influence exclusive breastfeeding should include grandmothers in their interventions to achieve maximum impact.

Prevalence of Exclusive Breastfeeding and its Predictors among mothers in Micheweni, Chake-Chake and North ‘A’ districts, Zanzibar

“…If fathers and family members are supportive of breastfeeding, the mother is more likely to breastfeed her baby for longer [31]. This study found that mothers were not strongly supported to breastfeeding from many of the family members; husband, grandmother, community classes and from TBAs (Table 2).…”

“…The influence of social networks and family supports to breastfeeding have been documented previously; and their effects to EBF [31]. If fathers and family members are supportive of breastfeeding, the mother is more likely to breastfeed her baby for longer [31].…”

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications

“…Similarly, in India, peer counselling through mother support groups showed improved initiation within an hour of birth, EBF and decreased prelacteal feeding at 2 and 5 years post-baseline (94) . The present review also underscores the importance of involvement of family members, who can influence when, what and how babies are fed (6,95) . A study in Indonesia demonstrated that multilevel breast-feeding promotion, including individuals, families, communities and health facilities, resulted in a tenfold higher prevalence of EBF at 6 months in the intervention v. control group (91) .…”

Factors Related to the Practice of Exclusive Breastfeeding in Different Cities of the States Minas Gerais and Bahia, Brazil

“…The influence of maternal and paternal grandparents on bottle feeding for infants and consumption of water, teas and other types of milk has also been demonstrated in a recently published systematic review [21,22]. In the present study, grandmother influence as an exposure variable was not evaluated.…”