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An Ecological Approach to Breastfeeding

Tiedje, Linda Beth PhD, RN, FAAN; Schiffman, Rachel PhD, RN; Omar, Mildred PhD, RN, WHNP; Wright, Jackie MSN, RN; Buzzitta, Carol BSN, RN; McCann, Alyne MSN, FNP; Metzger, Sandra MSN, FNP

MCN, The American Journal of Maternal/Child Nursing: May-June 2002 - Volume 27 - Issue 3 - p 154-161
feature articles: CE

Purpose Current numbers of breast-feeding mothers are well below Healthy People 2010 goals of 75% in the early postpartum period, 50% at 6 months, and 25% at 1 year. A promising line of research is the use of an ecological model for breastfeeding that includes factors traditionally examined in breastfeeding (mother/infant and family) as well as mesosystem and exosystem sources of influence on families (healthcare delivery system, community, and societal/cultural).

Study Design and Methods A telephone survey was conducted with 95 primiparous, postpartum women using closed and open-ended items. Content analysis was used with the transcribed comments from these telephone interviews, to test the fit of a preexisting ecological model for breastfeeding.

Results The comments of postpartum women provided a rich source of information about the many mother-infant, family, healthcare delivery system, community, and societal/cultural factors that influence breastfeeding. These all fit the ecological breast-feeding model proposed.

Clinical Implications Efforts to improve rates of breastfeeding in this country to meet year 2010 goals must consider the many contextual factors that influence feeding. Interventions to promote breastfeeding should exceed the individual level, and occur at many layers simultaneously. The ecological model provides direction for the multiple interventions needed to increase rates and duration of breastfeeding.

Linda Beth Tiedje is Adjunct Associate Professor, Michigan State University, Department of Epidemiology, Lansing, MI. She can be reached c/o Department of Epidemiology, 4660 S. Hagadorn, Suite 600, East Lansing, MI 48823 (e-mail:

Rachel Schiffman is Associate Professor, Michigan State University School of Nursing, East Lansing, MI, where Mildred Omar is Associate Professor, and Jackie Wright is Associate Professor.

Carol Buzzitta is Director, Expectant Parents Organization, Lansing, MI.

Alyne McCann is a Family Nurse Practitioner, Blue Care Network Family Health Center, Midlard, MI.

Sandra Metzger is a Perinatal Nurse Practitioner, Sparrow Health Systems, Lansing, MI.

Copyright © 2002 Wolters Kluwer Health, Inc. All rights reserved