Abstract
Objective
Breastfeeding beyond infancy provides health benefits for both children and breastfeeding parents but supporting it is not an established practice in health promotion in Western countries. The present study is the first to present a framework describing the measures required in health care settings to develop counseling and support for long-term breastfeeding. The study was carried out in Finland and provides perspectives into the development of breastfeeding counseling practice in Western healthcare settings.
Methods
This qualitative descriptive study employed online focus group interviews (n = 4) and inductive content analysis. The participants (N = 22) were public health nurses (n = 12) with experience in supporting long-term breastfeeding in maternity and child health clinics, and trained breastfeeding peer supporters (n = 10), who play a key role in promoting breastfeeding beyond infancy. To support consensus-building during the development of the framework, a feedback round of the analysis was conducted among the participants.
Results
The framework consisted of two main categories: Individual counseling, and Structural-level support. Individual counseling involved active promotion of long-term breastfeeding, counseling during infancy to enable continuation of breastfeeding, counseling for long-term breastfeeding and a family-centered approach. Structural-level support included a system structured to support long-term breastfeeding and ensured competence related to long-term breastfeeding support.
Conclusions
The framework outlines the key counseling content and practical strategies to effectively support families with breastfeeding beyond infancy. The results emphasize the need for multi-level actions, from individual professionals to organizational structures, to create supportive environments for long-term breastfeeding within health care services.
Practice Implications
The framework offers practical value for enhancing training initiatives for health professionals and for developing maternal and child health services at the organizational level.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s13006-026-00873-2.
Keywords: Long-term breastfeeding, Breastfeeding counseling, Breastfeeding support, Professional competence, Public health nursing, Health promotion, Framework
Highlights
Breastfeeding beyond infancy benefits the health of children and breastfeeding parents.
The framework shows the multidimensionality of health care support for long-term breastfeeding.
Long-term breastfeeding counseling requires consideration of families’ individual needs.
There is a need for system-level improvements to support and promote long-term breastfeeding in Finland.
The framework can be utilised in nursing education and in the training of health professionals in Western countries.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s13006-026-00873-2.
Background
As long-term breastfeeding provides health benefits for both children and breastfeeding parents, the World Health Organization’s (WHO) recommendation for optimal breastfeeding duration is up to two years or beyond for every child [1]. In addition to health benefits, families consider breastfeeding beyond infancy to allow for valuable moments and practical relief in everyday life and parenting [2, 3].
After infancy, breastfeeding, along with age-appropriate solid foods, promotes the optimal growth and development of a child [4]. In addition, long-term breastfeeding protects the child against infections and obesity in childhood and later life and reduces the risk of type 2 diabetes and certain cancers for both the child and the breastfeeding parent [5, 6]. In particular, long-term breastfeeding plays a valuable role in reducing the breastfeeding parent’s risk of breast cancer and related economic burden [6–8].
Despite this evidence, the benefits of breastfeeding are often perceived mainly as benefits the child receives during the first year of life. As policymakers and health care services lack an understanding of the benefits of breastfeeding beyond infancy, it is not systematically promoted or supported. Without a status as a health promotion intervention and support from health authorities, breastfeeding beyond infancy is perceived as anomalous and strange in Western cultures [2, 9]. The decline in long-term breastfeeding is reflected in issues such as suboptimal breastfeeding recommendations and a lack of long-term breastfeeding statistics in Europe [10, 11].
Parents who breastfeed a toddler or an older child may face bewilderment and criticism, also in health care services [12, 13]. Health professionals’ knowledge and attitudes towards long-term breastfeeding vary, and their competence may be more related to their personal breastfeeding experiences than evidence-based training [14]. From the breastfeeding parents’ perspective, unsupportive attitudes and insufficient knowledge among health professionals may lead to mistrust towards the health care system. As a result, parents engaging in breastfeeding beyond infancy tend to seek support and advice from peer supporters. [15, 16]
The health care system could play a significant role in promoting long-term breastfeeding, as families meet multiple health professionals in maternity and child health services during pregnancy and the early years of the child’s life. To provide consistent, high-quality support for families, health professionals need training to improve their knowledge and attitudes towards breastfeeding beyond infancy [14, 17]. However, evidence-based training and interventions to support breastfeeding beyond infancy are lacking [13], and there is no earlier research about the practices related to counseling for long-term breastfeeding in maternity and child health services. To develop an educational intervention on this under-researched topic, a framework is needed to capture the key components of the phenomenon.
The aim of this study is to provide a framework of counseling and supporting long-term breastfeeding in Finnish health care settings.
In this study, the concepts long-term breastfeeding and breastfeeding beyond infancy are used as synonyms to describe breastfeeding a one-year-old or older child.
Methods
Design
This study has a qualitative descriptive design based on focus group interviews, inductive content analysis and consensus building with a feedback round.
Setting and sample
The participants in this study (N = 22) were public health nurses (n = 12) with experience in supporting long-term breastfeeding in maternity and child health clinics, and trained breastfeeding peer supporters (n = 10) who had experience in supporting breastfeeding beyond infancy [15, 18]. This sample was chosen to represent the best available practical expertise on the topic.
This study was conducted in Finland, which is considered a breastfeeding-friendly Nordic country. In Finland, maternity and child health clinics provide families with counseling and monitoring during pregnancy and the first years of the child’s life. The services cover at least 99.5% of expecting families and families with a child under 7 years old [19], so public health nurses at maternity and child health clinics encounter practically all families who breastfeed beyond infancy. In the country’s national guidelines, breastfeeding support is defined as a part of the content of counseling provided during the child’s first year of life or as long as breastfeeding continues [20].
Breastfeeding peer support in Finland is organised by a publicly funded, non-profit association (Finnish Association for Breastfeeding Support). The peer supporters have personal experience of breastfeeding, have completed training and work as volunteers in the association. Many of the peer supporters are also health professionals or lactation consultants. Organized peer support reaches approximately 20,000 families each year, which represents about half of all families with a baby in Finland [21].
Data collection
The data were collected through focus group interviews (n = 4): two groups were formed for public health nurses and two for trained breastfeeding peer supporters. The interviews took place in February and March of 2025. The participants were recruited using snowball sampling through networks of breastfeeding peer supporters and breastfeeding professionals. As supporting long-term breastfeeding requires expertise acquired through additional training and experience, snowball sampling was a reasonable method to efficiently reach participants with the highest level of familiarity and understanding of the phenomenon under study [22].
The participants gave their informed consent to participate in the study using an electronic REDCap registration form. In addition, the form was used for gathering statistical background data of the participants, namely their age, years of work experience in maternity and child health clinics or as a voluntary peer supporter, breastfeeding-related training, and personal experience of parenthood and long-term breastfeeding. All the background information was gathered during registration: in the interview and feedback sessions, the participants presented themselves with pseudonyms only.
The focus group interviews were conducted online via the Zoom videoconferencing platform (Zoom Communications, Inc.) and recorded. The online interview method was selected as it enables convenient participation independently of geographic location. The participants were informed about the online interview platform and interview practice before the interviews, and no technical challenges emerged during the process. The aim was to form groups of five to six participants, but due to minor changes in the participants’ schedules, there were four to seven participants in each interview, which is still considered an appropriate size for online focus groups [23]. The total duration of the four recorded focus group interview sessions was 5 hours and 50 minutes. The data from the interviews were manually transcribed by the first author (Niina Pöyhönen). The total extent of the transcribed data was 64 pages (font Calibri, size 12, single line spacing).
Two authors (Niina Pöyhönen, Oona Ojantausta) with professional competence to breastfeeding counselling and background from public health nursing/midwifery/breastfeeding peer supporting conducted the interviews. The interviews followed the same semi-structured form based on a series of questions. In addition, clarifying questions were asked if needed. The themes for the questions were the same for both groups, but the public health nurses were asked to focus on the context of maternity and child health clinics, while the peer supporters were asked to describe the needs of long-term breastfeeding parents in general. The interview topics were based on previous studies on the topic. The groups were asked to describe their perceptions regarding supportive information, parents’ needs, questions and experiences, counseling practices and the role of maternity and child health clinics in supporting long-term breastfeeding. The interview guide is provided in the supplementary materials.
Data analysis
The participants’ background characteristics were presented as descriptive statistics using the IBM SPSS Statistics v. 29.0.2.0 software. Inductive content analysis was selected as the analysis method because, as a content-sensitive method, it works well with complex data and a new research topic [24]. The data from the interviews were prepared and organised using the ATLAS.ti software. Two of the authors (XX, YY) carefully familiarized themselves with the data by reading it several times. The selected analysis unit was a statement or phrase that answered the research question. These units were coded and organised into subcategories by the same two authors. The abstraction process continued with a discussion on organising subcategories to upper categories and, further, to main categories [24]. An example of the abstraction process is shown in Table 1.
Table 1.
Example of the abstraction process. An example of the formation of a part of the main category “individual counseling”
| Citation | Condensation | Code Groups | Subcategory | Upper category | Main category |
|---|---|---|---|---|---|
| “It can be really unpleasant at times. It doesn’t directly mean that you want to stop breastfeeding.” | You don’t necessarily want to stop breastfeeding, even though it’s unpleasant. | Respecting the meaningfulness of the continuation of breastfeeding | Acknowledging the meanings the family attributes to breastfeeding | Family-centered approach | Individual counseling |
| “It could also be that you can try to keep going during a difficult moment, because quitting isn’t a piece of cake either.” | Stopping breastfeeding is not a simple thing to do. | ||||
| “It’s such a big thing that it’s not as simple as “Stop breastfeeding” or “Now you can stop breastfeeding.” It can be a really big deal for many people.” | Stopping breastfeeding is a big deal for many people. | ||||
| “Just like many other things in parenting or between family members, it’s also not something that should be underrated, or where instructions to stop it should be given without really good reasons.” | Health professionals should not advise a parent to stop breastfeeding without good reasons. | ||||
| “I also see that it’s not necessarily about nutrition anymore, although of course it is about that too. But it’s not in the families’ minds, and I don’t feel like it is either, but it’s more about intimacy and interaction and all that other good stuff, and then the meals are a separate matter.” | In families’ minds, breastfeeding is not about nutrition, but about intimacy and interaction and more. | Listening to the family’s experiences of the different meanings of breastfeeding | |||
| “It is not at all clear-cut, and it can depend a lot on a person’s thoughts and the situation as to what they find meaningful in breastfeeding.” | Families may perceive different things related to breastfeeding as meaningful. | ||||
| “Breastfeeding can still be important and is such a comforting and safe thing in the turmoil of life. It’s such a thing that it’s truly meaningful in that moment.” | Families may experience breastfeeding as something that brings comfort and security to their lives. | ||||
| “I think it’s really great that you said that breastfeeding is not just about a child getting milk from the breast. I don’t need to add anything to this, but somehow, I just wanted to admire what a big thing we are dealing with.” | In the child health clinic, there should be an understanding that breastfeeding is not just about breastfeeding for the child and the breastfeeding parent. |
The feedback round was used for building consensus during the framework development process. All participants were informed about the opportunity to take part in the feedback round and received the link to the online meeting. The results of the analysis were presented for those attending the feedback round (n = 8) and they were asked to assess if there was any deficiency in the accuracy or comprehensiveness of the overall view of long-term breastfeeding support [25]. Consensus was reached after the first feedback round, and therefore no additional rounds were needed.
Results
Characteristics of the sample
The research participants (N = 22) were experienced breastfeeding supporters representing maternity and child health clinics and breastfeeding peer support. Most of the participants had a personal experience of breastfeeding a child beyond infancy. Descriptive statistics of the participants are shown in Table 2.
Table 2.
Characteristics of the participants (N = 22)
| PHNs (n = 12) |
Peer supporters (n = 10) |
|
|---|---|---|
| Age median | 42 | 38 |
| Qualifications for breastfeeding support n (%) | ||
| WHO 20 h breastfeeding counselor | 11 (91.7) | 6 (60.0) |
| BF counselor trainer* or IBCLC | 10 (83.3) | 3 (30.0) |
| Peer supporter | 5 (41.7) | 10 (100.0) |
| Work experience years median | ||
| In maternity and child health clinics | 6 | |
| As breastfeeding peer supporter | 9 | |
| Personal experience n (%) | ||
| Own child/children | 10 (83.3) | 10 (100.0) |
| Breastfeeding beyond infancy | 9 (75.0) | 9 (90.0) |
| Participation in additional training on long-term breastfeeding | ||
| Yes | 5 (41.7) | 5 (50.0) |
| No/Don’t know | 7 (58.3) | 5 (50.0) |
*Finnish qualification for breastfeeding professionals
Abbreviations: PHNs, Public health nurses; BF, breastfeeding; IBCLC, International Board Certified Lactation Consultant
Results of the qualitative analysis
The framework is presented in Fig. 1. Two main categories were identified: (1) Individual counseling, and (2) Structural-level support.
Fig. 1.
A framework of long-term breastfeeding counseling and support
Individual counseling
Individual counseling includes active promotion of long-term breastfeeding, counseling during infancy to enable continuation of breastfeeding, counseling for long-term breastfeeding and a family-centered approach.
Active promotion of long-term breastfeeding
Long-term breastfeeding may not be visible or brought up in breastfeeding counseling. The participants underlined that it is the professionals’ responsibility to ensure that breastfeeding is not ignored after infancy but, instead, still promoted and supported.
Approaches to the active promotion of long-term breastfeeding include normalizing long-term breastfeeding and systematically initiating discussions about breastfeeding until its cessation.
“In my opinion, maternity and child health clinics should normalize all aspects of breastfeeding for children aged over one year old. However, we live in a society where people tend to trust the information they receive from healthcare professionals, so in that sense, it would be really important for the information provided to be both normalizing and evidence-based.” -Public health nurse
“A common challenge is that after the one-year check-up, breastfeeding often disappears from the discussion unless the family brings it up themselves. For example, I remember one four-year-old child’s visit, in which the family sought help with night weaning, yet there was no documentation of breastfeeding in the previous three years.” -Public health nurse
In addition, health professionals can utilize breastfeeding during child health clinic visits as a gentle way to regulate the child’s emotions and relieve vaccination-related pain.
“It would be important for the public health nurse to normalise breastfeeding beyond the age of one during the appointment, for example, in connection with vaccinations, or whenever the child seeks comfort at the breast.” -Peer supporter
It is also important to promote the visibility of long-term breastfeeding with materials and images and create a positive atmosphere by openly demonstrating a supportive attitude.
“Maybe there should be a pride-flag-like flag for a long-term breastfeeding-friendly place on the public health nurse’s desk to make it visible that this is a safe space to talk about it.” -Peer supporter
Counseling during infancy to enable continuation of breastfeeding
The participants emphasized that breastfeeding counseling during the first year, or even during pregnancy, plays a major role in determining whether breastfeeding can continue beyond one year of age. Health professionals should consider this and provide information about the possibility of continuing breastfeeding after parental leave and securing the continuation of breastfeeding in infant-year counseling. Securing the continuation of breastfeeding is especially essential when providing information about complementary feeding and infant sleep.
“During the 8-month visit, health professionals very often pressure you to stop nighttime breastfeeding if there is any fussing at night. Unfortunately, nighttime weaning can easily lead to weaning before the age of one.” -Public health nurse
Counseling for long-term breastfeeding
The participants pointed out that the content of breastfeeding counseling provided to support long-term breastfeeding differs from that given during infancy. Counseling for long-term breastfeeding should cover the following topics: combination of breastfeeding and complementary feeding, nighttime breastfeeding, changing breastfeeding practices and rhythms, utilizing breastfeeding as a parental tool, and weaning.
“It is important for all breastfeeding parents to hear that breastfeeding an older child can be paced in a parent-led way, and it doesn’t have to be as child-led as it is with an infant.” -Peer supporter
There may be a need for individual counseling related to a new pregnancy, medical conditions and breastfeeding problems. In addition, health professionals should provide information about the health benefits of long-term breastfeeding. They should also support the family during the transition period at the end of parental leave by providing strategies to combine breastfeeding with working life and daycare.
“Even when breastfeeding an older child, problems can arise that cannot be resolved through peer support alone. In such cases, families also have the right to receive professional help for breastfeeding from healthcare services.” -Peer supporter
Family-centered approach
The participants emphasized that the role of breastfeeding after the first year is different from that during infancy, and it is important for professionals to understand and respect families’ wishes and views.
A family-centered approach requires acknowledging the meanings the family attributes to breastfeeding, respecting the family’s preferences in the counselling and supporting the breastfeeding parent’s autonomy. Health professionals should support the parent-child interaction as part of breastfeeding counseling. This should include consideration of the non-breastfeeding parent.
“Breastfeeding parents are often pressured by their relatives, friends, or partners to stop breastfeeding. In those cases, it is important that the public health nurse provides support and encouragement, affirming that breastfeeding can continue for as long as both the breastfeeding parent and the child feel comfortable.” -Public health nurse
“Sometimes it feels like the other parent is more interested in continuing breastfeeding than the breastfeeding parent. Sometimes, for example, in families with a Muslim background, the father has quoted the Quran that the child should be breastfed until the age of two, so sometimes in situations like this I wonder if this is the mother’s decision or the father’s decision.” -Public health nurse
It is important to acknowledge the child’s presence in breastfeeding discussions and to support parents in facing the diverse emotions that breastfeeding can stir up. At the core of the family-centered approach is the understanding that breastfeeding holds significant emotional meanings to family members, and its cessation should also be supported with sensitivity.
“I have told many families to take pictures of their last breastfeeding moments to commemorate them.” -Public health nurse
Structural-level support
Structural-level support includes a system structured to support long-term breastfeeding and ensuring competence related to long-term breastfeeding support.
A system structured to support long-term breastfeeding
The participants considered that there is a lack of consistent, system-level support in maternity and child clinic services, even though this would be crucial for protecting long-term breastfeeding.
Achieving support for long-term breastfeeding requires developing counseling service pathways to be accessible to every breastfeeding family without restrictions on children’s ages. It is also essential to utilize different levels of breastfeeding support from professional breastfeeding counseling to peer support services.
“The age limits in breastfeeding support pathways are artificial and should not be imposed. It would be essential to clearly communicate that the services are intended for all families, regardless of whether they are planning to breastfeed, are breastfeeding a baby, or are breastfeeding an older child.” -Peer supporter
Grounding breastfeeding counseling in recommendations and evidence requires implementing the WHO recommendations and the Baby-Friendly Hospital Initiative (BFHI) at the system level. In addition to individual counseling, families should have access to materials on long-term breastfeeding provided by health care services.
Utilizing documentation is essential for ensuring the continuity of care. Good quality documentation should include documenting breastfeeding until weaning, considering previous documentation and compiling statistics on breastfeeding data.
“In our system, there is no option to record the duration of breastfeeding. This makes it difficult to track the goals of the Baby-Friendly program, as the necessary data cannot be obtained from patient records.” -Public health nurse
Ensured competence related to long-term breastfeeding support
The participants highlighted that it is necessary to develop the knowledge and attitudes of professionals to support long-term breastfeeding. Health care organisations must invest in strengthening professionals’ competence by providing education on long-term breastfeeding to everyone involved in the care of breastfeeding families.
“I know that there are still colleagues who believe that long-term breastfeeding provides no benefits – and yet, there is never any training provided about the topic.” -Public health nurse
While the organisation is responsible for providing support to ensure professional competence, each individual professional is responsible for reflecting on their own competence. This includes identifying personal competence gaps and personal attitudes towards breastfeeding.
“It would be great if all professionals had a shared, positive way to address long-term breastfeeding. That way, families would not receive harmful, conflicting messages from health care, and a consistent approach to breastfeeding could be genuinely applied in the best interest of the families.” -Public health nurse
Discussion
This study was carried out in Finland, a country that is generally supportive of breastfeeding, but where long-term breastfeeding is less well recognized and supported within healthcare settings. This reflects the situation in many Western countries, where breastfeeding beyond infancy is seen somewhat odd [2, 9]. Frameworks serve as a bridging tool between theory and practice [26]. This study presents a framework of supporting long-term breastfeeding in the context of maternity and child health clinics in Western countries. The framework consists of two levels: individual counseling and structural-level support. The individual counseling level represents the practical dimension of health care, while the structural level captures the organizational factors that directly enable the implementation of long-term breastfeeding counseling and the competence of health professionals. In this respect, the framework aligns with theories utilized in the health promotion context, which similarly conceptualize health promotion as a multilevel process encompassing both individual-level actions and organizational or structural conditions that enable and sustain health-promoting practices. [27, 28]. The framework is primarily intended for the development of training, but it can also be applied to examine practices at both professional and organizational levels, and to contribute to broader scientific discussion on the topic.
The results of this study indicate that, in services offered to families, the promotion and individual counseling for long-term breastfeeding should begin at an early stage, possibly already during pregnancy, and continue until breastfeeding ends. This is consistent with the learning objectives of the WHO/UNICEF Baby-Friendly Hospital Initiative Training Course for Maternity Staff, which emphasize that healthcare professionals should understand the importance of continued breastfeeding up to two years of age and beyond when counseling families. However, the WHO/UNICEF training materials are lacking practical aspects of counseling families who continue breastfeeding beyond infancy. This highlights the need for research to strengthen the evidence base for long-term breastfeeding counseling [29].
This study identifies several key areas of long-term breastfeeding-related counseling. In addition to information, families need helpful strategies to manage their situations and challenges related to breastfeeding a toddler or an older child. These findings align with previous studies showing that changes in families’ daily lives, particularly a parent returning to work and a child starting day care, increase the need for practical instructions regarding the continuation of breastfeeding [30]. Such transitions also raise questions related to the child’s sleep and broader dietary changes associated with growth and development [13]. The results further indicate that counseling on certain themes, such as nighttime breastfeeding, is not consistently evidence-based. This finding reflects earlier reports of mothers’ experiences [2; 9] as well as documented gaps in the long-term breastfeeding guidance competence of public health nurses [14]. In this study, participants also stated that pediatricians and oral health professionals may compromise breastfeeding promotion by providing harmful or fallacious advice.
In addition to the continuity and content of counseling, the results of this study highlight an understanding that an individual and family-centered approach is a fundamental premise for supporting long-term breastfeeding. Families’ thoughts and preferences regarding long-term breastfeeding vary considerably and are shaped by cultural, social, and personal contexts. Individuality is therefore a central principle of high-quality breastfeeding counseling. Each counseling encounter should be guided by the needs, preferences, and perspectives expressed by the family at that specific time. Health professionals should approach counseling without predefined expectations, actively listen to families, and tailor guidance in a flexible and responsive manner. These principles are also reflected in established breastfeeding counseling core competencies and WHO/UNICEF training standards [29, 31].
To implement such individualized and responsive counseling in practice, adequate professional competence is required. Health professionals’ breastfeeding guidance competence comprises knowledge, skills, and attitudes [32, 33], with positive attitudes forming the foundation for the active promotion of breastfeeding beyond infancy. Regarding long-term breastfeeding, attitudes can be strengthened by improving the knowledge base [14, 17]. It is known that counseling for long-term breastfeeding requires different competencies compared with breastfeeding counseling during the early weeks and months postpartum [13]. However, there has previously been limited understanding of the specific components of long-term breastfeeding counseling. The framework presented in this study demonstrates that such counseling requires the development of competencies across multiple areas and highlights a clear need for targeted training. Previous studies [17] and the participants of this study noted that, in addition to information, photographs depicting breastfeeding of an older child may be effective in improving attitudes. Such materials are currently scarce, and their production would require investments at organizational and national levels. This would constitute a concrete health promotion action, increasing the visibility and normalization of long-term breastfeeding within health care settings and in society more broadly.
Beyond individual competence, supporting long-term breastfeeding also requires structural and organizational commitment. All health professionals involved in the care of families should promote evidence-based information and demonstrate supportive attitudes toward long-term breastfeeding. Participants in this study suggested that, after infancy, breastfeeding as a topic may disappear from discussions between families and health professionals. This observation is supported by reports from breastfeeding parents indicating that breastfeeding is no longer addressed as the child grows older [9, 34]. Some health professionals may consider counseling related to long-term breastfeeding outside the scope of their practice [35], which may reflect negative attitudes or insufficient competence. The omission of breastfeeding discussions after infancy undermines the health promotion of both children and parents. The initiation of breastfeeding-related discussions by health professionals could be facilitated through enhanced education, as greater knowledge is associated with more positive attitudes toward long-term breastfeeding [14]. However, training of health professionals alone may not be sufficient to ensure the implementation of new practices if the organizational culture does not actively support change and the normalization of long-term breastfeeding as part of routine care [28]. At the organizational level, the promotion of long-term breastfeeding could be strengthened through the development of guidelines and documentation practices, including the systematic collection of statistics on breastfeeding beyond one year of age.
A qualitative approach was used to strengthen the trustworthiness of the results, as the study addressed a topic that has received limited attention in earlier research. Since supporting and promoting long-term breastfeeding is not an established component of care in maternity and child health clinics in Finland, and the public health nurses participating in this study represented positive exceptions, skilled breastfeeding peer supporters were also included to reinforce the findings. During the focus group interviews, repetition of similar themes was already evident during the second interview, and the third and fourth interviews did not generate new categories but instead deepened those previously identified. This indicated that sufficient data saturation had been achieved [36, 37]. Inductive content analysis was considered a suitable method for examining and presenting the data in a sensitive and detailed manner, providing a comprehensive description of the phenomenon [24]. In addition, a feedback round was conducted to strengthen the validity of the results [25], with participants confirming that the findings accurately described ideal long-term breastfeeding support in maternity and child health clinic settings. The researchers conducting the interviews and analysis possessed strong professional and personal expertise in long-term breastfeeding, enabling an in-depth understanding of the phenomenon and fostering trust with participants. However, neither researcher had worked in maternity and child health clinics, which supported an objective perspective in the development of the framework [24].
Limitations
The present qualitative study was conducted in a small Nordic country and reflects the experiences and competence of the participating public health nurses and peer supporters. As with qualitative research in general, the findings are not intended to be statistically generalizable, and their transferability to other contexts should be considered with caution. The participants considered the possibilities of the Finnish maternity and child health clinic system to guide and support long-term breastfeeding. Not all countries necessarily have the same resources for breastfeeding counseling in healthcare, although even then the importance of health professionals’ positive attitudes towards long-term breastfeeding is emphasized in interactions with families. It is also important to note that the formation of this framework was based on focus group interviews with participants who were thoroughly familiar with the topic and who identified the development needs for improving long-term breastfeeding counseling practice. Thus, this framework represents an ideal stage of long-term breastfeeding counseling and support and does not necessarily describe the existing nursing practice. To strengthen the evidence base, further research on the development of breastfeeding counseling for long-term breastfeeding is needed across a wider range of settings and from the perspectives of both breastfeeding supporters and parents from diverse socioeconomic and cultural backgrounds.
Relevance to clinical practice
This study represented a framework of supporting long-term breastfeeding in the context of maternity and child health clinics in Finland. The framework provides guidance in developing health professionals’ competence and system-level structures in maternal and child health clinics. It can be utilised to develop training for health professionals in Western countries.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Acknowledgements
We thank the public health nurses and breastfeeding peer supporters who contributed to this study.
Author contributions
NP and OO designed the work and carried out the data collection, analysis and interpretation. RI and MK contributed significantly to the development and revision of the work.
Funding
Open access funding provided by Tampere University (including Tampere University Hospital). The authors received no funding for the research.
Data availability
The datasets used and analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval statement
The study has received a favourable statement from the Ethics Committee of the Tampere Region (4/2025). All participants gave written informed consent to participate in our study prior to data collection. The study adhered to Finnish National Board on Research Integrity (TENK) guidelines (2019) regarding the ethical principles of research with human participants and ethical review in the human sciences in Finland (Available at: https://tenk.fi/sites/default/files/2021-01/Ethical_review_in_human_sciences_2020.pdf)
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and analysed during the current study are available from the corresponding author on reasonable request.