The effect of spousal support perceived by mothers on breastfeeding in the postpartum period

Abstract

Objective

To examine the effect of mothers’ perceived spousal support on breastfeeding during lactation.

Material and Methods

This is a descriptive cross-sectional study. The sample of the study consist of 80 mothers who were registered with a Pediatric Adolescent Women and Reproductive Health Center. The socio-demographic and obstetric descriptive information form and Women’s Perceived Spouse Support Scale in Early Puerperium Process were used for the collection of data. Data were analyzed with number and percentage, t-test, chi-square test, ANOVA, and Tukey test.

Results

The mean age of the mothers who participated in the study was 27.05±3.50, while the mean age of the spouses was 30.58±4.12. It was determined that 41.3% of the mothers and 48.8% of the spouses were high school or higher graduates and 68.8% of the mothers didn’t work and all of the spouses worked. Most of the mothers (63.7%) were primiparous and 60% had a cesarean section, 56.3% did not receive lactation education and consultation, and most of the women had exclusive breastfeeding. The mean score of the Women’s Perceived Spousal Support Scale in the Early Puerperium Period of the exclusively breastfeeding mothers was 72.93 while the partial breastfeeding mothers’ was 54.93 (p=0.00). Also, it was found that males with younger age group and high school and lower education level had less support for their spouses (p=0.03, p=0.02), and the rate of exclusive breastfeeding was higher in the spouses of males in higher education level (p=0.01).

Conclusion

Mothers who received more support from their spouses during the postpartum period had higher breastfeeding rates. It was determined that males with younger age and education level below high school gave less support to mothers in breastfeeding.

What is already known on this topic?

• In the postpartum period, mothers also need support from their spouses to start and continue breastfeeding.

• Spousal support positively affects the baby’s diet, the mother’s breastfeeding preference, the duration of breastfeeding, and the exclusive breastfeeding rate.

• Health professionals need to identify the mother’s need for spousal support and plan appropriate care.

What this study adds on this topic?

• Exclusive breastfeeding rates of mothers who receive more support from their spouses during the postpartum period are higher.

• Younger men give less support to mothers in breastfeeding.

• Men with an education level below high school give less support to mothers in breastfeeding.

Introduction

It has been proven that nutrition with breast milk and breastfeeding have many developmental, psychological, social, and economic benefits for both the baby and the mother (1). Breastfeeding, which continues for two years or more, also contributes to the optimal programming of the baby’s lifelong health and development (2, 3). In the literature, it has been shown that there is a positive relationship between the amount of breast milk a child receives and the reduced risk of childhood cancer, infections, obesity, and atopic disease (4–6). Also, breastfeeding is an emotional and social interaction tool for mother-baby-family.

According to the Turkey Demographic and Health Survey results after the birth of babies in Turkey, where almost all breastfed, but it was found that additional foods were started in the early period (7). In some studies, conducted in the world and our country, the decrease in breastfeeding rates in the early period was determined to depend on many factors such as the mother’s return to work, problems with the breast (breast abscess and mastitis, nipple cracks, nipple anomalies, etc.), the baby’s inability to grasp the breast well, women’s inability to get help from healthcare professionals, and women’s perceived difficulties with breastfeeding (8–13). An important factor that is overlooked among these factors is spousal support. It is seen that studies on this factor are very limited.

In the postpartum period, mothers also need support from their husbands to start and continue breastfeeding (14). Participation of spouses in prenatal education programs causes changes in family health during pregnancy, birth, and newborn periods (15). In studies conducted on the support and effect of spouses on breastfeeding, it has been determined that spousal support positively affects the baby’s feeding style, the mother’s breastfeeding preference, the duration of breastfeeding, and the exclusive breastfeeding rate (16–20). Health professionals need to determine the mother’s need for spousal support and plan appropriate care during this period (21).

Although the women have a say in the decision-making process along with the transition to a modern structure, patriarchal, and traditional values in Turkey continue (22, 23). It is thought that spouses, who have an active role in the decisions made within the family as per Turkish culture, may also influence the decisions of mothers regarding breastfeeding behaviors during the breastfeeding process (24).

This study aims to examine the effect of spousal support perceived by mothers during the breastfeeding period on breastfeeding.

Material and Methods

Type of study

The study is a descriptive cross-sectional study.

The universe and sample of the study

The study was conducted in the family planning outpatient clinic of a Pediatric Adolescent Women and Reproductive Health Center between October 2018 and January 2019. The sample of the study consisted of women between the ages of 18–45, primiparous or multiparous, in the first six-week postpartum period and who volunteered to participate in the study. The sample size was determined to be 80 according to the sampling method with a known universe.

Data collection tools

The socio-demographic and obstetric descriptive information form (21, 25, 26) prepared by the researchers in line with the literature and the Spouse Support Scale Perceived by Women in the Early Postpartum Period were used to collect the data. The scale was developed by Şahin et al. (21) according to the characteristics of Turkish culture. While the Cronbach Alpha value of the scale is 0.87, the highest score that can be obtained is 80 and the lowest score is 16. The increase in the average score indicates that spousal support in the early postpartum period is perceived at a sufficient level, while the decrease is perceived insufficiently. In our study, the Cronbach Alpha value of the scale was found to be 0.90.

Statistical analysis

IBM Statistical Package for Social Sciences version 22.0 (IBM SPSS Corp.; Armonk, NY, USA) package program was used to analyze the data. Number and percentage calculations, chi-square test for analysis of categorical variables, t-test for analysis of the difference between means, Anova test, and Tukey test for further analysis were used. Statistical significance level was accepted as p<0.05 in the analyzes.

Ethical aspect of the study

Permission was obtained from Dokuz Eylül University Non-Interventional Research Ethics Committee (Decision No: 2018/26-08, Date: 18.10.2018) and Provincial Health Directorate (Number: 77597247-604.02 Date: 30.11.2018) for the study. Our study has been prepared following the Helsinki principles. Also, verbal and written consent was obtained from the research participants.

Results

According to the findings obtained as a result of the study, the mean age of the mothers participating in the study is 27.05±3.50. It was determined that 41.3% of the mothers were high school and above graduates, 68.8% of them did not work. The mean age of the spouses is 30.58±4.12, the education level of 48.8% is high school and above, and all of them work (Table 1).

Table 1.

Socio-demographic characteristics of mothers and their spouses n (80)

Socio-demographic and obstetric features	Mothers		Spouses
	n	%	n	%
Age
20–26	36	45.0	12	15.0
27–33	39	48.8	43	53.8
34–38	5	6.3	25	31.3
Education status
High school↓	47	58.8	41	51.3
High school↑	33	41.3	39	48.8
Working status
Working	25	31.2	80	100.0
Not working	55	68.8	0	0.0

It was determined that most of the mothers participating in the study (63.7%) were mothers for the first time, 60% of the delivery method is cesarean section. It was found that 56.3% of the mothers did not receive breastfeeding training, and most (60%) breastfeeding was exclusive breastfeeding.

As a result of the analysis, the minimum score obtained by the mothers on the “ Women’s Perceived Spousal Support Scale in the Early Puerperium Period “ scale was determined as 35 and the maximum score as 80. The mean scale score of the mothers is 65.72±12.76.

The mean score of “ Women’s Perceived Spousal Support Scale in the Early Puerperium Period “ of mothers who participated in the study who were exclusively breastfeeding compared to mothers who were partially breastfeeding was statistically significantly higher (p<0.05) (Table 2).

Table 2.

Mothers’ breastfeeding types according to their spouse support perceived in the early postpartum period (n=80)

Type of breastfeeding	Perceived spouse support during the early postpartum period
	χ̄±SS	Test/p
Exclusive breastfeeding (n=47)	72.93±5.72	t=−8.542
Partial breastfeeding (n=33)	54.93±12.83	p=0.000*

^*p<0.05

Also, a significant difference was found between the spouses’ age and educational status and their support for mothers (p<0.05). In the Tukey test conducted for the advanced analysis of Anova, it was determined that the difference between the groups was caused by spouses aged 26 and under and 34 years old and over. It was found that the younger age group and the spouses with high school and below education level supported mothers less (Table 3).

Table 3.

Spouse support perceived by mothers during the early postpartum period according to the characteristics of spouses (n=80)

Features of spouses	Perceived spouse support during the early postpartum period
	χ̄±SS	Test/p
Age
20−26	57.08±15.75	F=3.640
27−33	66.58±12.64	p=0.031*
34−38	68.44±9.81
Education status
High school ↓	62.74±15.17	t=−2.32
High school ↑	69.21±8.10	p=0.023*

^*p<0.05

When the effect of socio-demographic characteristics of spouses on breastfeeding styles was examined, it was determined that there was no significant difference between breastfeeding styles according to their ages (p=0.321). However, a significant difference was found between breastfeeding styles according to education levels (p=0.012). Exclusively breastfeeding rates of mothers whose spouses have university and higher education levels were found to be higher (Table 4).

Table 4.

Breastfeeding types according to socio-demographic characteristics of spouses (n=80)

Socio-demographic characteristics of spouses	Type of Breastfeeding				X2	p
	Exclusive Breastfeeding		Partial Breastfeeding
	n	%	n	%
Age
20–26	5	10.6	7	21.2	2.24	0.321
27–33	28	59.6	15	45.5
34–38	14	29.8	11	33.3
Education status
High school ↓	18	38.3	25	75.8	10.94	0.012*
High school ↑	29	61.7	8	41.3

^*p<0.05

Discussion

In our study, it was found that the positive spousal support perceived by mothers during the early puerperium was effective on the high rates of exclusive breastfeeding. Also, it was observed that spousal support perceived by spouses by age groups and education level significantly affected the exclusive breastfeeding rates.

The early postpartum period is important in terms of supporting mothers in breastfeeding, ensuring exclusive, and continuing breastfeeding. The support received from the social environment and especially the support of the spouse to the mother has a positive effect on the breastfeeding experience. Similarly, the lack of social support, especially spousal support, can negatively affect these experiences (27). In a study, when the spouses support the mother, women prefer breastfeeding more, and the rate and duration of exclusive breastfeeding increase (17). In a study conducted in Turkey, in this period that the more time that a mother shares with her spouse and positive communication of mothers with their spouses was found to increase breastfeeding success (28).

In the postpartum period, mothers need to get support from their spouses in starting and continuing breastfeeding. A study was conducted with 1059 women to determine the factors that affect the initiation and the duration of breastfeeding in Australia. At the end of the study, similar to our study, a strong relationship was found between breastfeeding and perceived spousal support. It has been determined that spouses have a significant influence on mothers’ decision to breastfeed and women who receive support from their spouses are less likely to stop breastfeeding (29). Support from spouses can influence mothers’ breastfeeding decisions. Breastfeeding intention and duration were evaluated in another study conducted to measure the effect of spouse in breastfeeding. It has been determined that the sensitivity of the spouses towards mothers positively affects the intention and duration of breastfeeding (30). It is also known that spouses play an important role in influencing mothers’ decision to breastfeed and the continuation of breastfeeding. In the study of Su and Ouyang (31), it was determined that one of the most important sources that encourage breastfeeding is the way mothers perceive the attitude of the spouse. It is thought that breastfeeding self-efficacy perceptions of mothers who receive positive and active support from their spouses will increase.

In our study results, it was determined that younger age group spouses supported mothers less. A randomized controlled study was conducted in eight maternity hospitals in Western Australia in which prenatal breastfeeding training was given to spouses to initiate and maintain breastfeeding. Similarly, in this study, the rate of breastfeeding of the babies of younger spouses in the first week of the postpartum was found to be lower compared to the older age group (32). A study was conducted to investigate sociodemographic factors that may have an impact on the initiation of breastfeeding. Unlike our research results, it was determined that the age of the spouses did not affect the initiation of breastfeeding in this study (33).

According to the findings obtained in our study, it was determined that spouses with high school and above education provided more support to mothers in the early postpartum period. A study was conducted with 715 mothers and spouses in Taiwan to investigate the effect of breastfeeding support on working mothers’ intention to continue breastfeeding (34). Similar to our study, it was determined that spouses with university and higher education level support mothers more in breastfeeding, and breastfeeding times are longer.

In a study conducted in Turkey, according to socio-demographic characteristics of spouses, breastfeeding of mothers was evaluated by observation. According to the results of the study, it was determined that the education level of the spouses affected breastfeeding and the breastfeeding success of the mothers whose spouses were university graduates were higher (28). A study was conducted in Sweden to define the effects of the socioeconomic status of spouses on the breastfeeding period. In this study also, the first 6 months breastfeeding rates of the babies of spouses with low educational level were found to be lower (35).

In this study, it was determined that the age and education status of the spouses affected the mothers’ perception of spousal support and breastfeeding styles (exclusive, partial breastfeeding). This result can be considered as the reflection of fathers’ readiness for the father role due to the increase in their age and educational status, the increase in the value they give to their babies, and the more support they give to their spouses concerning breastfeeding.

Result

As a result of examining the breastfeeding patterns of mothers with high spousal support during the postpartum period, it was determined that mothers in this group mostly performed “exclusive breastfeeding”, while fathers who were younger than 26 years of age and whose education level was high school and below gave less breastfeeding support to mothers.

Contribution to the Field

This study shows that spousal support during the postpartum period has a positive effect on breastfeeding styles. As a result of many studies conducted in the world and our country, it is known that breastfeeding education has a positive effect on breastfeeding success. However, it was determined that many mothers who participated in the study did not receive breastfeeding training. For this reason, organizing and conducting the training to be given to mothers and fathers in the prenatal and postnatal period is of great importance.

For breastfeeding to become effective and sustainable as a behavior, spouses should be included in systematic breastfeeding training and counseling programs where they can provide the necessary support to mothers in breastfeeding and learn the importance and benefits of breast milk (27).

Health professionals should provide training on how spouses can provide more breastfeeding support to breastfeeding mothers. In these educational processes, educators should especially focus on improving the behaviors of father and father candidates to reduce the loneliness of mothers and to develop compassionate behaviors (36).

Also, especially young couples with low education levels should be supported more in breastfeeding training. Training programs should be structured by the characteristics of this group. It should be ensured that young and lowly educated spouses are included in breastfeeding education programs from the prenatal period.