Table 2 Barriers to breastfeeding mapped to the Community Energy Balance Framework’s cultural-contextual influences
Cultural-contextual influences | Barriers to breastfeedinga |
|---|---|
Sociocultural influences | • Social norms that discourage breastfeeding • Limited social support for breastfeeding • Lack of role models • Limited knowledge of the benefits of breastfeeding • Lack of self-efficacy to breastfeed • Concept of “las dos cosas” (the belief that providing both breast milk and infant formula benefits infants) |
Structural influences | • Disproportionate marketing of infant formula to racial/ethnic minorities • Availability of free infant formula (e.g., through the Special Supplemental Nutrition Program for Women, Infants, and Children) • Difficulty in continuing breastfeeding while working |
Historical experiences and adaptations | • Breastfeeding as part of people’s culture was lost over time due to factors such as marketing of infant formula and lack of practices and policies that encourage and support breastfeeding such as adequate maternity leave |
Social determinants of healthb | • Lack of access to health care, including lack of accessible breastfeeding support (e.g., lactation consultants were often unaffordable, clinicians were ill-equipped to provide support, lack of insurance to cover lactation consultants) • Lack of transportation • Housing instability • Food insecurity |