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A recent study shows that mothers with partners who smoke are less likely to breastfeed their babies, suggesting that breastfeeding promotion efforts should target smoking families, and particularly include those with smoking fathers/partners.
The Australian Infant Feeding Guidelines recommend exclusive breastfeeding for the first 6 months of a child’s life followed by continued breastfeeding to 12 months and beyond, or for as long as the mother and child desire.
The Australian Institute of Health and Welfare (AIHW) routinely collects and publishes data on the smoking status of pregnant mothers, but does not publish data on the smoking status of fathers with pregnant partners.
We know that maternal smoking is associated with a reduction in breastfeeding but little is known about the effect of partner smoking on breastfeeding.
Why is breastfeeding important for smoking families?
Children of smoking parents are at increased risk of overweight/obesity and respiratory tract infections (here and here). Smoking increases the risk of cardiovascular disease and early mortality in adults (here).
Breastfeeding has protective effects on the aforementioned problems. For example, breastfeeding reduces the risk of cardiovascular hospitalisation and cardiovascular-related mortality in Australian women (here). Breastfeeding also reduces the risk of overweight/obesity in childhood (here). Breastfeeding protects children from respiratory illnesses (here), especially children who have been exposed to environmental tobacco (here).
What is already known about the breastfeeding behaviour of parents who smoke?
Mothers who smoke are less likely to breastfeed their babies. There is a tendency for smoking mothers either to never start breastfeeding or to stop breastfeeding sooner than non-smoking mothers (here and here).
The importance of the social determinants of health
We acknowledge that parental age, income, employment and level of education influence parental smoking and breastfeeding behaviour. We know that smoking is more common in Australians with lower incomes and a lower level of education (here). We know that breastfeeding is less common in these groups as well (here).
What we studied
Our study examined the association of parental smoking status with breastfeeding intent and duration in the first 2 years of a child’s life using data from an Australian trial.
Participants were 1155 mothers from antenatal clinics across four local health districts in New South Wales (NSW), Australia. During pregnancy (baseline) mothers were asked whether they intended to breastfeed their baby. At 6, 12 and 24 months of their child’s life, mothers were asked about their breastfeeding practice. At each of the four time points we also collected data about the smoking status of mothers and their partners. Seven hundred and twenty mothers completed all four surveys.
What we found
Consistent with previous reports in the literature, we found that smoking mothers were less likely to breastfeed their babies at the age of six months when compared with non-smoking parents.
A new finding was that non-smoking mothers with smoking partners were less likely to breastfeed their babies at 6 and 12 months of age and were less likely to intend to breastfeed their babies at all.
At 24 months of a child’s life, there was no significant difference in breastfeeding rates between smoking and non-smoking parents.
The proportion of mothers still breastfeeding at 24 months was low, irrespective of parental smoking status.
The results provide evidence of an inverse association between smoking and breastfeeding even after many of the obvious potential confounding factors have statistically been accounted for. The study therefore provides insight into what might be happening within populations of Australian parents regarding smoking and breastfeeding.
Targeting men in breastfeeding promotion
To our knowledge, this is the first study to examine the impact of smoking fathers/partners on the breastfeeding behaviour of mothers over time.
There are already considerable efforts being made to promote breastfeeding to women. For example, a NSW Health publication states that to improve breastfeeding practices, all women are to “receive consistent, evidence based information, education and support during the maternity continuum and early childhood periods regarding infant feeding” (here).
We advocate for increased breastfeeding promotion to smoking fathers because the evidence suggests that targeting fathers/partners in breastfeeding promotion improves breastfeeding outcomes (here) and because we know that partners who smoke tend to have babies with poorer breastfeeding outcomes. Specific programs aimed at promoting breastfeeding to smoking fathers might improve breastfeeding initiation and duration at an Australian population level.
Fathers and society share responsibility with mothers for breastfeeding outcomes
Smoking and breastfeeding are behaviours with important public health implications worldwide.
Mothers are stigmatised for smoking (here) and for their infant feeding practices but paternal smoking and partner responsibility for the health of women and children are often understated (here).
Mothers have a right to choose how they feed their babies but they do not hold full responsibility for their breastfeeding outcomes. Partners, extended families, the broader community and policymakers have important roles to play in supporting mothers to breastfeed. It is a shared social responsibility to facilitate and promote breastfeeding (here).
Dr Katharine Blaze is a Paediatrician and alumna of the University of Sydney School of Public Health. She works at the Centre for Community Child Health of the Royal Children’s Hospital in Melbourne and at the Victorian Forensic Paediatric Medical Service.
Dr Huilan Xu is an experienced statistician, Research and Evaluation Officer in the Population Health Research and Evaluation Hub of the Sydney Local Health District.
Professor Louise Baur is a Paediatrician and Childhood Obesity Clinician-Researcher at the Children’s Hospital at Westmead and at the University of Sydney.
Professor Li Ming Wen is a Population Health Researcher and the Director of the Population Health Research and Evaluation Hub in the Sydney Local Health District. Li Ming and his team were recipients of the NSW Health Awards in 2014 for their contribution to Preventative Health, specifically in childhood obesity prevention.
The authors would like to acknowledge Dr Limin Buchanan for her contribution to this study.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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