Influence of social media on maternal decision-making and breastfeeding practices

Abstract

Breastfeeding practices are influenced by multifactorial determinants including individual characteristics, external support systems, and media influences. This commentary emphasizes such complex factors influencing breastfeeding practices. Potential methodological limitations and the need for diverse sampling in studying breastfeeding practices are highlighted. Further research must explore the interplay between social influences, cultural norms, government policies, and individual factors in shaping maternal breastfeeding decisions.

Key Words: Exclusive breastfeeding; Breastfeeding promotion; Mass communication; Maternal decision-making; Social media

Core Tip: Maternal breastfeeding decisions are influenced by multifactorial biopsychosocial determinants. Inaccurate information on social media may exaggerate potential difficulties in breastfeeding, promote the use of formula milk alternatives, or undermine mothers' confidence in their abilities to breastfeed. Addressing misinformation on social media channels is crucial for empowering informed maternal decision-making.

TO THE EDITOR

Maternal education about breastfeeding using the Women- and Child-Friendly Institution model (WCFI) in Columbia has been recently found to be significantly associated with increased exclusive breastfeeding (EBF) rates[1]. This research highlights key factors associated with EBF discontinuation and reveals a link between exposure to information from mass communication channels and lower rates of achieving EBF for up to 4 months (OR 0.52; 95%CI: 0.31-0.84). While this finding suggests a negative association between receiving information from mass communication media and maintaining EBF, it is important to consider further expositions on this topic.

Determinants of breastfeeding practice are known to be multifactorial and influenced by a complex interplay of individual characteristics (age, occupation, smoking, obesity, pre-pregnancy feeding patterns), external support systems (social support, birth complications, cesarean delivery), and psychological well-being (stress, anxiety, self-efficacy) apart from ideological, racial, and ethnic determinants[2]. It is clear that no single factor operates in isolation, and the interplay between these elements must be considered to fully grasp how mothers decide on breastfeeding practices. The authors of the study have considered several confounding factors in the analysis of results but may have missed others, such as maternal occupation, socioeconomic status, social support, or infant health, which could influence EBF[1]. Also, the large number of variables considered in the regression analysis relative to the sample size may have lead to overfitting, which potentially reduces the reliability of reported associations. Therefore, conducting a sensitivity analysis would be helpful to address likely biases and to test the robustness of the reported findings apart from addressing multicollinearity among included variables.

Further, providing information on standardizing interview methods could help readers comprehend the influence of interviewer questions on the participant responses. The validity and reliability of the 25-question telephone survey are also worth discussing. Recording the interviews with participant consent could allow quality control and minimize interviewer variation. An additional qualitative research approach with focus group discussions involving participants could provide deeper insights into mothers' breastfeeding experiences and reasons for EBF discontinuation. Some of the other limitations of the study are potential selection and recall biases. Employing a more diversified sampling strategy that includes mothers from different socioeconomic backgrounds could reduce selection bias. Mothers may not accurately recall details about breastfeeding practices and subtle factors influencing them from months or even years earlier.

The findings reported by Murillo Galvis et al[1] significantly contribute to the existing knowledge on breastfeeding practices by laying the groundwork for further exploration of the distinct roles that different forms of mass communication media (including digital social media, newspapers, television advertisements, etc.) may play in influencing breastfeeding practices. Factors such as maternal age, education level, socioeconomic status, cultural background, and access to healthcare resources may impact the extent to which mothers are influenced by media messages and their subsequent breastfeeding practices[3]. A reciprocal relationship exists between individuals' beliefs in their ability to successfully perform a behavior and their social environments[4]. Media messages about breastfeeding can reflect and perpetuate broader cultural norms, societal attitudes, and healthcare practices related to infant feeding. The quality and content of breastfeeding-related information disseminated as well as individual characteristics and behaviors of mothers are, therefore, worth considering in such investigations.

The problem of misinformation about breastfeeding on social media and other mass communication platforms is complex to tackle. Previous studies indicated that inaccurate or harmful information about breastfeeding, such as exaggerating potential difficulties in breastfeeding and promoting the use of formula milk alternatives undermine mothers' confidence in their abilities to breastfeed[5-7]. Social media has become a key battleground for marketing commercial complementary foods, raising concerns alongside its growing popularity[5]. While traditional marketing methods for infant feeding formulas have been extensively critiqued, the strategies employed in the digital realm remain unexamined. Formula milk companies often use social media and other mass media for subtle and sometimes less obvious marketing that can create an inclination towards supplementing or replacing breastfeeding[6]. Mothers frequently seek breastfeeding information and support on social media, but the lack of reliability and the presence of conflicting information can be more confusing than helpful[7].

To conclude, while the current study offers valuable insights into the impact of the WCFI model on EBF, a deeper understanding of breastfeeding practices requires exploring a broader range of influences. Future studies should focus on refining research methodologies to explore how media interactions with cultural norms and individual factors influence breastfeeding practices. Individual characteristics, media literacy, social support systems, and government policies play significant roles in this regard. Given the challenges of misinformation and marketing tactics online, ensuring supportive media environments with accurate information is crucial to empower mothers' infant feeding decisions.