- World Breastfeeding Week focuses - sensibly - on supporting breastfeeding in the first six months of a child’s life, but breastfeeding beyond six months is important, too.
- Mothers and caregivers are turning increasingly to social media for breastfeeding support, including beyond six months.
- Research is scant on how well virtual communities affect behavior, particularly in LMICs.
- Betibuti, a Facebook group for mothers in Viet Nam, provides a window on the role of virtual communities.
The conversations occur in snippets of text, and they spread quickly across thousands of devices linked via the internet. “My husband wants me to introduce formula because the baby cries a lot. What do I do?” “Was your family supportive?” “The first time, my family was not supportive, and I did everything for breastfeeding by myself.”
Up to relatively recently, these conversations might have occurred at a meeting place where mothers share and confide on things like breastfeeding – perhaps around a village water pump, at a market during a lull in the afternoon or in an office break room. But in 2020, more conversations like this are occurring in online forums.
As we continue celebrating breastfeeding this month, we want to talk about breastfeeding for children after six months—in the complementary feeding period. With online groups adding more moms daily and social distancing and quarantine restrictions globally due to COVID-19, it made sense to base this discussion on what role online support groups might play.
Spoiler alert: We simply do not know enough about the influence of social media on breastfeeding – particularly beyond six months. Nevertheless, we felt these groups are making enough of a mark to merit discussion – even if we don’t know what they might mean for social and behavior change. This is a topic we will return to in future posts.
Breastfeeding and complementary feeding
Let’s start with some basic facts: Breastfeeding doesn’t stop being the best food for a child at 6 months; rather, breastmilk alone is not enough. It becomes essential to introduce other foods at six months. Breastfeeding promotion and support generally tend to prioritize early initiation of breastfeeding and exclusive breastfeeding for the first six months.
This makes sense. Strategies in place, in many countries, that address the structural and policy environment for breastfeeding—e.g., maternity protections, breastfeeding-friendly work and other spaces, preventing inappropriate marketing of BMS—are all necessary for continued breastfeeding, too. Continued breastfeeding depends on a mother’s early success. If she continues to breastfeed exclusively for the first six months she is more likely to continue beyond to the recommended two years. But it takes more than that for social and behavior change for continued breastfeeding.
A mother’s intention turns out to be strongly predictive of how long she will breastfeed, with the caveat that the context is supportive (see "Why invest, and what it will take to improve breastfeeding practices?"). That may seem obvious but understanding what informs a mothers’ intentions is not, and it often gets lost in the focus on introducing food in a timely fashion and providing enough quality food.
Breastfeeding support goes virtual
Virtual support groups for parenting and child feeding are not new and their membership is growing as women gain access to smart phones and peer support online. Breastfeeding support groups on Facebook and other platforms are prevalent all over the world. In Nigeria, social media platforms like WhatsApp, Facebook and Instagram are expanding, with over 20 million active monthly users on Facebook alone. In many communities, mobile phones are more common than toilets. The Myanmar Parenting Network is a closed group with about 30,000 followers and growing. In Nigeria, the Mamalette Facebook group has almost 240,000 participants. Can virtual communities offer us any insights into the question of the intention to breastfeed? They do create new opportunities to engage with mothers but toward what end and who do they reach?
Some qualitative research from high-income countries suggests the answer is maybe. It shows that social media groups can positively influence breastfeeding-related attitudes, knowledge, and behaviors and lead to a longer duration of breastfeeding, but relatively little is known in LMIC. These groups are self-selected, and it seems likely such groups attract predominantly mothers who already want support for breastfeeding. What this experience means for the breastfeeding intentions and attitudes of other mothers is uncertain at best.
The case of Betibuti
Betibuti is a public breastfeeding community on Facebook in Viet Nam with over 267,000 members. Alive & Thrive has worked with Betibuti, in particular to address the unethical and illegal marketing of breastmilk substitutes, which involved a virtual campaign to name and shame the companies engaging in such practices.
“With my second child, I had trouble breastfeeding and searched on the internet and found Betibuti,” she said. “In this group we have a lot of information in files and attachments to help breastfeeding mothers." The number of doctors who help mothers with breastfeeding problems is limited. “So, mothers turn to groups like this for more information on breastfeeding and they find mothers that are successful in breastfeeding, understand the difficulties of it, and who can be supportive. There are many similar groups, but Betibuti is one that has detailed scientific information and helps moms to practice breastfeeding,” Nam said.
Membership in Betibuti has opened a window on breastfeeding issues for women in Viet Nam.
“I think Betibuti is reaching mothers and supporting their efforts to breastfeed, but I think it depends on the mother. If she wants to enough, she can find the solution. When you want something (badly) enough, everything will help make it come true.”
That highlights the self-selection issue we mentioned earlier. Maybe these are the motivated mothers who are already committed to breastfeeding and the group simply allows them to find the support they need from like-minded mothers, not those without the intention to continue. Nam said Betibuti is just one means of support for mothers to breastfeed; they need others.
“Not only online but offline meetings and other opportunities to cheer, support, and celebrate” are necessary, she said. “The government can support mothers to breastfeed longer and train healthcare workers (to support them). There is only one International Board Certified Lactation Consultant (IBCLC) in the country and I want to be the second. When we have a lot of IBCLCs in Viet Nam we can have more impact on healthcare workers, because we can talk to them about breastfeeding, not just healthcare.”
As World Breastfeeding Week focuses attention on breastfeeding, typically emphasizing early initiation and exclusive breastfeeding, groups like Betibuti are opening up avenues for promoting breastfeeding beyond six months. While we may have more questions than answers today, these groups undoubtedly increase opportunities to reach more mothers with supportive information and advice. That’s worth celebrating.
What are your experiences with virtual communities to support continued breastfeeding or complementary feeding? Share them in the comments below or on social media. Use the hashtag #Inspire4SBC on Twitter and Facebook.
I am Sofa from Indonesia. The same thing happened in my country, especially in the middle class. However, here, supporting groups are more often formed based on the month of birth of the child. Admins and group members will discuss topics that are very relevant to their baby's developmental stages. At the beginning, the topic of discussion would be around the postpartum period, breastfeeding, pumping, etc. until finally after 6 months of discussing complementary food, even the weaning process and toilet training when the group has been running for 2 years.
This article provides insight into a simple program that can be done by anyone to form a supporting system, it's worth a try.