Negative experiences of breastfeeding beyond the infancy age of one year in public - a deductive content analysis of a cross-sectional global sample.

Background: The global recommendations of continuing breastfeeding for two years and beyond are not being realised. Barriers to breastfeeding beyond the infancy age of one year continue to be seen globally despite the recognition that facilitating it could prevent 823,000 child and 98,000 parent deaths every year. The visibility of breastfeeding in public, particularly for those who continue to breastfeed, is thought to be reducing and this in turn impacts public acceptability. However, research exploring women's experiences breastfeeding in public typically focuses on newborns. Therefore, this study explores negative experiences of continuing breastfeeding, between the ages of 1 to < 2 years, in a global sample of participants.

Methods: A cross-sectional design via an online self-completed questionnaire was adopted to collect data from women, at one point in time, who had experience of breastfeeding a child between the ages of 1-2 years. Participants who had experienced a negative response were asked to share their experiences in a free text question. A content analysis was adopted to explore the information conveyed by the participants through the conceptualising of condensed broad category descriptions.

Results: There were 2,562 women who had a negative experience of breastfeeding in public places, 1,674 from five continents (Europe 994, America 948, Asia 51, Australia 161, Africa 20, Unknown 12) shared their experience. The findings present four categories: Unsolicited Opinion (56%), Judgemental (39%), Indecent Act (16%) and, Prohibited (7%). Commonly there were experiences of unwanted advice or being shamed and stigmatised to undermine breastfeeding practice. More zealous public reactions, such as implying child abuse, sexualising breastfeeding, or expressing shock and disgust were less common. The least likely to occur were experiences of being told to refrain from, move away or cover up.

Conclusions: The findings reaffirmed that there is a wider social stigma experienced by women breastfeeding beyond infancy in public. This highlights that women who continue to breastfeed are being shamed and blamed for their breastfeeding choices. More efforts are needed to address social and cultural challenges, with an increase in wider knowledge to support breastfeeding beyond infancy.