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Do fathers' attitudes support breastfeeding? A cross-sectional questionnaire-

based study in Mumbai, India
Article in Indian Journal of Medical Sciences · January 2012

DOI: 10.4103/0019-5359.110861 · Source: PubMed
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30
ORIGINAL ARTICLE
DO FATHERS’ ATTITUDES SUPPORT BREASTFEEDING?

A CROSS‑SECTIONAL QUESTIONNAIRE‑BASED STUDY
IN MUMBAI, INDIA
SUNIL KARANDE, SANJAY PERKAR
ABSTRACT
CONTEXT: The views of fathers have been shown to be important determinants

of infant feeding decisions, but men’s attitudes toward breastfeeding and
formula feeding have rarely been explored. AIMS: To explore the relationship
between maternal and paternal infant feeding attitudes and their impact on
the duration of exclusive breastfeeding. SETTINGS AND DESIGN: Prospective
questionnaire‑based cross‑sectional study conducted in a tertiary care public
hospital. MATERIALS AND METHODS: From May 2009 to September 2010, a
convenience sample of 238 parents of infants (>6 months to <1 year of age) were
included. Each parent’s attitude toward infant feeding was measured by the Iowa
Infant Feeding Attitude Scale (IIFAS). STATISTICAL ANALYSIS USED: Pearson’s
correlation test, independent samples t ‑test, and one‑way analysis of variance
were carried out for statistical significance. RESULTS: Only 83 (34.9%) mothers had
exclusively breastfed their babies for 4‑6 months. A mother’s “total” infant feeding
attitude score was significantly correlated with her husband’s score ( r = 0.43,
P < 0.01). The couples shared similar “individual” infant feeding attitudes to all but
four of the 17 items. These 13 “individual” attitudes favorable toward breastfeeding
were related to its optimal nutritional value, convenience of administration, ease of
digestibility, unique role in mother‑infant bonding, acceptability of breastfeeding
in public places, and long‑term health benefits to babies. Only maternal attitudes
played an influential role in achieving an exclusive breastfeeding period of
4‑6 months. CONCLUSIONS: Fathers’ attitudes do support breastfeeding, but do not
influence the time duration of exclusive breastfeeding.
Key words: Attitudes, complementary feeding, exclusive breastfeeding, infant formulas,

mothers
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Department of Pediatrics, Lokmanya Tilak Municipal www.indianjmedsci.org
Medical College and General Hospital, Sion, Mumbai, India DOI:
Address for correspondence: 10.4103/0019-5359.110861
Dr. Sunil Karande,
Flat 24, Joothica, 5th Floor, 22 A, Naushir Bharucha Road, PMID:
Mumbai ‑ 400 007, India.
E‑mail: karandesunil@yahoo.com *****************************
Indian Journal of Medical Sciences, Vol. 66, No. 1 and 2, January and February 2012
FATHERS’ ATTITUDES REGARDING BREASTFEEDING 31
INTRODUCTION India over a period of 18 months, from May

2009 to September 2010. There was no reliable
Breastfeeding is an unequalled way of data which mentioned the recent exclusive
providing ideal food for the healthy growth breastfeeding rate at 6 months in our city.
and development of infants. [1] “Exclusive Hence, the study sample was by necessity a
breastfeeding” is defined as no other food convenience sample. Parents who currently
or drink, not even water, except breast milk, had an infant child more than 6 months but less
but allows the infant to receive drops and than one year of age were included. Parents of
syrups (vitamins, minerals, and medicines).[1] infant twins and those who were known to have
Before 2001, the World Health Organization a mental illness or to be HIV seropositive were
(WHO) global recommendation was that excluded from the study. The socio‑demographic
infants be exclusively breastfed for between characteristics of each infant and parent
4 and 6 months.[1,2] In 2001, this advice was were noted. The modified Kuppuswami’s
changed, and exclusive breastfeeding is now classification was used to determine the family’s
recommended for the first 6 months of life socio‑economic status.[6,7] Each parent was given
with the introduction of complementary foods the “Iowa Infant Feeding Attitude Scale (IIFAS)”
thereafter and continued breastfeeding for the to complete in a quiet secluded room.[8] Each
first 2 years.[1‑3] parent completed this self‑administered
questionnaire independently without interacting
It is known that positive maternal attitudes with each other in about 25‑30 min. If parent
toward breastfeeding plays a major role in was illiterate the questionnaire was read out and
determining her decision to breastfeed and the responses noted.
duration of exclusive breastfeeding.[4] The views
of fathers have been shown to be important Measuring parental attitudes toward infant
determinants of infant feeding decisions, but feeding with Iowa infant feeding attitude scale
men’s attitudes toward breastfeeding and The IIFAS was used to assess each parent’s
formula feeding have rarely been explored.[5] attitude toward infant feeding [Table 1].[8] The
IIFAS consists of 17 attitude questions, wherein
We conducted this study to explore the eight were favorable toward breastfeeding and
relationship between maternal and paternal the remaining nine questions favorable toward
infant feeding attitudes and their impact on the formula feeding. The scale is designed to cover
duration of exclusive breastfeeding. various dimensions of infant feeding [Table 1].
For example, there are questions concerning
MATERIALS AND METHODS the costs of infant feeding (e.g., “Breast milk is
cheaper than formula”), nutrition (e.g., “Breast
Selection of cases milk is the ideal food for babies”), convenience
T h is p r o s p e c ti v e q uest ionnaire‑based (e.g., “Formula feeding is more convenient
cross‑sectional study was conducted in the than breastfeeding”), and infant bonding
Department of Pediatrics at a tertiary care (e.g., “Breastfeeding increases mother‑infant
public hospital and medical college in western bonding”). Each respondent indicated the extent
32 INDIAN JOURNAL OF MEDICAL SCIENCES
Table 1: The Iowa infant feeding attitude scale[8] score was computed by means of an equally
Statement SD D N A SA weighted sum of responses to the individual
*The benefits of 1 2 3 4 5
breastfeeding last only
items. Total attitude scores could range from
as long as the baby is 17 (reflecting positive formula feeding attitudes)
breastfed
*Formula feeding is 1 2 3 4 5
to a high of 85 (indicating attitudes that favored
more convenient than breastfeeding). A total score of 51 indicated
breastfeeding
Breastfeeding increases 1 2 3 4 5
a neutral “overall” attitude. An item score of 3
mother‑infant bonding indicated a neutral “individual” attitude. The
*Breast milk is lacking in iron 1 2 3 4 5
IIFAS is a reliable (Cronbach’s alpha ≥0.85) and
Formula fed babies are 1 2 3 4 5
more likely to be overfed valid instrument for assessing attitudes toward
than breastfed babies
infant feeding.[8]
*Formula feeding is the 1 2 3 4 5
better choice if the mother
plans to go back to work
The IIFAS was pilot tested for usability and
Mothers who formula feed 1 2 3 4 5
miss one of the great joys of translated from English into Marathi and
motherhood
Hindi using the forward–backward method by
*Women should not 1 2 3 4 5
breastfeed in public places professional native translators specialized in
such as restaurants
medicine.
Breastfed babies are 1 2 3 4 5
healthier than formula fed
babies
Consent and ethical approval
*Breastfed babies are more 1 2 3 4 5
likely to be overfed than Our study was approved by the scientific and
formula fed babies
ethics committees of our institution. Written
*Fathers feel left out if a 1 2 3 4 5
mother breast feeds informed consent of both the parents to
Breast milk is the ideal food 1 2 3 4 5 participate in the study was taken.
for babies
Breast milk is more easily 1 2 3 4 5
digested than formula Data analysis
*Formula is as healthy for an 1 2 3 4 5
infant as breast milk The data were analyzed using the Statistical
Breastfeeding is more 1 2 3 4 5 Package for Social Sciences, Version 15 for
convenient than formula
Breast milk is cheaper than 1 2 3 4 5
Windows (SPSS; Chicago, IL, USA). Firstly, the
formula IIFAS mean scores (±SD) for the study mothers
*A mother who occasionally 1 2 3 4 5
drinks alcohol should not
and fathers were computed. Secondly, Pearson’s
breastfeed her baby correlation test was employed to determine the
SSD=Strongly disagree, D=Disagree, N=Neutral, A=Agree,
SA=Strongly agree, Items marked with asterisks (*) are
correlation between mothers’ attitude scores
favorable to formula feeding and are reverse scored (i.e., 1=5, and fathers’ total scores. Thirdly, the means
2=4, 4=2, and 5=1); Higher scores indicate more positive
attitudes toward breastfeeding; A strongly breastfeeding of ‘total attitude’ and each ‘individual attitude’
attitude has a score of 5 for each question
scores were compared using the independent
to which he/she agreed with each statement, samples t‑test. Fourthly, one‑way analysis
on a 5‑point Likert Scale ranging from “strongly of variance (ANOVA) test was employed to
disagree” to “strongly agree.” Items that favored determine differences in infant feeding attitudes
formula feeding were reverse scored (i.e., 1 = 5, of mothers and fathers, respectively, in relation
2 = 4, 4 = 2, and 5 = 1), and a total attitude to exclusive breastfeeding duration (<1 month,
1 to <4 months, 4‑6 months and > 6 months). Table 2: Clinical and socio‑demographic
P values < 0.05 (two‑tailed) were taken as characteristics of the study parents
Factor n %
statistically significant.
Maternal
Age
RESULTS 18 to <24 116 48.74
24 to <35 116 48.74
≥35 6 2.52
Description of the study parents Education level
A total of 238 couples participated in the Graduate or post‑graduate 4 1.7
High school certificate 15 6.3
present study [Table 2]. The mean age of
Middle school certificate 64 26.9
mothers was 24.9 years (SD 3.9, range Primary school certificate/ 101 42.4
literate
18.0‑42.0). The mean age of fathers was
Illiterate 54 22.7
29.3 years (SD 5.4, range 20.0‑42.0). Majority Working status
of the couples belonged to the upper lower Yes 2 0.8
No 236 99.2
socio‑economic strata of society. Other
Tobacco/alcohol consumption
details of clinical and socio‑demographic Yes 22 9.2
characteristics of the study parents are No 216 90.8
Paternal
given in Table 2. The clinical and Age
socio‑demographic characteristics of infants 18 to <24 26 11.0
are given in Table 3. 24 to <35 116 73.0
≥35 39 16.0
Education level
Correlation of total attitude scores of Graduate or post‑graduate 5 2.1
study parents High school certificate 30 12.6
Middle school certificate 72 30.3
Total attitude scores ranged from 51 to Primary school certificate/ 109 45.8
78 (mean 67.13, SD ± 4.90) for mothers and literate
Illiterate 22 9.2
from 49 to 80 (mean 67.55, SD ± 5.38) for
Working status
fathers [Table 4]. A mother’s total attitude score Yes 237 99.6
was significantly correlated to her husband’s No 1 0.4
Family
score (r = 0.43, P < 0.01) indicating that both Family type
had similar infant feeding attitudes. Nuclear 109 45.8
Joint 129 54.2
Religion
Comparison of infant feeding attitudes of Hindu 123 51.6
study parents Muslim 109 45.8
Christian 3 1.3
The couples shared similar “total” attitudes
Sikh 3 1.3
which were favorable toward breastfeeding Socio‑economic status
[Table 4]. The couples shared similar Upper middle 2 0.8
Lower middle 19 8.0
“individual” infant feeding attitudes to all
Upper lower 214 89.9
but four of the 17 items [Table 4]. Although Lower lower 3 1.3
the couples favorably agreed that “fathers Type of residence
Hut 98 41.2
do not feel left out if a mother breast
Chawl 126 52.9
feeds,” the mean scores of mothers for this Flat 14 5.9
Table 3: Clinical and socio‑demographic had exclusively breastfed their babies for
characteristics of infants 4‑6 months (mean 68.60, SD 4.38) had
Factor n %
significantly higher total attitudes scores
Infant
Gender (F = 6.580, df = 3, 234, P < 0.0001);
Male 131 55.0 (ii) mothers who had exclusively breastfed
Female 107 45.0 their babies for <1 month (mean 3.25, SD
Birth order
1.39) had significantly lower individual attitude
First 67 28.2
Second 93 39.1 scores (F = 5.169, df = 3, 234, P = 0.002) for
Third 57 23.9 item 1 (“the benefits of breastfeeding last only
Fourth or more 21 8.8
as long as the baby is breastfed”); (iii) mothers
Gestation
Pre‑term 22 9.2 who had exclusively breastfed their babies
Term 216 90.8 for <1 month (mean 3.69, SD 1.40) had
Birth weight significantly lower individual attitude
Low 32 13.4
scores (F = 6.748, df = 3, 234, P < 0.0001)
Normal 206 86.6
Type of delivery for item 2 (“formula feeding is more
Vaginal 199 83.6 convenient than breastfeeding”); (iv) mothers
Caesarean/Assisted 39 16.4
who had exclusively breastfed their babies
Place of delivery
Home 37 15.5 for >6 months (mean 3.40, SD 1.24) had
Hospital 201 84.5 significantly lower individual attitude scores
(F = 5.217, df = 3, 234, P = 0.002) for item
item were significantly lower (P = 0.006). 10 (“breastfed babies are more likely to
Although the couples favorably agreed that be overfed than formula fed babies”); (v)
“breast milk is cheaper than formula,” the mothers who had exclusively breastfed their
mean scores of fathers for this item were babies for <1 month (mean 4.44, SD 1.03)
significantly lower (P = 0.005). Although the had significantly lower individual attitude
couples concurrence was favoring formula scores (F = 2.863, df = 3, 234, P = 0.038)
feeding when both agreed that “a mother for item 7 (“mothers who formula feed miss
who occasionally drinks alcohol should not one of the great joys of motherhood”);
breastfeed her baby” and that “formula fed (vi) mothers who had exclusively breastfed
babies are not more likely to be overfed their babies for <1 month (mean 4.81, SD
than breastfed babies;” the mean scores of 0.40) had significantly lower individual
mothers for these two items were significantly attitude scores (F = 6.261, df = 3, 234,
lower (P = 0.027 and P = 0.047, respectively). P < 0.0001) for item 12 (“breast milk is the
ideal food for babies”); (vii) mothers who had
Mothers’ infant feeding attitudes and exclusively breastfed their babies for <1 month
duration of exclusive breastfeeding duration (mean 4.88, SD 0.34) had significantly lower
Only 83 (34.9%) mothers had exclusively individual attitude scores (F = 2.901, df = 3,
breastfed their babies for 4‑6 months 234, P = 0.036) for item 13 (“breast milk is
[Table 5]. Differences in attitude scores more easily digested than formula”); and
[Table 5] indicated that (i) mothers who (viii) mothers who had exclusively breastfed
Table 4: Comparison of Iowa infant feeding attitude scale scores of study parents
Infant feeding attitudes Mean (SD) Mean P value* 95% CI
Mothers Fathers difference
(n=238) (n=238)
Favorable to formula feeding
The benefits of breastfeeding last only 4.09 (0.99) 4.13 (1.02) –0.04 0.664 –0.22 to 0.14
as long as the baby is breastfed
Formula feeding is more convenient 4.22 (1.04) 4.21 (1.03) 0.01 0.916 –0.18 to 0.20
than breastfeeding
Breast milk is lacking in iron 3.25 (0.82) 3.34 (0.79) –0.09 0.223 –0.24 to 0.06
Formula feeding is the better choice if 2.55 (1.24) 2.53 (1.25) 0.02 0.861 –0.20 to 0.24
the mother plans to go back to work
Women should not breastfeed in public 3.41 (1.47) 3.24 (1.54) 0.17 0.219 –0.10 to 0.44
places such as restaurants
Breastfed babies are more likely to be 3.78 (1.20) 3.75 (1.22) 0.03 0.787 –0.19 to 0.25
overfed than formula fed babies
Fathers feel left out if a mother breast 3.86 (1.43) 4.19 (1.19) –0.33 0.006 –0.57 to 0.09
feeds
Formula is as healthy for an infant as 4.65 (0.75) 4.69 (0.67) –0.04 0.540 –0.17 to 0.09
breast milk
A mother who occasionally drinks 1.72 (1.12) 1.97 (1.33) –0.25 0.027 –0.47 to 0.03
alcohol should not breastfeed her baby
Favorable to breastfeeding
Breastfeeding increases mother infant 4.93 (0.27) 4.90 (0.44) 0.03 0.370 –0.04 to 0.10
bonding
Formula fed babies are more likely to 1.97 (1.14) 2.19 (1.27) –0.22 0.047 –0.44 to 0.003
be overfed than breastfed babies
Mothers who formula feed miss one of 4.65 (0.64) 4.67 (0.74) –0.02 0.753 –0.14 to 0.10
the great joys of motherhood
Breastfed babies are healthier than 4.82 (0.70) 4.85 (0.61) –0.03 0.618 –0.15 to 0.09
formula fed babies
Breast milk is the ideal food for babies 4.97 (0.17) 4.97 (0.18) 0.00 1.000 –0.03 to 0.03
Breast milk is more easily digested 4.97 (0.16) 4.94 (0.28) 0.03 0.152 –0.01 to 0.07
than formula
Breastfeeding is more convenient than 4.74 (0.61) 4.72 (0.68) 0.02 0.736 –0.10 to 0.14
formula
Breast milk is cheaper than formula 4.55 (0.97) 4.26 (1.23) 0.29 0.005 0.09 to 0.49
Total score 67.13 (4.90) 67.55 (5.38) –0.42 0.374 –1.35 to 0.51
Maximum achievable score for each question is 5, *Independent samples t‑test, P value <0.05 significant, df=474; SD=Standard
deviation, r=Range, diff=Difference, df=Degree of freedom, CI=Confidence interval
their babies for 4‑6 months (mean 4.90, and individual attitude scores (all except for
SD 0.34) had significantly higher individual item 6) were not significantly related to the
attitudes scores (F = 3.043, df = 3, 234, duration of exclusive breastfeeding. Fathers
P = 0.030) for item 15 (“breast milk is more whose wives had exclusively breastfed
easily digested than formula”). their babies for 1 to <4 months (mean 2.15,
SD 1.14) had significantly lower individual
Fathers’ infant feeding attitudes and attitudes scores (F = 2.733, df = 3, 234,
duration of exclusive breastfeeding duration P = 0.044) for item 6 (“formula feeding is the
Differences in attitude scores [Table 6] better choice if the mother plans to go back
indicated that fathers total attitude scores to work”).
Table 5: Mothers’ infant feeding attitudes scores correlated with duration of exclusive breastfeeding duration
outcome
Infant feeding attitudes Exclusive breastfeeding duration outcome F P value*
<1 month 1 to <4 months 4‑6 months >6 months
(n=16) (n=54) (n=83) (n=85)
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
The benefits of breastfeeding last only 3.25 (1.39) 4.24 (0.89) 4.23 (1.00) 4.02 (0.89) 5.169 0.002
Formula feeding is more convenient 3.69 (1.40) 4.17 (1.23) 4.59 (0.65) 3.99 (1.05) 6.748 <0.0001
than breastfeeding
Breast milk is lacking in iron 3.38 (1.03) 3.44 (0.79) 3.23 (1.02) 3.13 (0.53) 1.717 0.164
Formula feeding is the better choice if 2.94 (1.53) 2.37 (1.41) 2.61 (1.16) 2.52 (1.14) 0.987 0.400
Women should not breastfeed in public 3.63 (1.50) 3.61 (1.49) 3.46 (1.59) 3.19 (1.33) 1.116 0.343
Breastfed babies are more likely to be 3.63 (1.20) 3.98 (1.04) 4.06 (1.16) 3.40 (1.24) 5.217 0.002
Fathers feel left out if a mother breast 3.88 (1.41) 3.87 (1.44) 4.05 (1.42) 3.66 (1.43) 1.048 0.372
feeds
Formula is as healthy for an infant as 4.31 (1.01) 4.74 (0.56) 4.61 (0.96) 4.68 (0.52) 1.491 0.218
breast milk
A mother who occasionally drinks 1.44 (0.81) 1.69 (1.06) 1.88 (1.30) 1.65 (1.02) 1.014 0.387
Breastfeeding increases mother infant 4.94 (0.25) 4.96 (0.19) 4.95 (0.27) 4.89 (0.31) 1.013 0.388
bonding
Formula fed babies are more likely to 1.94 (1.12) 1.96 (1.23) 1.87 (1.21) 2.07 (1.02) 0.432 0.730
Mothers who formula feed miss one of 4.44 (1.03) 4.76 (0.43) 4.75 (0.60) 4.53 (0.67) 2.863 0.038
Breastfed babies are healthier than 4.56 (1.03) 4.81 (0.65) 4.82 (0.81) 4.88 (0.52) 0.946 0.419
formula fed babies
Breast milk is the ideal food for babies 4.81 (0.40) 4.96 (0.19) 5.00 (0.00) 4.98 (0.15) 6.261 <0.0001
Breast milk is more easily digested 4.88 (0.34) 4.98 (0.14) 5.00 (0.00) 4.96 (0.19) 2.901 0.036
than formula
Breastfeeding is more convenient than 4.69 (0.48) 4.67 (0.82) 4.90 (0.34) 4.64 (0.65) 3.043 0.030
formula
Breast milk is cheaper than formula 4.44 (1.03) 4.48 (1.08) 4.59 (1.04) 4.58 (0.82) 0.233 0.873
Total score 64.81 (5.09) 67.70 (5.40) 68.60 (4.38) 65.76 (4.55) 6.580 <0.0001
A strongly breastfeeding attitude has a score of 5 for each question, Items favorable to formula feeding are reverse scored,
Strongly agree=5, Strongly disagree=1, *One‑way ANOVA, P<0.05 significant, df=3, 234
DISCUSSION namely, the IIFAS. The present study has

documented a strong correlation between
To the best of our knowledge, this is the first the “total” infant feeding attitudes of mothers
and fathers indicating that couples, in our
Indian study that has simultaneously documented
setting, tend to share similar “overall” attitudes
maternal and paternal infant feeding attitudes
which are favorable toward breastfeeding.
and analyzed their impact on the duration of Couples also share similar “individual” attitudes
exclusive breastfeeding; and that too utilizing which are favorable toward breastfeeding,
an easily administered and scored instrument, namely, those related to its optimal nutritional
Table 6: Fathers’ infant feeding attitudes scores correlated with duration of exclusive breastfeeding duration
outcome
Infant feeding attitudes Exclusive breastfeeding duration outcome F P value*
<1 month 1 to <4 months 4‑6 months >6 months
(n=16) (n=54) (n=83) (n=85)
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
The benefits of breastfeeding last only 3.69 (1.14) 4.06 (1.12) 4.28 (1.00) 4.11 (0.93) 1.706 0.166
Formula feeding is more convenient 4.13 (0.96) 4.19 (1.18) 4.31 (1.04) 4.14 (0.94) 0.427 0.734
than breastfeeding
Breast milk is lacking in iron 3.50 (1.10) 3.28 (0.71) 3.41 (0.91) 3.27 (0.63) 0.760 0.517
Formula feeding is the better choice if 2.69 (1.45) 2.15 (1.14) 2.76 (1.26) 2.52 (1.24) 2.733 0.044
Women should not breastfeed in public 3.44 (1.50) 3.39 (1.60) 3.17 (1.56) 3.19 (1.52) 0.342 0.795
Breastfed babies are more likely to be 3.94 (0.93) 3.74 (1.31) 3.94 (1.20) 3.53 (1.21) 1.739 0.160
Fathers feel left out if a mother breast 3.88 (1.36) 4.37 (1.10) 4.14 (1.34) 4.18 (1.06) 0.819 0.484
feeds
Formula is as healthy for an infant as 4.56 (0.63) 4.72 (0.60) 4.76 (0.71) 4.64 (0.69) 0.684 0.562
breast milk
A mother who occasionally drinks 2.25 (1.18) 1.96 (1.43) 1.98 (1.39) 1.91 (1.26) 0.292 0.832
Breastfeeding increases mother infant 4.94 (0.25) 4.83 (0.61) 4.93 (0.46) 4.92 (0.28) 0.690 0.559
bonding
Formula fed babies are more likely to 2.19 (1.38) 2.07 (1.26) 2.04 (1.21) 2.41 (1.31) 1.399 0.244
Mothers who formula feed miss one of 4.69 (0.48) 4.59 (0.81) 4.76 (0.73) 4.64 (0.74) 0.669 0.572
Breastfed babies are healthier than 4.69 (1.01) 4.89 (0.37) 4.86 (0.67) 4.86 (0.58) 0.450 0.717
formula fed babies
Breast milk is the ideal food for babies 5.00 (0.00) 4.93 (0.26) 4.98 (0.15) 4.98 (0.15) 1.253 0.291
Breast milk is more easily digested 5.00 (0.00) 4.91 (0.35) 4.95 (0.27) 4.94 (0.28) 0.468 0.705
than formula
Breastfeeding is more convenient than 4.69 (0.48) 4.59 (0.90) 4.86 (0.52) 4.67 (0.68) 2.009 0.113
formula
Breast milk is cheaper than formula 3.94 (1.53) 4.30 (1.25) 4.36 (1.25) 4.21 (1.16) 0.600 0.616
Total score 67.19 (6.17) 66.96 (6.57) 68.47 (4.61) 67.09 (5.05) 1.262 0.288
A strongly breastfeeding attitude has a score of 5 for each question, Items favorable to formula feeding are reverse scored,
Strongly agree=5, Strongly disagree=1, *One‑way ANOVA, P<0.05 significant, df=3, 234
value, convenience of administration, ease of We found only three other studies that have
digestibility, unique role in mother‑infant bonding, documented and analyzed the infant feeding
acceptability of breastfeeding in public places, attitudes of couples simultaneously.[9‑11] Scott,
and long‑term health benefits to babies. The et al. (Scotland)[9] had utilized the IIFAS to
present study also documents that maternal document the infant feeding attitudes of 108
attitudes play a significant role in achieving an expectant couples and determined to what
exclusive breastfeeding period of 4‑6 months. In degree their individual attitudes during early
contrast, paternal attitudes do not influence the pregnancy were predictive of the method of infant
period of exclusive breastfeeding. feeding at discharge from hospital. They too had
[Downloaded free from http://www.indianjmedsci.org on Monday, April 29, 2013, IP: 59.181.130.124] || Click here to downl
reported that infant feeding attitudes tended to digested than formula; (iii) formula feeding is not
be shared by couples. They found that maternal more convenient than breastfeeding; (iv) the act
and not paternal infant feeding attitudes was of breastfeeding is one of the greatest joys of
a predictor of infant feeding choice.[9] Tohotoa, motherhood; and (v) that the long‑term benefits
et al. (Australia)[10] had conducted a qualitative of breastfeeding for their baby include increased
exploratory study on 76 couples whose baby was immunity to fight infections, better eye‑sight,
either being breastfed or were breastfed in the and intelligence. Thirdly, the present study
past 6 months. They had reported that paternal has identified that mothers who exclusively
emotional, practical, and physical supports were breastfeed for more than 6 months wrongly
important factors required to promote successful believe that “Breastfed babies are more likely to
breast feeding.[10] Avery and Magnus (US)[11] after be overfed than formula fed babies.” To prevent
conducting focused discussions with 121 group delay in timely initiation of complementary
participants had reported that male partners feeding, women should be educated that the
had favorable attitudes toward breastfeeding quantity of breast milk for the nutritional needs
and deferred to their pregnant partners’ feeding of their baby is sufficient only for the first
decisions.[11] 6 months.
Practical implications of the study Fourthly, our study has documented that fathers
What is the utility of the present study? Firstly, do not feel left out when their wives are breast
the study has documented that although fathers’ feeding nor do they feel embarrassed when
attitudes do support breastfeeding, they do their wives breast feed in public places. These
not currently influence the time duration of findings are heartening keeping in mind that a
exclusive breastfeeding. The National Family report from US has stated that fathers may feel
Health Survey‑3 for India has reported that excluded, jealous, and resentful to the detriment
exclusive breastfeeding rate at 6 months is of breastfeeding success and the adult couple
only about 30% with a median duration of relationship.[13] Recent reports indicate that
exclusive breastfeeding of 3.7 months.[12] Our couples in US and UK get embarrassed and
results emphasize the acute need to target hence disapprove of breastfeeding in public.[11,14]
and educate husbands about the benefits of Fifthly, there is a need to educate mothers who
breastfeeding to ensure that they too develop intend to return to their jobs (and their husbands)
pro‑active attitudes toward breastfeeding. This that it is easy to store their breast milk in a
would help improve the current low exclusive clean container(s) at room temperature or in the
breastfeeding rate at 6 months. Secondly, the refrigerator before leaving for work and even
present study has identified the unfavorable at their work place. This would enable them to
“individual” attitudes of mothers who exclusively continue predominantly breastfeeding their baby
breastfeed for <1 month. To prevent this and minimize the need for formula feeding.
unfortunate situation, it should be emphasized
to women during their antenatal visits and even Limitations of the study
after delivery that (i) breast milk is the ideal food Our study has at least three limitations.
for their baby; (ii) breast milk is more easily Firstly, the study sample was by necessity
a convenience sample. Secondly, an young child feeding. Geneva: World Health

overwhelming majority (91.2%) of respondents Organization; 2003.
belonged to the lower socio‑economic strata 4. Losch M, Dungy CI, Russell D, Dusdieker LB.
Impact of attitudes on maternal decisions regarding
of society. Thus the results may not be
infant feeding. J Pediatr 1995;126:507‑14.
generalizable to the rest of city or to other
5. Clifford J, McIntyre E. Who supports breastfeeding?
parts of our country. Future studies in other
Breastfeed Rev 2008;16:9‑19.
parts of our city and country that use more 6. Kuppuswamy B. Manual of socioeconomic status
representative samples should be conducted (Urban). 2nd ed. Delhi: Manasayan;1981.
to verify our findings. Thirdly, the respondents 7. M i s h r a D , S i n g h H P . K u p p u s w a m y ’ s
were interviewed in the hospital setting and socioeconomic status scale – A revision. Indian
not in their homes. This might have influenced J Pediatr 2003;70:273‑4.
some respondents to give what they perceived 8. De la Mora A, Russell DW, Dungy CI, Losch M,
to be socially desirable responses. However, Dusdieker L. The Iowa infant feeding attitude
we had assured all respondents that their scale: Analysis of reliability and validity. J Appl
Soc Psychol 1999;29:2362‑80.
participation in the study would not affect their
9. Scott JA, Shaker I, Reid M. Parental attitudes
medical care and the information provided
toward breastfeeding: Their association with
would not be shared with any medical staff,
feeding outcome at hospital discharge. Birth
making it unlikely that this was the case. 2004;31:125‑31.
10. Tohotoa J, Maycock B, Hauck YL, Howat P,
In conclusion, we state that the role of paternal Burns S, Binns CW. Dads make a difference:
involvement in baby‑feeding decisions needs An exploratory study of paternal support for
to be acknowledged and researched in breastfeeding in Perth, Western Australia. Int
our country. This would help in developing Breastfeed J 2009;4:15.
strategies to improve paternal attitudes toward 11. Avery AB, Magnus JH. Expectant fathers’ and
mothers’ perceptions of breastfeeding and
breastfeeding and ultimately help improve the
formula feeding: A focus group study in three US
current low exclusive breastfeeding rate at
cities. J Hum Lact 2011;27:147‑54.
6 months.
12. Ramji S. Breastfeeding‑A 3D experience. Indian
J Med Res 2011;134:141‑2.
REFERENCES 13. Jordan PL, Wall VR. Supporting the father when
an infant is breastfed. J Hum Lact 1993;9:31‑4.
1. World Health Organization. The optimal duration 14. Henderson L, McMillan B, Green JM, Renfrew MJ.
of exclusive breastfeeding. Report of an expert Men and infant feeding: Perceptions of
consultation. Geneva: World Health Organization; embarrassment, sexuality, and social conduct
2001. in white low‑income British men. Birth 2011;38:
2. Kramer MS, Kakuma R. The optimal duration of 61‑70.
exclusive breastfeeding. A systematic review.
Geneva: World Health Organization; 2002. How to cite this article: Karande S, Perkar S. Do fathers’
attitudes support breastfeeding? a cross-sectional questionnaire-
3. World Health Organization and united nations based study in Mumbai, India. Indian J Med Sci 2012;66:30-9.
Source of Support: Nil. Conflict of Interest: None declared.
Children’s Fund. Global Strategy for Infant and
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Do fathers' attitudes support breastfeeding? A cross-sectional questionnaire-

Article in Indian Journal of Medical Sciences · January 2012

Sunil Karande Sanjay Perkar

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DO FATHERS’ ATTITUDES SUPPORT BREASTFEEDING?

CONTEXT: The views of fathers have been shown to be important determinants

Key words: Attitudes, complementary feeding, exclusive breastfeeding, infant formulas,

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INTRODUCTION India over a period of 18 months, from May

DISCUSSION namely, the IIFAS. The present study has

a convenience sample. Secondly, an young child feeding. Geneva: World Health

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