Expectant parents' views of factors influencing infant feeding decisions in the antenatal period: A systematic review.
OBJECTIVE
To explore the factors that influence expectant parents' infant feeding decisions in the antenatal period.


METHODS
Mixed method systematic review focussing on participant views data.


METHODS
CINAHL, Medline, Embase and PsychInfo databases were interrogated using initial keywords and then refined terms to elicit relevant studies. Reference lists were checked and hand-searching was undertaken for 2 journals ('Midwifery' and 'Social Science and Medicine') covering a 3 year time period (January 2011-March 2014). Key inclusion criteria: studies reflecting expectant parents' views of the factors influencing their infant feeding decisions in the antenatal period; Studies in the English language published after 1990, from developed countries and of qualitative, quantitative or mixed method design.


METHODS
A narrative interpretive synthesis of the views data from studies of qualitative, quantitative and mixed method design. Data were extracted on study characteristics and parents' views, using the Social Ecological Model to support data extraction and thematic synthesis. Synthesis was influenced by the Evidence for Policy and Practice Information and Co-Ordinating Centre approach to mixed method reviews.


RESULTS
Of the 409 studies identified through search methods, 17 studies met the inclusion criteria for the review. Thematic synthesis identified 9 themes: Bonding/Attachment; Body Image; Self Esteem/Confidence; Female Role Models; Family and Support Network; Lifestyle; Formal Information Sources; Knowledge; and Feeding in front of others/Public. The review identified a significant bias in the data towards negative factors relating to the breastfeeding decision, suggesting that infant feeding was not a choice between two feeding options, but rather a process of weighing reasons for and against breastfeeding. Findings reflected the perception of the maternal role as intrinsic to the expectant mothers' infant feeding decisions. Cultural perceptions permeated personal, familial and social influences on the decision-making process. Expectant mothers were sensitive to the way professionals attempted to support and inform them about infant feeding choices.


CONCLUSIONS
By taking a Social Ecological perspective, we were able to explore and demonstrate the multiple influences impacting on expectant parents in the decision-making process. A better understanding of expectant parents' views and experiences in making infant feeding decisions in the prenatal and antenatal periods will inform public health policy and the coordination of service provision to support infant feeding activities.
University of East Anglia, Edith Cavell Building, Norwich Research Park, Norwich NR4 7TJ, United Kingdom. Electronic address: c.roll@uea.ac.uk.
Coralie L
CL
Roll
Promoting Community and Family Health Unit, Research, University of East Anglia, Edith Cavell Building, Norwich Research Park, Norwich NR4 7TJ, United Kingdom. Electronic address: f.cheater@uea.ac.uk.
Francine
F
Cheater
D003657:Decision Making; D005260:Female; D006801:Humans; D007225:Infant Food; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology*
Antenatal; Bottle feeding; Breast feeding; Choice; Decision-making; Fathers; Infant feeding; Mothers; Parents; Social Ecological Model