Although the benefits of breastfeeding are broadly acknowledged with the efforts of the government and several medical societies, the rate of exclusive breastfeeding through 6 months is lower in Korea than in developed countries.
This study aimed to investigate pediatricians’ perceptions of breastfeeding barriers and the current breastfeeding counseling environment and propose government policies to encourage breastfeeding in Korea.
Fourteen survey questions were developed during meetings of Korean Society of Breastfeeding Medicine experts. The Korean Pediatric Society emailed a structured questionnaire to domestic pediatricians registered as official members of the Korean Pediatric Society on May 4, 2021, and June 3, 2021. This study examined the survey responses received from 168 pediatricians.
The 168 respondents included 62 professors, 53 paid doctors, and 53 private physicians. Breastfeeding was recommended by 146 Korean pediatricians (86.9%). However, only 99 responders (59%) currently provide breastfeeding counseling in hospitals. Most respondents stated providing less than 15 minutes of breastfeeding counseling time in the clinic. Moreover, 89.88% of the respondents responded that they would participate in breastfeeding counseling education if an appropriate breastfeeding counseling program was newly established.
This study showed that, although Korean pediatricians had a positive attitude toward breastfeeding, limited counseling was provided for parents. Along with policy support to improve the medical environment through the establishment of an appropriate breastfeeding counseling program, high-quality counseling and an increased breastfeeding rate are expected.
Breastmilk from an infant’s mother is the most appropriate, personalized form of nutrition, and many studies have demonstrated the benefits of breastmilk [
Although modern infant formulas have been manufactured since 1912 to replace breastfeeding for infants who are unable to breastfeed, the present rate of exclusive breastfeeding through 6 months is 25.6% in the Unites States, 37.4% in Japan, and 18.3% in Korea, indicating that formula feeding accounts for a larger proportion of infant nutrition than breastmilk [
To improve the breastfeeding rate, efforts are being made at various levels in the world. International organizations such as World Health Organization and United Nations Children’s Fund have recommended that infant should be breastfed exclusively for the first 6 months [
In Korea, the rate of exclusive breastfeeding has decreased from 59.5% at one week of age to 5.6% after 6 months of age [
The purpose of the study was to investigate pediatricians’ perception of breastfeeding barriers and the current medical environment for breastfeeding counseling. Another purpose of this study was to propose addition government policies to encourage breastfeeding in Korea.
To understand the status of breastfeeding counseling in Korea, a total of 14 survey questions were developed through 3 meetings of experts affiliated with the Korean Society of Breastfeeding Medicine. The Korean Pediatric Society sent a structured questionnaire to a total of 6,000 domestic pediatricians registered as official members of the Korean Pediatric Society on May 4, 2021 and June 3, 2021 via email. The questionnaire form used Google Forms (
The survey was completed by 175 respondents (2.92%). There were 62 professors, 53 paid doctors, and 53 private physicians. In addition, 3 were on leave of absence and 4 were serving in the military (
To determine differences in response to the questionnaire according to responder groups, categorical variables were analyzed by chi-square tests or Fisher exact test and expressed as numbers and percentile. The level of significance was set at
This study conformed to ethical guidelines of the World Medical Association Declaration of Helsinki. The present study protocol was reviewed and approved by the Institutional Review Board (IRB) of Soonchunhyang University Seoul Hospital (IRB approval No. 2021-02-022). The need for informed consent was also waived by the IRB of Soonchunhyang University Seoul Hospital.
Characteristics of respondents are shown in
Of 168 respondents 60 (35.71%) reported that breastfeeding counseling lasted 5 to 10 minutes, 45 (26.79%) answered that it lasted 10 to 15 minutes, and 41 (24.40%) answered that it lasted 5 minutes or less (
Of all respondents (n=168), 99 (58.93%) provided information about breastfeeding in the hospitals (
Neonatal jaundice (n=67, 39.88%) and insufficient weight gain (n=32, 19.05%) were neonatal main factors that stopped breastfeeding according to respondents (
Of 168 respondents, 93 (55.36%) answered that they always recommended breastfeeding, followed by 53 (31.55%) who answered they usually recommended it, and 19 (11.31%) who left it to the mother’s judgment (
Among total respondents (n=168), 70 (41.67%) chose the age group within 6 months of age, followed by 59 (35.12%) who chose the age group within 12 months, 24 (14.29%) who chose the age group within 24 months, and 13 (7.74%) who chose the age group within 1 month (
Of total respondents (n=168), 76 (45.75%) answered that it was appropriate to add the breastfeeding counseling fee which was 100% of the first-visit medical expense and 50 (30.12%) chose to add counseling fee which was 200% of the first-visit medical expense (
In all groups of respondents, training time of 5 hours was chosen as the most appropriate time, followed by training time of 10 hours (
Suggestions for improving breastfeeding included the following: (1) expanding maternal and child rooming-in immediately after childbirth and reinforce breastfeeding education for workers in maternal hospitals and postpartum care centers; (2) promote breastfeeding awareness through public service advertisement and increase mass media exposure; (3) establish the environment and equipment (e.g., refrigerator) for breastfeeding or pumping breast milk at work; and (4) provide practical education on mother’s difficulties and concerns about breastfeeding besides a structured education.
This study showed that although Korean pediatricians had a positive attitude on breastfeeding, breastfeeding counseling for parent was limited. We conducted this study using survey responses of 168 pediatricians. Currently, approximately 87% of Korean pediatricians recommend breastfeeding in hospitals. Despite the fact that ‘I did not recommend to stop breastfeeding’ was not presented as a selectable answer for neonatal factor in stopping breastfeeding, 30.36% of total respondents added this to other additional opinions. The majority (n=151, 89.88%) answered that they would participate in education for qualification if an appropriate breastfeeding consultant fee was implemented.
However, only 99 respondents (59%) were currently providing breastfeeding counseling in a hospital. The majority of respondents stated that the counseling time in the clinic was less than 15 minutes.
Neonatal jaundice and insufficient weight gain were the most common neonatal factors for pediatricians to stop mothers from breastfeeding. The most common maternal factors were medication and underlying disease. This result was similar to the factors for early cessation of breastfeeding reported in previous studies conducted on mothers [
Regarding the appropriate breastfeeding counseling fee, the plan of adding 100% of the first-visit medical expenses to medical expense had the highest response rate. Regarding the duration for breastfeeding counseling qualifications, education time of 5 hours was selected the most.
During the coronavirus disease 2019 pandemic, 17.9% of hospitals reduced in-person lactation support and 59.7% of hospitals provided in-person breastfeeding consultations after discharge [
Thus, to promote breastfeeding, increasing the participation of pediatricians in breastfeeding counseling with the establishment of appropriate breastfeeding counseling fees and expanding practical and high-quality breastfeeding education not only to doctors, but also to medical staff in postpartum care centers and maternity hospitals need to be considered.
This study has several limitations. First, the Korean Pediatric Society sent an email for a questionnaire to a total of 6,000 official members registered. However, only a total of 175 (2.92%) responded. Secondly, to investigate the difference in respondents’ propensity for risk factors that induce them to stop mothers from breastfeeding, specific situations and cases encountered in the hospital could be presented. However, the depth and details of the questions were lacking. Lastly, we could not compare or investigate the difference in respondents’ disposition toward exclusive breastfeeding between full-term and premature infants.
In conclusion, this study investigated pediatricians’ perception of breastfeeding barriers and the current medical environment for breastfeeding counseling in Korea. Along with policy support to improve the medical environment through the establishment of an appropriate breastfeeding counseling fee, high-quality counseling and an increase in the breastfeeding rate are expected.
No potential conflict of interest relevant to this article was reported.
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conceptualization: YRL, HJS, YMA, SMS, YJK, Ellen AR K, YJS, DYY, SML, JYL, JAL, SHC, ESJ, EKC, JSH; Data curation: SPB, WHH; Formal analyses: SPB, WHH; Methodology: SPB, YRL; Project administration: YRL; Visulization: SPB; Writing-original draft: SPB; Writing-reveiw and editing: WHH, YRL
Flow chart showing the study groups.
Response to breastfeeding recommendation when there is no clear medical reason for its discontinuation. Values are presented as number (%).
Response to training time to qualify for breastfeeding counseling. Values are presented as number (%).
Respondents’ characteristics
Clinic | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) |
---|---|---|---|
Tertiary hospital | 44 (70.97) | 6 (11.32) | 0 (0) |
General hospital | 17 (27.42) | 15 (28.3) | 0 (0) |
Children hospital | 0 (0) | 6 (11.32) | 5 (9.43) |
Maternity hospital | 1(1.61) | 18 (33.96) | 0 (0) |
Clinic | 0 (0) | 8 (15.09) | 48 (90.57) |
Subspecialty | 60 (96.77) | 19 (35.85) | 8 (15.09) |
Values are presented as number (%).
Current breastfeeding counseling in hospitals
Variable | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) | Total |
---|---|---|---|---|
Counseling time for breastfeeding | ||||
<5 min | 16 (25.81) | 17 (32.08) | 8 (15.09) | 41 (24.40) |
5–10 min | 27 (43.55) | 15 (28.30) | 18 (33.96) | 60 (35.71) |
10–15 min | 12 (19.35) | 17 (32.08) | 16 (30.19) | 45 (26.79) |
15–30 min | 6 (9.68) | 3 (5.66) | 9 (16.98) | 18 (1.071) |
≥30 min | 1 (1.61) | 1 (1.89) | 2 (3.77) | 4 (2.38) |
Average number of outpatient (<2 yr) during the 1 week | ||||
<30 | 24 (38.71) | 14 (26.42) | 12 (22.64) | 50 (29.76) |
≥30 | 38 (61.29) | 39 (73.58) | 41 (77.36) | 118 (70.24) |
Values are presented as number (%).
Breastfeeding counseling currently provided in hospitals
Breastfeeding counseling | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) | |
---|---|---|---|---|
Actively provide information |
25 (40.98) | 22 (41.51) | 17 (32.08) | 0.633 |
Less actively provide information |
14 (22.95) | 10 (18.87) | 11 (20.75) | |
Less passively provide information |
11 (18.03) | 6 (11.32) | 12 (22.64) | |
Passively provide information |
11 (18.03) | 15 (28.30) | 13 (24.53) |
Values are presented as number (%).
Information is provided even if parents have no questions.
Information is provided on request.
Providing sufficient information in response to questions is difficult
Information is provided only on request.
Neonatal factors contributing to breastfeeding cessation (multiple responses possible)
Neonatal factor | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) | Total | |
---|---|---|---|---|---|
Neonatal jaundice | 27 (43.55) | 22 (41.51) | 18 (33.96) | 67 (39.88) | 0.554 |
Not recommend to stop | 15 (24.19) | 17 (32.08) | 19 (35.85) | 51 (30.36) | 0.378 |
Poor weight gain | 8 (12.9) | 10 (18.87) | 14 (26.42) | 32 (19.05) | 0.184 |
Dehydration | 10 (16.13) | 9 (16.98) | 7 (13.21) | 26 (15.48) | 0.852 |
Diarrhea | 6 (9.68) | 5 (9.43) | 3 (5.66) | 14 (8.33) | 0.779 |
Vomiting | 4 (6.45) | 3 (5.66) | 5 (9.43) | 12 (7.14) | 0.807 |
Atopic dermatitis | 1 (1.61) | 1 (1.89) | 5 (9.43) | 7 (4.17) | 0.124 |
Values are presented as number (%).
Maternal factors contributing to breastfeeding cessation (multiple responses possible)
Maternal factor | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) | Total | |
---|---|---|---|---|---|
Mother’s medication | 38 (62.3) | 30 (58.82) | 26 (49.06) | 94 (56.97) | 0.345 |
Underlying disease | 26 (42.62) | 21 (41.18) | 20 (37.74) | 67 (40.61) | 0.865 |
To reinstate | 7 (11.48) | 11 (21.57) | 14 (26.42) | 32 (19.39) | 0.118 |
Mastitis | 8 (13.11) | 10 (19.61) | 7 (13.21) | 25 (15.15) | 0.565 |
Not recommend to stop | 9 (14.75) | 9 (17.65) | 7 (13.21) | 25 (15.15) | 0.815 |
Mental health | 2 (3.28) | 2 (3.92) | 3 (5.66) | 7 (4.24) | 0.891 |
Inverted nipple | 1 (1.64) | 0 (0) | 0 (0) | 1 (0.61) | >0.999 |
Values are presented as number (%).
Age groups that should be provided breastfeeding counseling
Age group | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) | Total (n=168) | |
---|---|---|---|---|---|
Up to 1 month of age | 5 (8.06) | 5 (9.43) | 3 (5.66) | 13 (7.74) | 0.352 |
Up to 6 months of age | 28 (45.16) | 26 (49.06) | 16 (32.19) | 70 (41.67) | 0.352 |
Up to 12 months of age | 18 (29.03) | 17 (32.08) | 24 (45.28) | 59 (35.12) | 0.352 |
Up to 24 months of age | 10 (16.13) | 5 (9.43) | 9 (16.98) | 24 (14.29) | 0.352 |
Values are presented as number (%).
Appropriate breastfeeding counseling fees and training
Variable | Professor (n=62) | Paid doctor (n=53) | Private physician (n=53) | Total (n=168) | ||
---|---|---|---|---|---|---|
Breastfeeding counseling fee | 0.524 | |||||
18,000 KRW, 100% of first-visit medical fee | 27 (44.26) | 28 (53.85) | 21 (39.62) | 76 (45.78) | ||
36,000 KRW, 200% of first-visit medical fee | 18 (29.51) | 14 (26.92) | 18 (33.96) | 50 (30.12) | ||
54,870 KRW, equivalent to chronic kidney disease education fee | 8 (13.11) | 5 (9.62) | 6 (11.32) | 19 (11.45) | ||
61,850 KRW, equivalent to ostomy education fee | 0 (0) | 1 (1.92) | 2 (3.77) | 3 (1.81) | ||
98,840 KRW, equivalent to in-depth treatment at a tertiary hospital | 6 (9.84) | 1 (1.92) | 4 (7.55) | 11 (6.63) | ||
Whether to participate in breastfeeding education for qualification | 0.795 | |||||
Yes | 55 (88.71) | 50 (94.34) | 46 (86.79) | 151 (89.88) | ||
No | 3 (4.84) | 2 (3.77) | 4 (7.55) | 9 (5.36) |
Values are presented as number (%).
KRW, Korean won.