Blyth R, Creedy DK, Dennis CL, Moyle W, Pratt J, De Vries S, M Effect of maternal confidence on breastfeeding duration: an application of breastfeeding self-efficacy theory. Birth. 2002; 29:(4)278-284

Broadfoot M, Britten J, Tappin DM, MacKenzie JM The baby friendly hospital initiative and breast feeding rates in Scotland. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2005; 90:(2)F114-F116

Brockway M, Benzies K, Hayden KA Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: a systematic review and meta-analysis. Journal of Human Lactation. 2017; 33:(3)486-499

Goujard C, Bernard N, Sohier N Impact of a patient education program on adherence to HIV medication. Journal of Acquired Immune Deficiency Syndrome. 2003; 34:(2)191-194

Hoddinott P, Craig LC, Britten J, McInnes RM A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open. 2012; 2:(2)

McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ Infant feeding survey 2010.Leeds: Health and Social Care Information Centre; 2012

McInnes RJ, Hoddinott P, Britten J, Darwent K, Craig LC Significant others, situations and infant feeding behaviour change processes: a serial qualitative interview study. BMC Pregnancy and Childbirth. 2013; 13:(1)

Rothman AJ, Sheeran P, Wood W Reflective and automatic processes in the initiation and maintenance of dietary change. Annals of Behavioral Medicine. 2009; 38:s4-s17

£2 million more for breastfeeding support. 2018. (accessed 4 October 2020)

Sheeran P, Orbell S Using implementation intentions to increase attendance for cervical cancer screening. Health Psychology. 2000; 19:(3)

Effect of obstacles/tips card on breastfeeding drop-off

02 September 2021
Volume 29 · Issue 9



Many mothers report having stopped breastfeeding sooner than they would have liked.


We test whether a planning card reduces breastfeeding drop-off.


We recruited 81 women who were at least 36 weeks pregnant at antenatal classes in Lothian, Scotland. By systematic assignment, participants received no card; an obstacles/tips card, which details common breastfeeding obstacles and tips to overcome them; or an enhanced obstacles/tips card, which additionally featured an intentions prompt on its reverse side. Between 10–14 days after the due date, we measured rates of exclusive and any breastfeeding.


On discharge, feeding methods were similar across all three groups. At 10-14 days, drop-off was four-fold higher in the control group than in either of the two card groups (p=0.026).


The obstacles/tips cards offer potential as a means to achieve reductions in breastfeeding drop-off.

Scotland has historically seen low rates of breastfeeding and the Scottish Government has identified breastfeeding initiation and maintenance as a public health priority (Scottish Government, 2018). In support of these goals, NHS Boards within Scotland have implemented the UNICEF Baby Friendly Initiative by revising policies and increasing training for midwives and health visitors to support breastfeeding (Broadfoot et al, 2005). Initiation rates have increased but maintenance remains a problem. The Scottish Government's Diet and Healthy Weight Delivery Plan sets out a commitment to reduce drop-off in breastfeeding rates at 6–8 weeks after birth by 10% by 2025 (Scottish Government, 2018). Of babies born in 2017–2018, breastfeeding was initiated in 64% of cases but at the 6–8 week follow-up, just 41% continued to receive any breastmilk (ISD, 2018). Despite its substantial commitment to breastfeeding, high rates of breastfeeding drop-off remain a stubborn problem in Scotland.

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