Definitions of breastfeeding: call for the development and use of consistent definitions in research and peer-reviewed literature

Abstract

Background: There has been a significant increase in the number of published peer-reviewed articles on breastfeeding over the last two decades. However, in part because of the lack of clear or consistent definitions used in these publications, generalization and comparison of findings have been difficult, and interpretation of findings is often limited. This study was undertaken to examine this issue by assessing if and what definitions of breastfeeding have been used in a variety of relevant journals and the source of those definitions.

Materials and methods: An iterative systematic approach was used to select articles for review from major breastfeeding and health-related journals. Articles were reviewed for use of breastfeeding terminology, descriptors (e.g., exclusive, partial), and full definitions. Descriptive analysis was carried out using Excel (Microsoft(®), Redmond, WA). A flow chart was developed to examine sources of definitions in use.

Findings: Descriptors are seen 68% of the time, and full definitions are only offered in slightly more than a quarter (28%) of the articles. Among those journals that are primarily dedicated to breastfeeding research, 43-64% included descriptors, and 20-29% included definition of the descriptor. The pediatric journal included a high percentage with descriptors (77%), but only 18% were defined further. Among the other journals, there was a wide range (0-60%) with descriptors but fewer providing definitions. Only 26 articles offered a definition, and of these, 21 articles included a citation. Most derived from the Interagency Group for Action on Breastfeeding and World Health Organization definitional schemas.

Discussion: There remains a need by journals for increased requirement of inclusion of breastfeeding definitions and by researchers of attention to their use. For this to occur, there must first be the reconfirmation and/or development of a set of consistently utilized definitions that are applicable for the study of behaviors, support interventions, and health outcomes for both the mother and of the child. Therefore, an inclusionary international Working Group Process Approach is recommended, similar to that used in 1988, with confirmation and dissemination by all major organizations and agencies.