Barriers to Breastfeeding Research (2019)

Background: Nepal has the best prolonged breastfeeding rates in the world with around 66% of babies under six months being breastfed, and around 89% of children still breastfeeding at two years (reported by the World Health Organization (WHO). The recommendation by WHO is currently to have at least 6-months of exclusive breastfeeding. The previous Barriers to Breastfeeding study in the U.S. was predominantly with caucasian, middle class moms. In order to be able to address the global market with an infant feeding solution, it is crucial to parallel that research and discover the challenges that women face in countries that have the worst breastfeeding continuity rates (the U.S. is one of the worst), as well as learn from the challenges that moms are able to overcome in countries that have some of the best breastfeeding rates (Nepal is one of the best).

Intervention: For two weeks I conducted in home community interviews with breastfeeding mothers, as well as key stakeholders such as clinicians working with infants to gather qualitative data and identify the primary barriers to breastfeeding. This included interviews as Dullakel Pediatric Hospital with Dr. Prakash Sunder Shrestha, President of the Nepal Breastfeeding Promotion Forum and interviews with nurses at Propokar Maternity Hospital, where there is an average of 15,000 babies born every month. Qualitative surveys were administered verbally in interview form with clinicians as well as digitally including the following questions from the U.S. study:

  • Did you experience difficulty latching in your breastfeeding journey?
  • If so, what do you think caused that?
  • What do you think helped you through that?
  • Did you experience difficulty latching if/after you introduced a bottle?
  • What do you look for when you buy a bottle? What kind of bottles have you tried?
  • What made one better than another?

Results: The primary barrier to breastfeeding identified in the U.S. exists here: nipple confusion. The difference is the management of the problem at the policy level, strictly prohibiting the use of bottles in hospitals. “What happens if a mom cannot be with her baby?” “Breastfeeding is the expected and culturally supported norm. If a mom is critically ill, we use this little spoon to slowly drip her pumped breastmilk into the infant’s mouth.”- Neonatologist and chief of the Dullakel Research department, Dr. Prithuja Poudyal. ~66% of breastfeeding women in the community have the cultural support and health education on the importance of breastfeeding, enabling them to avoid introducing standard bottles prior to six months.

  • Years: 2019
  • Location: Nepal
  • Role: Research Nurse

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Concept Testimonial


Nepal is increasing maternal leave to 14 weeks- but how can we expect exclusive breastfeeding when moms have to go back to work after that?” asked Dr. Prakash Sunder Shrestha, President of the Nepal Breastfeeding Promotion Forum in the Barriers to Breastfeeding Interview.

We agreed that formula and bottle companies have the positioning power to make a difference and that currently, formula marketing plays on the fear that mom can’t produce enough milk- causing early introduction of bottles. After realizing Nepal faces the same challenges with current bottles on the market, yet has done a good job bolstering cultural support and hospital protocol that prevents introducing a product at all, I spilled my thought process behind The Natural Nipple. “Why not have industry take the lead in driving the policy change that promotes breastfeeding, rather than presenting, up until now, the primary barrier against it?” I asked. “There are few people like you and me in this world,” replied Dr. Shrestha. “Formula companies have the funding to buy policy change by putting their curriculum now at the medical education level and spend millions of dollars on advertising why moms need it. It’s the human right of the baby to have breastmilk.” “I agree, it’s not scientific marketing, but if this is how the consumer and future key stakeholders are digesting information why not fight fire with fire? In the 30 years that you’ve been trying, the policy still hasn’t changed to the degree that you hoped would support breastfeeding families.” Ultimately, our time together resulted in the unified view of the solution to the hospitals and community that can sanitize products: a better bottle nipple.

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