Table 3 Barriers to integrated care in breastfeeding support, according to integrated care fields
Integrated care response groups according to categorization of open-ended responses (n) | Total n = 1,168 | ||||||
|---|---|---|---|---|---|---|---|
Vertical integrationa (268) | Within one sector (52) | Incentives (87) | Health promotion strategiesb (454) | Health inequalities (19) | Horizontal integration (23) | Shared decision- making (265) | |
Lack of concerted action within healthcare to cooperate towards integrated care in breastfeeding support (88) | Lacking implementation of Baby-Friendly standards (26) | Lacking incentives of health insurance companies to motivate breastfeeding as disease prevention (35) | Lacking policies and their implementation to protect, promote and support breastfeeding (127) | Lacking research on policy implementation (26) | Differing breastfeeding rates among social classes contribute to exacerbate health inequalities (11) | Lacking education of kindergarten teachers and lacking normalization of breast-feeding in child education (13) | Lack of visible marketing strategies for breastfeeding to counter formula marketing (93) |
Lack of healthcare providers competent in breastfeeding support, lacking recognition of expertise within healthcare (64) | Lacking quality of breastfeeding support within hospitals (14) | Lack of healthcare system incentives to prevent unnecessary supplementation and interventions at birth (24) | Lacking impact of NBCs on policies and lacking coordination of policies and protagonists (76) | Lacking promotion of breastfeeding as a preventive measure (25) | Lacking access to adequate breastfeeding support, independent of socioeconomic factors (4) | Lacking competence of school teachers in the field of breastfeeding (5) | Lacking perception of breastfeeding as the norm, and lacking breastfeeding-friendliness in society (57) |
Lack of physicians’ cooperation towards integrated care in breastfeeding support (49) | Lacking integration of adequate breastfeeding support into routine hospital care (12) | Lack of adequate compensation from health insurance companies for receiving and providing breastfeeding support (16) | Lack of high-quality and ethically sound research and its funding, independent of commercial interests (68) | Lacking foundation of NBCs c, d as Delivery Systems in several countries (20) | Lacking access to breastfeeding support impairs patient satisfaction with healthcare (4) | Lack of family counselling services with competence in breastfeeding support (5) | Lack of consistent information on breastfeeding by healthcare professionals (35) |
Lack of researchers’ knowledge on breastfeeding, lack of practice-oriented research to improve breastfeeding support (34) | Lacking incentives for parents for breastfeeding and the donation of human milk (12) | Lacking support and funding for breastfeeding promotion from governments, health insurance companies, politicians (42) | Lacking legislation to protect and promote breastfeeding, including adequate maternal leave (20) | Lacking dissemination of relevant research to practitioners and the public (35) | |||
Lack of cooperation between voluntary and professional practitioners (19) | Lacking implementation and monitoring of the Coded (36) | Lack of health policies facilitating a patient-centered approach in providing breastfeeding support (8) | Lacking information and education of the public, including prenatal courses (34) | ||||
Lack of human milk bank networks to facilitate integrated care in breastfeeding support (14) | Lack of prioritizing breastfeeding protection and promotion towards “health before profit” (8) | Lacking control of sponsored media portrayal of infant feeding (11) | |||||