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Table 3 Barriers to integrated care in breastfeeding support, according to integrated care fields

From: Towards integrated care in breastfeeding support: a cross-sectional survey of practitioners’ perspectives

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)
  1. aMore details of the “Vertical Integration” category can be found in Additional file 1
  2. bMore details of the “Health Promotion Strategies” category can be found in Additional file 2
  3. cMore details of the “Delivery System” category can be found in Fig. 1
  4. dSee “Abbreviations” following the main manuscript