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Soziale Ungleichheit beim Stillen in Deutschland

Stand der empirischen Forschung und Handlungsempfehlungen

Breastfeeding: socio-economic differences in Germany

State of empirical analyses and recommendations

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Zusammenfassung

Hintergrund

Der Zusammenhang zwischen dem sozioökonomischen Status (SES) der Mutter einerseits und dem Stillen andererseits wurde bereits in mehreren empirischen Studien beschrieben, meist jedoch nur am Rande. Eine deutschsprachige Veröffentlichung speziell zum Thema „Stillen und SES“ liegt unseres Wissens bisher noch nicht vor. Es fehlt auch ein Überblick über die bereits verfügbaren empirischen Informationen zu diesem Thema. Dies hat dazu geführt, dass bis heute kaum über das Thema „soziale Ungleichheit beim Stillen“ diskutiert wird. Die hier vorgestellte Arbeit soll eine Antwort auf die Frage geben, in welchen sozialen Statusgruppen ein besonders großer Bedarf an Maßnahmen zur Förderung des Stillens vorhanden ist, und welche Handlungsempfehlungen sich daraus ableiten lassen.

Methoden

Der Überblick basiert auf einem systematischen Review epidemiologischer Studien, in denen (meist im Rahmen anderer Fragestellungen) Daten zum Stillen und/oder zur Stilldauer sowie zum SES erhoben wurden. Hauptquelle war dabei die elektronische Datenbank „Medline“.

Ergebnisse

Insgesamt wurden 15 Publikationen aus Deutschland gefunden, die eine Aussage über den Zusammenhang zwischen Stillen und SES beinhalten. In einer Studie wurde kein klarer Zusammenhang gefunden, sie weist allerdings eine sehr kleine Fallzahl auf. Die anderen 14 Studien ergeben dagegen ein deutliches Bild: Mütter mit einem höheren sozialen Status (zumeist definiert über den Bildungsabschluss) stillen häufiger und länger als Mütter mit einem niedrigen sozialen Status. In 8 weiteren Untersuchungen wurden zwar Daten zu Stillen und SES erhoben, jedoch nicht miteinander in Beziehung gesetzt.

Schlussfolgerung

In der Diskussion über das Stillen wird immer wieder betont, dass Muttermilch die beste Form der Ernährung für Säuglinge bis zu einem Alter von mindestens 6 Monaten sei. In Deutschland ist beim Stillen (nach einem deutlichen Tiefstand in den 1970er Jahren) in letzter Zeit wieder eine „Renaissance“ zu beobachten, aber offenbar ist eine intensivere Stillförderung besonders bei den unteren Statusgruppen erforderlich. Als Ansatz zur Erklärung dieser statusspezifischen Unterschiede beim Verbreitungsgrad gesundheitsrelevanten Verhaltens bietet sich das Modell „diffusion of innovations“ an.

Abstract

Background

In Germany, the association between breastfeeding behaviour (BF) and socio-economic status (SES) has not been studied in detail. However, ancillary reports from epidemiological research pursuing different objectives provide some information.

Methods

This systematic review, based on the search engine ‘MEDLINE’, summarizes the available information regarding initiation and duration of breastfeeding in the upper and lower social groups in Germany. Recommendations to enhance breastfeeding behaviour are presented.

Results

Fifteen studies with relevant information were identified. The paper with the smallest number of cases did not detect any differences between social groups, but all other studies reported a clear association of BF and SES, with mothers of the lower social groups breastfeeding significantly less frequently. Eight other study groups collected data on BF and SES but did not link them together.

Conclusion

Breast milk is known to be the very best nutrition for infants up to the age of 6 months. Despite a renaissance of breastfeeding after 1970, BF must still be encouraged in Germany, especially in women with lower SES. The concept of ‘diffusion of innovations’ by EM Rogers provides some explanation of these differences between socio-economic groups.

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  1. Institut für Gesundheitsökonomie und Management im Gesundheitswesen, GSF Forschungszentrum für Umwelt und Gesundheit, Ingolstädter Landstraße 1, 85758, Neuherberg, Deutschland

    I.-M. Rückert &  A. Mielck

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Rückert, IM., Mielck, A. Soziale Ungleichheit beim Stillen in Deutschland. Präv Gesundheitsf 3, 56–66 (2008). https://doi.org/10.1007/s11553-007-0088-7

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