‘I just don’t think it’s that natural’: adolescent mothers’ constructions of breastfeeding as deviant

Breastfeeding is recognised globally as the optimal method of infant feeding. For Murphy (1999) its nutritional superiority positions breastfeeding as a moral imperative where mothers who formula-feed are open to charges of maternal deviance and must account for their behaviour. We suggest that this moral superiority of breastfeeding is tenuous for mothers from marginalised contexts and competes with discourses which locate breastfeeding, rather than formula feeding, as maternal deviance. We draw on focus group and interview data from 27 adolescent mothers from socio-economically deprived neighbourhoods in three areas of the UK, and five early years professionals working at a Children’s Centre in the Northeast of England. We argue that breastfeeding is constructed as deviance at three ‘levels’ as (i) a deviation from broad social norms about women’s bodies, (ii) a deviation from local mothering behaviours and (iii) a transgression within micro-level interpersonal and familial relationships. Given this positioning of breastfeeding as deviant, breastfeeding mothers feel obliged to account for their deviance. In making this argument, we extend and rework Murphy’s (1999) framework to encompass diverse experiences of infant feeding. We conclude with reflections on future research directions and potential implications for practice.     

Understanding maternal breastfeeding confidence: a Gadamerian hermeneutic analysis of women's stories

Our aim in this Gadamerian hermeneutic study was to understand maternal breastfeeding confidence and its meaning through listening to women's voices describing their experiences within the context of the United States. We asked 13 women, aged 23 to 42 years, who had breastfed a child within the last 2 years to tell us their breastfeeding stories. Women experienced maternal breastfeeding confidence as a dynamic interaction between their expectations, their infant(')s breastfeeding behavior, and sources of support. They described experiences that enhanced or diminished their confidence. Health professionals can use these findings to plan approaches that promote and support maternal breastfeeding confidence.     

Understanding Maternal Breastfeeding Confidence: A Gadamerian Hermeneutic Analysis of Women's Stories

Our aim in this Gadamerian hermeneutic study was to understand maternal breastfeeding confidence and its meaning through listening to women's voices describing their experiences within the context of the United States. We asked 13 women, aged 23 to 42 years, who had breastfed a child within the last 2 years to tell us their breastfeeding stories. Women experienced maternal breastfeeding confidence as a dynamic interaction between their expectations, their infant^’s breastfeeding behavior, and sources of support. They described experiences that enhanced or diminished their confidence. Health professionals can use these findings to plan approaches that promote and support maternal breastfeeding confidence.     

Secrets and lies: Breastfeeding and professional paid work

This paper explores the conflict between health advice and organisational practice regarding breastfeeding. It focuses on the group of mothers with the highest rates of both breastfeeding initiation and of continuous employment following maternity leave: specifically, educated mothers in managerial and/or professional occupations. In this context, the paper investigates, through in-depth interviews, the embodied experiences of 20 heterosexual UK mothers, qualified to degree level, who returned to professional employment within 1 year of childbirth. The paper observes that mothers who attempted to combine breastfeeding with paid work did so with difficulty because the material activity of breastfeeding was 'taboo' within the workplace. Thus, the requirement to conform to organisational expectations regarding 'suitable' embodied behaviour contradicted health advice about what was 'best' for infant children. In order to comply with workplace requirements, mothers in the study were obliged either to cease breastfeeding or to conceal breastfeeding activities. In the light of mothers' experiences, the paper suggests that breastfeeding duration rates among professionally employed mothers can only be improved if negative attitudes about maternal bodies and employment are challenged and if employers, as well as mothers, are the focus of health initiatives aimed at promoting breastfeeding.     

Teaching interactions of black and Cuban teenage mothers and their infants

Possible factors related to maternal teaching styles are socioeconomic status, ethnic group membership, maternal age, maternal locus of control, and the mother's “hidden agenda” or goals for her child. In this study, 32 lower income, Black and Cuban, teenage and adult mothers and their 12 month old infants participated in a simple task teaching their infant how to operate a “Jack‐in‐the‐box”. The mothers were also interviewed on questionnaires designed to tap locus of control, “hidden agendas”, and demographic characteristics. The results showed that Cuban mothers demonstrated the task to their infant with verbalization significantly more often than the Black mothers. The groups did not differ on maternal “hidden agendas”. Adult mothers showed a more internal locus of control than teenage mothers. Infants of Black, teenage mothers vocalized significantly less often than infants of the other groups. Results of this study provide additional support for existing literature in which maternal age and cultural differences were reported for the amount of maternal verbalization during early teaching interactions.     

“That's Not a Beer Bong,It's a Breast Pump!” Representations of Breastfeeding in Prime-Time Fictional Television

Breastfeeding has been recognized as one of the key determinant in one's future health. Yet although most people are aware of the benefits, many women do not breastfeed their babies past the first few months. These low rates can be partially explained by negative cultural attitudes toward breastfeeding, which have been reinforced by media messages. This research explored representations of breastfeeding in entertainment media—an area that has been overlooked. A textual analysis was conducted on 53 fictional television breastfeeding representations, ranging in genre and audience, from Beavis and Butthead to Criminal Minds. Findings indicate that breastfeeding depictions are generally positive, but limited in scope to educated, older, Caucasian women breastfeeding newborns, with little discussion about how to overcome problems. Extended breastfeeding and nursing in public were conveyed as socially unacceptable, making other characters uncomfortable, often within the same storylines that sexualized breasts. While the frequency of representations in recent years was encouraging, the narrow definition of the “normal” nursing experience excluded many types of women and breastfeeding experiences. And, by failing to address breastfeeding challenges and conveying that extended breastfeeding or nursing in public is abnormal or obscene, these depictions reinforce myths about the ease of breastfeeding and may discourage women from breastfeeding past the newborn phase, and outside the privacy of their homes. These portrayals may help explain why breastfeeding has not been “normalized,” despite an international consensus that it is the best health choice for babies.     

Influence of Experiences and Perceptions Related to Breastfeeding One’s First Child on Breastfeeding Initiation of Second Child

Introduction Multiparas tend to initiate breastfeeding less than primiparas. While mothers often repeat the feeding method used for their first child with their second child, the way in which experiences and maternal perceptions related to breastfeeding one’s first child may influence breastfeeding initiation with a second child remain underexplored. The objective of this study was to investigate whether physiological or social experiences, and related psychological factors, reported at the end of breastfeeding one’s first child influence breastfeeding initiation with a second child. Methods Data from 174 multiparas who participated in the Infant Feeding Practices Study II, breastfed their first child, and completed the Year 6 Follow Up were analyzed using exact logistic regression. Results Mothers who reported experiencing trouble with the first baby’s suck or latch had lower odds of initiating breastfeeding (OR 0.15, 95% CI 0.04–0.56) than those who did not report this experience, whereas mothers who agreed that breastfed children are less likely to become obese had greater odds of initiating breastfeeding with a second child (OR 11.49, 95% CI 1.56–513.18) than those who did not agree. Discussion Efforts to facilitate breastfeeding initiation among multiparas may consider mothers’ previous experiences and beliefs associated with breastfeeding. Strategies to facilitate initiation may focus on addressing barriers mothers experienced while breastfeeding their first child and increasing awareness about how breastfeeding may prevent childhood obesity. Future research should explore how such approaches may impact breastfeeding outcomes with subsequent children.     

基于TOPSIS法和RSR法的2020年广西孕产妇保健服务质量综合评价

目的 对广西各地市妇幼保健服务质量进行评价,了解广西不同地区妇幼保健服务水平,为“十四五”广西相关部门进一步精准施策、改善孕产妇保健服务质量提供循证依据。方法 以2020 年广西及各地市的孕产妇保健服务相关指标（系统管理率、建卡率、孕产妇死亡率、住院分娩率、产后访视率和产前检查率）为基础,运用TOPSIS法和RSR法对广西各地区的孕产妇保健服务状况进行综合评价。结果 2020年,广西孕产妇死亡率为8.37/10万,孕产妇的系统管理率、建卡率、产后访视率、产前检查率和住院分娩率等指标均超过90%,其中,住院分娩率超过99%,部分地市达到100%。依据TOPSIS法计算所得的Ci值对广西各地市妇幼保健服务质量进行排序,前三位是梧州市、钦州市和北海市;末三位是是南宁市、防城港市和贺州市。TOPSIS法和RSR法相结合进行分档,梧州市、北海市、钦州市被评定为“好”;南宁市、防城港市被评定为“差”;其他地市被评定“中”。结论 广西不同地区之间孕产妇保健服务质量存在明显差异;进一步降低孕产妇死亡率,将是广西今后妇幼卫生保健工作的难点与重点。     

"I wanted to do a good job": experiences of 'becoming a mother' and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit

In mothers of preterm infants, the process of becoming a mother is initiated in a public and medical environment, in which the mothers become dependent on the benevolence and support of the staff. This setting and an experience of insecure social bonds impair the ability to become a mother during the infant's stay at the neonatal unit (NU), and breastfeeding may become a duty and not be mutually satisfying. Studies on how women experience becoming a mother and breastfeeding after the infant's discharge are sparse and this question is addressed in the present grounded theory study. Twenty five mothers, whose very preterm infants had received care in seven NUs in Sweden, were interviewed once, 1-12 months after discharge. We propose a model to increase understanding of the process of becoming a mother and breastfeeding, after the infant's discharge from the NU. The mother's emotional expressions in this process showed pendular swings from feeling emotionally exhausted to feeling relieved, from experiencing an insecure to a secure bond, and from regarding breastfeeding as being non-reciprocal to being reciprocal. Unresolved grief, the institutional authority at the NU and experiences of shame were three of the central barriers to a secure and reciprocal relationship. The pendular changes give us a deeper understanding of the variations in both attachment and attunement. Perhaps the negative extremes are more prominent among these mothers on account of their infant's illness and their NU experiences. If our proposed model is valid, it is vital that these findings are considered by those involved in the short- and long-term care in order to support the mothers to establish a secure bond, comprising both attachment and attunement.     

Duration of breastfeeding and its correlates in Bangladesh

The purpose of this study was to assess the duration of breastfeeding and the sociodemographic factors affecting it. Data for the study were drawn from the Bangladesh Demographic and Health Survey 2004. In total 5,364 mothers were included in the study. The life table and Cox's proportional hazards model were employed for the analysis of breastfeeding-related data, which showed that the average duration of breastfeeding was 31.9 months. Cox regression analysis revealed that the duration of breastfeeding was positively associated with maternal age, contraceptive-use, work status, and religion and was negatively associated with age at marriage, parity, delivery status, region, and maternal education. Younger mothers, having higher education, higher maternal parity, caesarean-section birth, being a Muslim, and mothers who have not used any contraceptive were associated with lower duration of breastfeeding. The findings suggest that health institutions can play a significant role in promoting breastfeeding in Bangladesh. Educational campaigns that stress the benefits of lactation are important strategies for encouraging mothers to breastfeed longer.     

From initiation to cessation: Turning points and coping resources in the breastfeeding experience of first-time mothers

While most mothers initiate breastfeeding, many do not continue for recommended durations. This study aimed to understand the gap between breastfeeding initiation and duration through an in-depth exploration of first-time mothers’ breastfeeding experiences. Contextual factors that may facilitate or deter breastfeeding maintenance were explored by identifying common turning points (significant events or periods promoting a change in thoughts/behaviors or facilitating maintenance) described by mothers with varied breastfeeding durations. In semistructured interviews conducted from March to June 2015, twenty-eight first-time mothers in Iowa were asked to describe their breastfeeding experiences from initiation through cessation. Using thematic analysis, seven turning points, consistent across varied durations and experiences were identified: breastfeeding problems, the unknowns, recurring stressors, living new life with baby, reentering social roles, special occasions, and letting go. Turning points were usually associated with stressful situations, and mothers described intrapersonal (e.g., determination) and interpersonal (e.g., social support) coping resources as facilitators of breastfeeding maintenance. These findings highlight contextual factors that may trigger turning points, representing critical intervention periods, and the importance of enhancing support networks. Interventions to facilitate longer breastfeeding durations should consider key turning points and availability of coping resources to determine strategies that best fit the mother at each point.     

The contribution of parental and community ethnicity to breastfeeding practices: evidence from the Millennium Cohort Study

BACKGROUND: The association of ethnic and social factors at the individual and community level with inequalities in starting, and continuing, to breastfeed remains unclear. We explored these factors using data from the Millennium Cohort Study. METHODS: We obtained data for 11 286 natural mothers [8207 (85%) white] of singleton infants, living in England at age 9 months. Breastfeeding mothers were defined as the proportion of all mothers who reported: putting their baby to the breast at least once and giving any breastmilk (initiation); and having started, continuing for at least 1 month (continuation). RESULTS: In England, 72% of all mothers started breastfeeding, and of these 70% continued for at least 1 month. White mothers were the least likely to start breastfeeding (70%), as were multiparous mothers (69%), younger mothers, those with no academic qualifications (51%), in routine occupations (59%), or living in disadvantaged communities (60%). For white mothers, having a partner of a different ethnic group was independently and positively associated with breastfeeding initiation and continuation to 1 month [adjusted rate ratios (95% CI): 1.14 (1.07-1.21) and 1.09 (1.03-1.16), respectively]. White lone mothers were more likely to initiate breastfeeding if they lived in high ethnic minority communities [adjusted rate ratio (95% CI): 1.42 (1.15-1.76)] rather than disadvantaged areas. For all mothers, maternal age at first motherhood was positively associated with breastfeeding [adjusted rate ratio (95% CI): 1.06 (1.04-1.08) per 5 year increase]. CONCLUSIONS: Significant inequalities in breastfeeding practices remain within the UK. White women are less likely to breastfeed and, for these women, partner and community ethnicity have an important relation to starting and continuing to breastfeed. Our findings suggest that public health strategies to increase breastfeeding need to be focussed on mothers who are young at first motherhood and address support offered by partners and the communities in which women live. Measures to evaluate the effectiveness of these strategies over time and between places should take account of changes in ethnic composition of the child-bearing population.     

Socioeconomic and health programme effects upon the behavioral management of diarrhoeal disease in northeast Thailand

This study investigates the effects of socioeconomic and health programme factors on preventive and curative health behaviors and assesses the impact of preventive health behaviors on the incidence of diarrhoea among children under five years of age. Methodological approaches included focus groups to uncover local definitions of diarrhoeal disease, a baseline survey which collected data on maternal preventive health behaviors for 1,364 children, and a monitoring system which collected data on the incidence of diarrhoea and on maternal curative behaviors among the same group of children. Results indicate that socioeconomic status and exposure to health programmes showed significant relationships with selected maternal preventive behaviors. Children whose mothers washed their hands before breastfeeding, gave their child food immediately after cooking and warmed foods each time before meals had significantly lower proportions with diarrhoea than children of mothers who did not practice these behaviors, and 70 percent of the children with diarrhoea were exposed to high risk of severe dehydration and related health complications. Implications of these findings for health programmes are discussed.     

Affect, corporeality and the limits of belonging: breastfeeding in public in the contemporary UK

The UK has some of the lowest breastfeeding duration rates in the industrialised world. This paper considers women's experiences breastfeeding in public as a factor in breastfeeding duration. Research is based on an analysis of: 11 interviews and a 46-person survey of new mothers in Southampton, Hampshire; 180 postings about breastfeeding in public on UK parenting website mumsnet; and a patent application for a 'portable lactation module'. I analyse these data through an engagement with the work of cultural theorist Sara Ahmed to argue that the 'limits of sociability' in public space in the UK can be marked through affective practice. This paper makes three unique contributions to scholarship. First, it increases understanding regarding an issue of direct importance to health policy by filling a gap in knowledge about women's experiences breastfeeding outside the home in the UK. Second, it contributes to the field of health geography by showing how affective environments can constrain health-promoting behaviours. Third, it extends conceptual work in human geography more broadly through an analysis of the relationships between affect, embodiment and urban subjectivity.     

初产妇母乳喂养的自我效能及相关影响因素探讨

目的通过调查初产妇产前对母乳喂养的基础知识的知晓和喂养态度,分析其影响因素,为促进初产妇进行母乳喂养提供依据。方法随机选择2011年10月-2013年3月在厦门市妇幼保健院住院分娩的正常初产妇368例,采用问卷调查方式,采取自行设计的一般情况调查表、社会支持评定量表和母乳喂养自信量表、母乳喂养自我效能简式量表进行测量。结果初产妇的母乳喂养自我效能总分为（103.2±16.4）分,其中文化程度、年龄、产假时间、产前辅导这几个因素下初产妇的自我效能差异存在统计学意义（P〈0.05）,其他方面因素,如职业、分娩方式和宗教信仰,初产妇的自我效能差异无统计学意义。结论厦门地区初产妇母乳喂养的自我效能较高,其中文化程度、年龄、产假时间、产前辅导是母乳喂养自我效能最重要的影响因素（P〉0.05）。     

Influence of grandmothers on breastfeeding practices

OBJECTIVE: To assess the influence of grandmothers on breastfeeding practices. METHODS: This was a prospective study on 601 mothers of normal babies born in a university hospital in the city of Porto Alegre, State of Rio Grande do Sul. Data were collected in the maternity ward and at home, one, two, four and six months after delivery, by means of interviews with the mothers. Information about grandmothers was obtained at the time of the first home visit. Multiple logistic regression was used to test associations between variables related to the grandmothers and the prevalence of breastfeeding. RESULTS: Abandonment of exclusive breastfeeding within the first month was significantly associated with maternal or paternal grandmothers who advised that water or tea (OR=2.2 and 1.8, respectively) and other kinds of milk (OR=4.5 and 1.9, respectively) should be given. Abandonment of breastfeeding within the first six months was associated with maternal and paternal grandmothers who advised that other kinds of milk (OR=2.4 and 2.1, respectively) should be given. Non-daily contact with the maternal grandmother was a protective factor for maintaining breastfeeding until six months. CONCLUSIONS: Grandmothers may have a negative influence on breastfeeding, both on its duration and its exclusivity. This information could be useful in the planning of strategies for promoting breastfeeding.     

“Why Aren't You Breastfeeding?”: How Mothers Living With HIV Talk About Infant Feeding in a “Breast Is Best” World

Infant feeding raises unique concerns for mothers living with HIV in Canada, where they are recommended to avoid breastfeeding yet live in a social context of “breast is best.” In narrative interviews with HIV-positive mothers from Ontario, Canada, a range of feelings regarding not breastfeeding was expressed, balancing feelings of loss and self-blame with the view of responsibility and “good mothering” under the current Canadian guidelines. Acknowledging responsibility to put their child's health first, participants revealed that their choices were influenced by variations in social and cultural norms, messaging, and guidelines regarding breastfeeding across geographical contexts. This qualitative study raises key questions about the impact of breastfeeding messaging and guidelines for HIV-positive women in Canada.     

Cesarean section and breastfeeding outcomes in an Indigenous Qom community with high breastfeeding support

Background and objectivesCesarean section may lead to suboptimal breastfeeding outcomes, though evidence has been mixed. Factors, such as premature birth, birth weight and maternal age may independently increase risk of cesarean and hinder breastfeeding initiation, while maternal preferences, support and sociostructural barriers may influence breastfeeding practices beyond the immediate postpartum period.MethodologyWe assessed impacts of cesarean section and gestational factors on breastfeeding duration among Indigenous Qom mothers in Argentina who have strong traditional breastfeeding support. We modeled transitions from exclusive breastfeeding to complementary feeding and from complementary feeding to full weaning in a Bayesian time-to-event framework with birth mode and gestational covariates (n = 89 infants).ResultsEstimated median time to full weaning was 30 months. Cesarean-delivered babies were weaned an average of 5 months later adjusting for gestational age, maternal parity and infant sex. No factors were associated with time-to-complementary feeding, and time-to-complementary feeding was not associated with time-to-full weaning.Conclusions and implicationsAmong Indigenous Qom mothers in Argentina, cesarean section was not associated with suboptimal breastfeeding outcomes. Although some Qom mothers do experience early breastfeeding problems, particularly following first birth, problems are not more frequent following cesarean delivery. Traditional postpartum kin and community support during prolonged postpartum periods may be instrumental in helping mothers to overcome early breastfeeding problems due to cesarean or other risk factors.