Pressure and judgement within a dichotomous landscape of infant feeding: a grounded theory study to explore why breastfeeding women do not access peer support provision

Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) is a recommended intervention to increase breastfeeding rates, a number of studies identify that engagement with BPS is problematic. Due to paucity of research in this area, this study explores why breastfeeding women do not access BPS in South‐West England. Utilising a constructionist grounded theory approach, 33 participants (women (n = 13), health professionals (n = 6) and peer supporters (n = 14)) participated in a semi‐structured interview (n = 22) or focus group (n = 11). Analysis involved open coding, constant comparisons and focussed coding. One core category and three main themes explicating non‐access were identified. The core category concerns women's experiences of pressure and judgement around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, ‘place and space of support’, describes the contrast between perceived pressure to breastfeed and a lack of adequate and appropriate support. Theme two, ‘one way or no way’, outlines the rules‐based approach to breastfeeding adopted by some health professionals and how women avoided BPS due to anticipating a similar approach. Theme three, ‘it must be me’, concerns how lack of embodied insights could lead to ‘breastfeeding failure’ identities. A background of dichotomised language, pressure and moral judgement, combined with the organisation of post‐natal care and the model of breastfeeding adopted by health professionals, may inhibit women's access to BPS. A socio‐cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted.