Breastfeeding experiences of Latina migrants living in Spain: a qualitative descriptive study

Background

The migratory flows in Spain have changed due to the arrival of a diverse migrant population. Among the new migrants the Latino collective predominate with more than half being women of childbearing age. There are no previous studies exploring breastfeeding experiences of migrants in a country where their mother tongue is spoken. This study aimed to explore Latina migrants’ breastfeeding experiences in a Spanish-speaking country.

Methods

A descriptive qualitative study was carried out in the main province in southern Andalusia between November 2019 and June 2020. The study used intentional sampling. The study participants were contacted by video calls and data were collected through a semi-structured in-depth interview (n = 19). The interviews were transcribed and analysed by thematic analysis.

Results

The nineteen participants were aged between 22 and 43 years old and came from six different countries in Latin America. The two main categories that emerged were breastfeeding facilitators and barriers, divided into ten interrelated sub-categories: working conditions; precarious socioeconomic conditions; lack of support (health professionals, family and society); physiological changes, pain and fatigue; ignorance and wrong beliefs; support networks (partner, health professionals and family); host country versus home country; religious practices/worship; appropriate attitude, knowledge and experience; and breastfeeding support groups. Most of the study participants stated that their breastfeeding experiences were influenced by barriers such as work and by facilitators such as peer support.

Conclusions

More support from caregivers and more sensitivity to cultural diversity were demanded by the women and well-trained professionals are needed to enable breastfeeding for a longer time. This paper provides caregivers, such as nurses, more knowledge about the care demanded by migrant women to ensure a longer breastfeeding experience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00423-y.

Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review

Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6 months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6 months; preferably according to Hispanic subgroups.

Factors contributing to infant overfeeding with Hispanic mothers

OBJECTIVE

To evaluate existing evidence on factors potentially contributing to infant overfeeding among Hispanic mothers that may explain the high infant overweight rates often seen among this ethnic group.

DATA SOURCES

Electronic databases including CINHAL and MEDLINE were searched for relevant studies published from 1998 to January 2012. Related article searches and reference list searches were completed on all included studies.

STUDY SELECTION

Thirty-five studies (nine qualitative, 15 cross-sectional, nine cohort, and two longitudinal) were identified that met the following inclusion criteria: (a) studies of Hispanic-only or multiethnic mothers, (b) studies of healthy full-term infants or toddlers, (c) studies in which a majority of the sample included children within the target age group (0-24 months of age), and (d) studies conducted in the United States. The methodological quality of the studies ranged from fair to excellent.

DATA EXTRACTION

Data extraction included content related to Hispanic infant feeding and weight gain.

DATA SYNTHESIS

Reviewed research fell into three main foci of inquiry: breastfeeding and formula-feeding beliefs, attitudes, and practices; family and cultural influences of maternal feeding beliefs and practices; and maternal perceptions of infant feeding satiety and weight gain. The Preferred Reporting Items of Systematic Reviews Meta-Analysis (PRISMA) guidelines were followed for data extraction and reporting the results of this integrative review.

CONCLUSION

Three major feeding practices and beliefs among Hispanic mothers potentially contribute to infant overfeeding. Hispanic mothers are more likely to practice nonexclusive breastfeeding, initiate early introduction of solid foods including ethnic foods, and perceive chubbier infants as healthy infants. Cultural norms driving family influences and socioeconomic factors play a role in the feeding tendencies of Hispanics. Empirical research is needed to further define the primary factors that influence Hispanic mothers feeding decisions and practices that contribute to excessive weight gain in their infants.

Why WIC Women Stop Breastfeeding?

Women who receive benefits from Women, Infants, and Children (WIC) are not meeting the recommendations for breastfeeding duration. The purpose of this descriptive correlational study was to examine maternal sociodemographic and time factors related to the reason for discontinuing breastfeeding for 238 WIC participants who initiated breastfeeding. This study is a secondary data analysis of existing longitudinal survey and administrative data from a Chicago-area community health center and WIC clinic. The average length of breastfeeding within this sample was 16 weeks. Women in this sample reported a perception of insufficient milk (PIM; 46%), returning to work/school (13%), and other maternal problems (13%) as the main reasons for discontinuing breastfeeding. Within the first 16 weeks, 65% of the women who discontinued breastfeeding cited PIM as the main reason, with 2 distinct time points at 5 weeks and 13 weeks. Women of Hispanic descent were more likely than non-Hispanic women to report this perception (odds ratio 2.66, P = .01, 95% confidence interval = 1.21-5.83). Although these women initiated breastfeeding, the national recommendation for breastfeeding duration was not met in this population. Additionally, many women stopped breastfeeding early due to PIM. There are distinct time points where culturally tailored interventions may be most effective.

The development and psychometric testing of East Asian Acculturation Scale among Asian immigrant women in Taiwan

OBJECTIVE

This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale.

DESIGN

An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity.

RESULTS

The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity.

CONCLUSIONS

The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

Clinical recommendations for promoting breastfeeding among Hispanic women

PURPOSE

To synthesize research regarding the low breastfeeding rates in Hispanic women living in the United States, particularly those who immigrate to this country and become acculturated.

DATA SOURCES

Extensive review of global literature on the subject.

CONCLUSIONS

Exclusive and continued breastfeeding rates in the United States have increased in recent years but remain low, and no state in the United States currently meets the Healthy People 2010 recommendations. Due to the increasing number of Hispanic women immigrating to the United States and having children, it is imperative to develop appropriate culturally specific guidelines in breastfeeding promotion programs. When providing care to a Hispanic mother, clinicians can best assist this population by holistically reviewing all aspects of a woman's life including her environment and relationships with others to provide positive outcomes that ultimately benefit Hispanic mothers and their newborns.

IMPLICATIONS FOR PRACTICE

Guidelines and interventions for initiating and continuing breastfeeding in Hispanic women are proposed, including providing a bilingual personal breastfeeding advocate, as well as group classes that incorporate traditional Hispanic cultural beliefs and allow the women to devise personal breastfeeding plans.

Breast-feeding attitudes and behavior among WIC mothers in Texas

OBJECTIVE

This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas.

DESIGN

This study used a cross-sectional design.

SETTING

Participants completed questionnaires at WIC clinic sites across Texas.

PARTICIPANTS

Mothers of young children who were receiving WIC benefits.

MAIN OUTCOME MEASURE(S)

Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice.

ANALYSIS

Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression.

RESULTS

A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk.

CONCLUSIONS AND IMPLICATIONS

Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs.

Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to Australia

BACKGROUND

Migrants from developing to developed countries rapidly develop more obesity than the host population. While the effects of socio-economic status on obesity are well established, the influence of cultural factors, including acculturation, is not known.

OBJECTIVE

To examine the association between acculturation and obesity and its risk factors among African migrant children in Australia.

DESIGN AND PARTICIPANTS

A cross-sectional study using a non-probability sample of 3- to 12-year-old sub-Saharan African migrant children. A bidimensional model of strength of affiliation with African and Australian cultures was used to divide the sample into four cultural orientations: traditional (African), assimilated (Australian), integrated (both) and marginalized (neither).

MAIN OUTCOME MEASURES

Body mass index (BMI), leisure-time physical activity (PA) and sedentary behaviours (SBs) and energy density of food.

RESULTS

In all, 18.4% (95% confidence interval (CI): 14-23%) were overweight and 8.6% (95% CI: 6-12%) were obese. After adjustment for confounders, integrated (beta=1.1; P<0.05) and marginalized (beta=1.4; P<0.01) children had higher BMI than traditional children. However, integrated children had significantly higher time engaged in both PA (beta=46.9, P<0.01) and SBs (beta=43.0, P<0.05) than their traditional counterparts. In comparison with traditional children, assimilated children were more sedentary (beta=57.5, P<0.01) while marginalization was associated with increased consumption of energy-dense foods (beta=42.0, P<0.05).

CONCLUSIONS

Maintenance of traditional orientation was associated with lower rates of obesity and SBs. Health promotion programs and frameworks need to be rooted in traditional values and habits to maintain and reinforce traditional dietary and PA habits, as well as identify the marginalized clusters and address their needs.

Working mothers breastfeed babies more than housewives

AIM

To examine the prevalence and determinants of breastfeeding and to identify perinatal, sociodemographic, psychosocial and environmental factors associated with maternal infant feeding intention.

METHODS

A sample of 3734 Greek mothers that delivered their infants in 2000 was recruited in a longitudinal cohort study. Data on duration of breastfeeding was based on a questionnaire answered by 76.6% of the participants at 8-12 months postpartum.

RESULTS

The rates of any breastfeeding at 3 and 6 months were 52% and 24%, respectively. The corresponding rates of exclusive breastfeeding were 37% and 17%. From Cox regression analysis mother's intention to breastfeed for a short time and upbringing in the area of Athens were significantly associated with early termination of any breastfeeding and exclusive breastfeeding. A positive intention to breastfeed was influenced by maternal entitlement more than 6 months, delivery in autumn or winter, mother's upbringing abroad and previous breastfeeding experience.

CONCLUSIONS

The rates of any breastfeeding and exclusive breastfeeding during the first year of life were fairly satisfactory. Programs to support breastfeeding are necessary and should encourage women to feel positive to breastfeed, focusing particularly on non-working mothers, mothers with a maternity entitlement less than 6 months and mothers who lack previous breastfeeding experience.

Breastfeeding as health-promoting behaviour for Hispanic women: literature review

AIM

This paper reports a literature review to synthesize the evidence that breastfeeding is a health-promoting behaviour for Hispanic women and to demonstrate the usefulness of the Health Promotion Model in understanding and increasing breastfeeding behaviours in Hispanic women.

BACKGROUND

While breastfeeding has been shown to promote the health of both mother and infant, it has not been widely viewed from the perspective of the Health Promotion Model.

METHODS

The CINAHL and MEDLINE databases were searched using the terms 'Hispanic' or 'Latina', 'breastfeeding' and concepts specific to the Health Promotion Model (interpersonal relationships, social support, acculturation, self-efficacy, barriers, benefits, and commitment). Only papers in the English language from 1990 to 2003 (except for classic papers) that used research techniques were reviewed. Only those addressing breastfeeding intention, initiation or duration were included. The reference lists of each paper were examined for additional empirical papers that linked any of the determinants of the Health Promotion Model to breastfeeding among Hispanic women. Papers were organized using the ten determinants as headings: prior related behaviour, personal factors, perceived benefits, perceived barriers, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences, immediate competing demands, and commitment to a plan of action. The review was conducted in 2003.

FINDINGS

The literature verifies that each of the 10 determinants of health-promoting behaviour also promotes breastfeeding for Hispanic women, particularly through the constructs of acculturation, interpersonal support, self-efficacy and immediate competing demands. Breastfeeding is not consistently defined in all studies, nor are Hispanic population groups uniformly classified according to country of origin. Specific interventions to promote breastfeeding have been implemented for women of Latin American origin, but randomized designs to measure outcomes have not been consistently employed with Hispanic women in the United States of America. Further intervention research is needed to confirm breastfeeding as a health-promoting behaviour and to inform breastfeeding education for this group.

Contemporary Trends in Infant Feeding Research

▪ Abstract  This review examines current research in the subfields of anthropology and related disciplines on the biocultural process of breastfeeding and broader questions of infant and young-child feeding. The themes of sexuality, reproduction, embodiment, and subjective experience are then linked to the problems women who breastfeed face in bottle-feeding cultures. Anthropologists have contributed to policy-relevant debates concerning women's work and scheduling in relation to infant care and exclusive breastfeeding. The extensive ethnographic work on children's transition to consuming household foods demonstrates the need to integrate research on breastfeeding with research on complementary feeding. Current debates around HIV and chemical residues in breastmilk call for a critical examination of the effects of globalization and corporate control on infant feeding practices. The literature shows how the narrow specialty of infant feeding has broad implications for the discipline.

La Familia: methodological issues in the assessment of perinatal social support for Mexicanas living in the United States

Do Mexicanas receive social support from a close network of family and friends during the perinatal period? To answer this question, a longitudinal ethnographic study followed 28 urban Mexican-origin women living in the US from their last trimester of pregnancy through their first month post-partum. A total of 93 interviews with Mexicanas focused on health and social support. All of the women lived in a large western city in the US but varied in their acculturation and income levels. Analyses identified four social support themes from women's experience (the emic analysis) and four social support typologies from the researcher (etic) analyses. The kinds of support women described as emanating from their support networks were inductively identified as Helping with Daily Hassles, Showing Love and Understanding, Being There for Me, and My Family Failing Me. Approximately half of the women reported densely supportive networks. The other women were disconnected from their support networks, or dealt with antagonism or instability in their networks. Women's perceptions of social support differed from the judgements made by the researcher about received support. Specifically, women perceived more network members in the supportive category than did the researcher by a factor of 1.4, and fewer network members in the disconnected category by a factor of 0.7. From an emic perspective, women listed only half as many antagonistic network members compared to the etic analysis (a factor of 0.50). These emic/etic discrepancies complicate clinical assessment of social support, but suggest that data on social support should be collected as part of the clinical processes of perinatal risking. To enhance assessment of social support, a clinically relevant guide is proposed for use by practitioners caring for Mexicanas in the perinatal period.

Breastfeeding care in multicultural populations

Although the number and diversity of minority women in the United States is growing, breastfeeding rates remain low. Nurses can increase breastfeeding rates in minority populations if they are aware of and appreciate cultural differences. Following an overview of culture's effect on breastfeeding, this article focuses on practical aspects of caring for breastfeeding mothers in various cultural groups. Breastfeeding educational programs are effective when they are culturally sensitive and emerge from the culture itself.