Community attitudes toward breastfeeding in public places among Western Australia Adults, 1995-2009

What Should a Breastfeeding Place in Public Spaces Be Like? A Qualitative Study on Women's Experiences

BACKGROUND

Mothers need a place in public spaces where they can comfortably breastfeed and care for their babies. The availability and design features of these places are critical for meeting mothers' safety and comfort needs while they are breastfeeding.

AIM

This study was conducted to examine mothers' experiences with breastfeeding places in public spaces.

METHODS

This study, which was planned as a phenomenological research, one of qualitative research designs, was conducted with mothers (n = 18) with breastfeeding experience in public places. Data were collected through in-depth interviews using a semi-structured questionnaire developed by the researchers. The thematic analysis method was employed to evaluate the data.

RESULTS

Study findings were examined under two main themes and 12 subthemes. Getting to the breastfeeding place was actually enough for many of the participants. Women who could not breastfeed for any reason in breastfeeding places stated that they came up with some solutions, such as breastfeeding in the car, feeding with formula, and not taking the baby with them. Participants' basic expectations about the breastfeeding place were that it met cleanliness, hygiene, privacy, and ventilation conditions.

CONCLUSIONS

It was found that women who tended to spend more time in public spaces recently encountered similar problems during the breastfeeding process. Breastfeeding environments should meet minimum standards such as cleanliness and privacy as well as having the necessary comfort, aesthetics, and decoration features.

How Does the Breastfeeding Environment Affect Satisfaction? A Scale Development Study

BACKGROUND

Women need a safe and comfortable environment to breastfeed their babies. The quality of breastfeeding environments in social areas is important for women's breastfeeding satisfaction.

AIM

The aim of this study was to develop a measurement tool for the evaluation of breastfeeding environments and to examine the impact of the quality of breastfeeding environments in social areas on breastfeeding satisfaction.

METHOD

The first phase of the study was conducted in methodological design and the second phase in cross-sectional design. The draft scale was applied to 365 women who had breastfeeding experiences in social environments during the postpartum 6 months-3 years period. In the first stage, scale development analyses were applied. In the second stage, the developed scale was applied to 255 women. Frequency, percentage, Cronbach's α coefficient, and correlation analysis were used in the analysis of the data.

RESULTS

The Ideal Breastfeeding Environment Assessment Scale, consisting of 23 items and four subdimensions, was obtained in the study. As a result of the application of the scale in the second stage, the mean score of the breastfeeding environments evaluated by the women was 23.43 ± 8.36. A statistically significant moderate-weak correlation was found between the ideality of breastfeeding environments and the satisfaction levels of women (p < .001).

CONCLUSION

It was determined that the developed scale is a valid and reliable measurement tool that can be used to evaluate breastfeeding environments. As the quality of breastfeeding environments increases, women's breastfeeding satisfaction increases.

Australian, Irish, and Swedish women's comfort levels when breastfeeding in public

BACKGROUND

Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women's decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding.

METHODS

A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25.

RESULTS

Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women's comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women's comfort levels.

CONCLUSION

This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women's perceived comfort levels, the influence of family members' perceptions of breastfeeding in public and women's experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.

The Practice of Breastfeeding in Public and its Associated Factors Among Egyptian Mothers

Introduction: The practice of breastfeeding in public (BFP) is associated with the perceived social norms. No sufficient knowledge is available regarding this practice, the attitudes related, and the significant associated factors in Egypt. Aim: To assess the prevalence of BFP, attitudes, barriers, and enabling factors. Methods: A cross-sectional study was conducted in Dakahlia Governorate, Egypt, including breastfeeding mothers whose babies were ≤12 months of age. A predesigned validated interviewer-administered questionnaire was used to collect data. Results: The study included 400 participants, 72.8% of them had practiced breastfeeding in public at least once. Regression analysis showed that being urban, high socioeconomic standard, having babies who were of normal birthweight and not the first in order were significant predictors of higher prevalence of BFP. Also, positive mother's attitude and having a family member who also practiced BFP were independent significant predictors. Finally, mothers who practiced breastfeeding in public are less likely to have supportive families' attitude. The most common causes of not practicing BFP is men's presence (94%), followed by husband disagreement (78.5%), absence of breast cover (69.3%), or feeling embarrassed (63.2%). Conclusion: Breastfeeding in public is a frequent practice among the studied mothers. Underlying factors associated with BFP can help guide tailored health education message to nursing mothers. Privacy was the keyword behind not practicing BFP.

Perception and practice of breastfeeding in public in Poland

BACKGROUND

The aim of the study was to get to know polish women's opinions and experiences regarding breastfeeding in public.

MATERIAL AND METHODS

A one-time 11-question survey aimed at women during lactation or breastfeeding in the past who completed a paper questionnaire or online questionnaire on the website (www.laktacja.pl). The study was conducted electronically from 1 September 2019 to 31 March 2020 in Maternity and Neonatal Departments, primary health-care clinics in various Polish cities. Data from 700 questionnaires were statistically analysed with the use of Pearson's chi-squared test of independency or Fisher's exacts test when applicable (small cell counts).

RESULTS

90% of the surveyed women expressed the opinion that it should be possible to breastfeed in public, and 78% of women have had such an experience. Most often it was their own cars, a room for a mother and child, a hall or just a place available when there was a need to feed the child (e.g., a bench, cafe, toilet). About 10% of women faced criticism while breastfeeding in a public place, and 8.6% of women have never breastfed the child out of the house due to the lack of proper place and conditions, embarrassment and no sympathy from other people.

CONCLUSION

Taking into account the benefits of long-term breastfeeding and the comfort of breastfeeding women, their children and the environment, it is necessary to create dedicated places for breastfeeding in public places.

It’s just a breast: an examination of the effects of sexualization, sexism, and breastfeeding familiarity on evaluations of public breastfeeding

Background

Despite the legal right to breastfeed in public, women may be concerned about negative reactions from others, which may in turn impact their decision to breastfeed in public. The current study examined whether women breastfeeding in public (e.g., at a coffee shop) would be evaluated differently than women breastfeeding in private (e.g., at home) and explored several explanations for the possible differences: sexualization of the female breast (including the perceivers’ gender and sexual comfort level, as well as the exposure of the breast while breastfeeding), sexist attitudes, and familiarity with breastfeeding.

Methods

In August 2018, 506 adult participants, residing in the United States and recruited from Amazon Mechanical Turk, were randomly assigned to view an image of a woman breastfeeding (or not) while wearing a cover (or not), in a private or public location. Participants then completed measures of their emotional responses, perceptions, and behavioral intentions toward the woman in the image as well as their sexual comfort level, hostile and benevolent sexism, and knowledge of and experience with breastfeeding.

Results

People had more favorable evaluations of breastfeeding (vs. non-breastfeeding) women, especially when they had greater sexual comfort, were more knowledgeable about breastfeeding, and were parents with at least one child who was breastfed. The location (public vs. private) and the presence or absence of a cover did not differentially influence evaluations of breastfeeding and non-breastfeeding women, nor did participants’ gender or level of sexist attitudes.

Conclusions

In general, people’s evaluations of breastfeeding appear to be favorable to the degree that the location of the breastfeeding is not particularly relevant to those evaluations.

Breastfeeding in Public: Challenges and Evidence-Based Breastfeeding-Friendly Initiatives to Overcome the Barriers

Introduction

Breastfeeding is the safest mode of infant feeding that is readily available at the right temperature and does not require supplies for its preparation. Despite the many benefits of breastfeeding, it is often challenging for breastfeeding mothers to breastfeed in public.

Methods

A review of the literature was undertaken to explore challenges hindering breastfeeding in public and ascertain evidence-based breastfeeding-friendly strategies to overcome those barriers.

Results

Major barriers to breastfeeding in public include negative public perceptions of breastfeeding, sociocultural barriers, embarrassment/lack of comfort, stigmatization, sexualization of breast, and nonconducive environment in public spaces. Evidence-based strategies to support breastfeeding in public include normalization of breastfeeding in public, increasing the visibility of breastfeeding through social media and public events, empowerment of breastfeeding mothers, positive role modeling, social support, and environmental modifications.

Conclusion

Implementation of evidence-based and innovative breastfeeding-friendly initiatives are essential to combat challenges surrounding breastfeeding in public spaces.

Understanding factors affecting breastfeeding practices in one city in the Kingdom of Saudi Arabia: an interpretative phenomenological study

Background

Breastfeeding duration has declined in the Kingdom of Saudi Arabia (KSA) in recent decades, although accurate national data about different breastfeeding indicators by infant age are lacking. This qualitative study, the first in KSA, aimed to understand the factors affecting mothers’ decisions and experiences regarding any breastfeeding practices.

Methods

A qualitative phenomenological approach was used to investigate mothers’ experiences of breastfeeding. Non-probability convenience sampling and snowballing strategies were designed to recruit participants. Semi-structured interviews were conducted with 16 mothers, from two hospitals and three primary health clinics in Al-Madinah city, from December 2017 to March 2018. Interpretative phenomenological analysis was the analysis framework.

Results

Three themes were identified: 1) ‘Up against the system’: policies, staff and systems were the main barriers to exclusive breastfeeding; 2) ‘Social support and negativity’: family support in the first 40 postpartum days protected breastfeeding continuation and was highly appreciated, but negative comments limited breastfeeding practices thereafter; and 3) ‘Managing tensions’: mothers’ religious beliefs about breastfeeding boosted their decisions; however, the challenge of managing tensions influenced mothers to stop breastfeeding earlier than they wished. The study revealed that mothers had no doubts about wanting to breastfeed their babies; but continuation was adversely affected by unhelpful hospital policies and staff actions, the lack of ongoing social support, and by others people’s negativity, rather than by the mothers’ own views. Stopping breastfeeding earlier than planned was a complex decision for most mothers. However, mothers said that they intended to breastfeed their next baby successfully.

Conclusions

Healthcare professionals (maternity staff, paediatricians and pharmacists) need education and training to support exclusive breastfeeding effectively. Increasing the number of hospitals with Baby Friendly Hospital Initiative accreditation, which includes staff practice changes, is needed to protect and support exclusive breastfeeding. Ongoing professional and peer support, and improving conditions at workplaces and universities, are needed to help mothers to continue breastfeeding successfully. Effective, coordinated national policies can support mothers’ decisions in relation to breastfeeding. Such changes will reduce the tensions experienced by women and help them to achieve their breastfeeding goals and to breastfeed for longer.

Young adults’ perceptions of breastfeeding in public: a focus group study

Objective

To elucidate the perceptions of young Chinese adults aged 18–25 toward adopting breastfeeding in public in Hong Kong Special Administrative Region (Hong Kong), China.

Methods

A descriptive and exploratory study design was adopted. Participants were recruited by convenience sampling. Focus group data were collected from three semi-structured interviews. Responses from 18 participants were audiotaped, transcribed verbatim, coded, and analyzed using content analysis.

Results

Four themes emerged that described the young adults’ perceptions and barriers toward breastfeeding practices: (1) adaptability of self and others, (2) cultural deem and practice, (3) convenience and connection, and (4) education and advocacy. Interestingly, all respondents (male and female) are aware of the benefits of breastfeeding. Their negative perceptions toward breastfeeding initiation and continuation originate from factors that are essentially extraneous to the mother–infant dyads (such as the breadth and intensity of sociopolitical support, the dominant social beliefs and norms, and the inadequacy of breastfeeding education in adolescent years).

Conclusions

In general, the young adult's perception of breastfeeding is dominated by sociopolitical and cultural-related factors. In particular, sexualization of breasts as a deep-rooted belief in the Chinese context negatively affects young adults’ perceptions and limits their breastfeeding practices.

Women's experiences with breastfeeding in public: An integrative review

BACKGROUND

Much evidence around public breastfeeding does not reflect experiences of the key stakeholder, the breastfeeding woman, and focuses upon the audience. Selective evidence has explored breastfeeding experiences revealing challenges with public breastfeeding as a serendipitous finding. Although women's experiences have been explored in specific contexts, insight into commonalities reflective of an international perspective is unknown.

OBJECTIVE

to explore, review and synthesise published literature on women's experience with public breastfeeding.

METHODS

An integrative review allows inclusion of findings beyond empirical evidence. Whittemore and Knafl's approach was used to capture and analyse evidence from varied sources to provide understanding of a phenomenon from diverse methodologies. PubMed, Medline, Ovid emBase, Scopus, Science Direct, the Cumulative Index of Nursing and Allied Health Literature and PsychINFO were searched. Inclusion criteria included publications in English after 2005 offering descriptions of women's experiences. Data evaluation included assessment of literature quality. A constant comparison approach involved comparing, analysing and drawing similar concepts into themes.

FINDINGS

Integration of women's experience with public breastfeeding from 27 publications covering 12 countries revealed two key themes, what women shared as 'enhancing' and 'challenging'. Challenges included four subthemes: 'drawing attention', 'sexualisation of breasts', 'awareness of others' discomfort', and 'efforts not to be seen'. Enhancing incorporated subthemes: 'supportive audience' and 'confidence'.

CONCLUSION

Challenges confirm an international commonality that women encounter during public breastfeeding suggesting a multilayered approach addressing community and societal behaviours is required. Insight to enhance public breastfeeding experiences offers direction to improve support.

Breastfeeding: Australian Breastfeeding Association volunteers are positive deviants in Australian society

PROBLEM

Australian breastfeeding rates are low, and strategies to increase them have been inadequate. New approaches for supporting breastfeeding are required.

BACKGROUND

Preliminary data suggested that Australian Breastfeeding Association members had higher exclusive breastfeeding rates than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted project provided an opportunity to determine which practices were influencing better breastfeeding outcomes.

AIMS

(1) To determine whether Australian Breastfeeding Association volunteer trainees were positive deviants regarding breastfeeding practices, (2) to explore characteristics or behaviours underpinning beneficial breastfeeding practices and (3) to identify modifiable characteristics to inform breastfeeding promotion.

METHODS

A cross-sectional, one-group survey design was used. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with the Australian Breastfeeding Association (N=174), and analysed using descriptive statistics.

FINDINGS

Participants in this project had higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Identified modifiable factors were knowledge and motivation to breastfeed, partner and peer support, birthing outcomes, immediate skin-to-skin contact, formula supplementation and positive attitudes to breastfeeding at work and breastfeeding in public.

DISCUSSION

Participants could be defined as positive deviants with positive attitudes towards breastfeeding. The personal behaviours and practices of this group may help inform future breastfeeding interventions.

CONCLUSIONS

Identifying positive deviants and supporting the broader community to adopt behaviours that explain improved breastfeeding outcomes could be powerful methods to produce change.

Place of sanctuary: an appreciative inquiry approach to discovering how communities support breastfeeding and parenting

Background

Significant efforts by governments at a global and national level have not resulted in a significant increase in the duration of breastfeeding to six months. The views of family and social networks, and community attitudes particularly around breastfeeding in public, influence infant feeding decisions. Yet many interventions designed to increase breastfeeding focus on the individual woman and have not been developed from the 'ground up' in consultation with women and communities. This study aimed to identify the key components of Mother Infant Caring Communities that promote and support breastfeeding and early parenting.

Methods

Appreciative Inquiry was used to facilitate a 'Community Conversation' workshop in two local councils in Australia. Thirty-five participants attended the community conversation workshops including new parents, grandparents, children's services, local government, and representatives from maternity and child health services. In addition, one focus group discussion was conducted with six retail business owners or managers. Qualitative content analysis was used to analyse data. This paper presents the findings of the first phase (the Discovery phase) of the study.

Results

Four major themes emerged: "PLACE - A community for everyone"; "A PLACE for children and families"; "Sometimes a PLACE to breastfeed" and "The parent room: a hidden and unsafe PLACE to breastfeed". Participants described the characteristics of communities that provided a sanctuary and fostered well-being for parents and infants including, open green spaces, safe playgrounds, walking tracks and community hubs. Shopping centres were described as having the potential to be the 'village'. Community-based services to support breastfeeding and parenting were highly valued. Yet in both sites, participants stated that breastfeeding was rarely observed in public and bottle feeding was more evident.

Conclusion

Breastfeeding and parenting are embedded in the places where women and families live. Community spaces including shopping centres, should be designed to include infants and young children and offer appropriate facilities such as safe and clean parenting rooms. Health services must work with local government, businesses, and diverse community members to identify what parents' value about their community and design and implement innovative local strategies to support breastfeeding.

Experiences and Perspectives About Breastfeeding in "Public": A Qualitative Exploration Among Normal-Weight and Obese Mothers

BACKGROUND

Women face societal and cultural barriers to breastfeeding. These challenges have been investigated in international studies and U.S. public opinion polls; however, mothers' experiences with breastfeeding in public in the United States remain unexplored. Research aim: The aim of this study was to describe the experiences of obese and normal-weight women with breastfeeding in public in central New York.

METHODS

Pregnant women ( N = 26) in central New York who intended to breastfeed and were either normal weight or obese were enrolled during their third trimester. A longitudinal, qualitative study was conducted to obtain information about women's experiences from birth through 3 to 6 months postpartum. Interviews were audio recorded, transcribed, and verified for accuracy. Transcripts were analyzed iteratively using conventional content analysis.

RESULTS

The concept of "public" was situational rather than a set of physical places; women experienced challenges while breastfeeding around others in private locations that were indistinguishable from those they encountered in places typically considered public. Women experienced social and physical awkwardness including perceived lack of acceptability, fear of confrontation, exposure, and positioning difficulties. They used strategies to reduce awkwardness, for example, being "discreet" and minimizing breastfeeding around other people. Obese women experienced similar challenges but to a greater degree than normal-weight women.

CONCLUSION

"Breastfeeding around others" described mother's experiences more accurately than "breastfeeding in public" and was experienced as awkward both socially and physically, particularly by obese women. Strategies are needed to normalize breastfeeding in the United States and to prepare mothers for the challenges of breastfeeding around others.

[Is breastfeeding in public socially accepted? : Experiences and attitudes of the general population and breastfeeding mothers]

BACKGROUND

Despite the undeniable benefits, breastfeeding in public has led in the past to controversies that gained a lot of media coverage. For this reason, the attitudes of the general population towards breastfeeding in public and the experiences of mothers who breastfeed in public were examined.

OBJECTIVE

The objectives were to collect current data on the perception and acceptance of breastfeeding in public.

MATERIALS AND METHODS

We surveyed 1003 respondents from the general population aged 14 years and over and 306 mothers with children of breastfeeding age on the subject of breastfeeding in public by means of computer-assisted web interviewing.

RESULTS

Of mothers, 6% reported that their experiences of breastfeeding in public tended to be rather or very negative. Of the general population sample, 66% held the fundamental opinion that breastfeeding should be possible everywhere at all times, compared to 80% of mothers (p < 0.05). Special differences can be seen for breastfeeding in restaurants and cafes. Although only just under 50% of the population sample approves of breastfeeding in these locations, it is not avoided by the majority of mothers (54%). Overall, knowledge of the benefits of breastfeeding is associated with increased acceptance of breastfeeding in public. No special demographic characteristics were observed for the group of persons with a negative attitude towards breastfeeding in public (6%).

CONCLUSIONS

No special target group for improving acceptance of breastfeeding in public can be identified in the population on the basis of the present findings. A conflict potential was identified for certain places and situations, however, which enables the development of strategies to increase acceptance.

Chinese women's experiences, emotions and expectations of breast-feeding in public: a qualitative study

OBJECTIVE

To explore Chinese mothers' experiences, emotions and expectations of breast-feeding in public places.

DESIGN

Exploratory qualitative study. Purposive sampling was used to recruit participants and face-to-face interviews were conducted. Themes were identified by content analysis.

SETTING

Two different geographical communities in Wuhan, Hubei Province, central China, March-May 2016.

SUBJECTS

A total of twenty-seven mothers aged 23-33 years, who had one child under 3 years of age and had experience of breast-feeding in public places.

RESULTS

Seven themes emerged from the interviews: struggling to balance infant's needs and personal feelings; embarrassed or natural emotion regarding breast-feeding in public places; effect of cultural and social norms; internalized concerns going beyond actual social reaction; measures to make breast-feeding in public places easier; desire for more public facilities; and expecting emotional support from society members.

CONCLUSIONS

More positive social support, favourable policies and necessary facilities were desired to enable mothers to breast-feed in an appropriate public location. Women expected increased public acceptance of breast-feeding practices and support from government health officials to ensure women's success in breast-feeding in public settings.

Attitudes of Chinese Adults to Breastfeeding in Public: A Web-Based Survey

OBJECTIVE

To explore Chinese adults' perceptions and attitudes toward breastfeeding in public places.

MATERIALS AND METHODS

This was a web-based survey including 10 items on breastfeeding participants (N = 2,021) who were recruited by convenience sampling.

RESULTS

Almost 95% believed that public places should have lactation rooms, 86% thought it was acceptable for mothers to breastfeed in this location, and 65% of respondents agreed that it was acceptable for mothers to breastfeed in public. Though 47% believed that viewing women breastfeeding in public was embarrassing, more than 80% felt that breastfeeding in public was appropriate and decent and did not violate social morality. More than 90% of respondents approved of policies supporting breastfeeding in public. Women, married people, those who had children, had some knowledge about breastfeeding, or had the experience of viewing women breastfeeding in public were more likely to hold positive perceptions and attitudes toward breastfeeding in public places.

CONCLUSIONS

Prior experience and knowledge about breastfeeding have a great influence on people's perceptions and attitudes toward breastfeeding in public, so education about breastfeeding is very important. Breastfeeding education should not only include the techniques of breastfeeding practices but also include information policies that support breastfeeding in public, including the importance of lactation rooms.

Public Attitudes Toward Breastfeeding in Public Places in Ottawa, Canada

BACKGROUND

In Ontario, Canada, breastfeeding in public is a protected right, yet even with these laws, attitudes toward breastfeeding in public can serve as a barrier to breastfeeding. Research aim: This study assesses public support for breastfeeding in public among adults in Ottawa, Ontario, and examines sociodemographic associations with negative attitudes toward public breastfeeding.

METHODS

Data from the 2015 Rapid Risk Factor Surveillance System (RRFSS), a population health telephone survey, were obtained for Ottawa. Adults ages 18 years and older were asked whether it was acceptable for a mother to breastfeed her baby in a restaurant and shopping mall ( n = 1,276). Descriptive statistics and regression were used to describe sociodemographic characteristics associated with negative attitudes.

RESULTS

Overall, 75% of respondents agreed that it was acceptable for a mother to breastfeed her baby in both a restaurant and shopping mall (restaurant: 78%; shopping mall: 81%). Respondents who did not have children at home, were less educated, had a mother tongue language other than French or English and who were retirees were less likely to support breastfeeding in restaurants and shopping malls. In addition, women and immigrants living in Canada for more than 15 years were less likely to support breastfeeding in shopping malls.

CONCLUSION

Despite a law to support public breastfeeding in Ontario, there is room to improve attitudes toward public breastfeeding. Increased public support for public breastfeeding can support women and children to achieve their feeding goals, particularly for those wanting to exclusively breastfeed.

Perceptions of Public Breastfeeding Images and Their Association With Breastfeeding Knowledge and Attitudes Among an Internet Panel of Men Ages 21-44 in the United States

BACKGROUND

Men's attitudes toward public breastfeeding may influence a woman's decisions about breastfeeding and her perceived comfort with public breastfeeding. Research aim: This study aimed to evaluate factors associated with men's visual perception of images of public breastfeeding.

METHODS

A 95-item online survey was administered to 502 U.S. men ages 21 to 44. Respondents were presented with four images of women breastfeeding and asked to evaluate agreement with 15 adjectives describing each image. Based on factor analysis, 13 of these adjectives were combined to create the Breastfeeding Images Scale for each image. An 8-item Situational Statements Scale and the 17-item Iowa Infant Feeding Attitude Scale (IIFAS) were used to assess breastfeeding knowledge and attitudes. Multiple regression was used to evaluate the association between breastfeeding attitudes and knowledge and the Breastfeeding Images Scale.

RESULTS

The image depicting a woman breastfeeding privately at home had the highest mean score of 71.95, 95% confidence interval (CI) [70.69, 73.22], on the Breastfeeding Images Scale, compared with 61.93, 95% CI [60.51, 63.36], for the image of a woman breastfeeding in a public setting. The overall mean scale score for the IIFAS was 56.99, 95% CI [56.27, 57.70], and for the Situational Statements Scale was 28.80, 95% CI [27.92, 29.69]. For all images, increasing breastfeeding knowledge and attitudes measured by the IIFAS and the Situational Statements Scale were associated with a more positive perception of the image.

CONCLUSION

Images of public breastfeeding are viewed less favorably by men in the sample than are images of private breastfeeding. Knowledge and attitudes toward breastfeeding are positively associated with perception of breastfeeding images.

Using breastfeeding images to promote breastfeeding among young adults

Young adults’ reactions to breastfeeding images were assessed using varied approaches. In Study 1, participants viewed posters from a breastfeeding campaign; many anticipated negative reaction to the campaign. In Study 2, participants viewed novel infant-feeding posters; breastfeeding posters were viewed for less time than bottle-feeding posters, regardless of the task assigned. In Study 3, participants were asked to rate their comfort level viewing infant-feeding images; greater discomfort was reported for breastfeeding images. Taken together, we argue that many young adults expect, and experience, discomfort viewing breastfeeding, but it is important to continue using breastfeeding images in promotion efforts.

The Ability of Posters to Enhance the Comfort Level with Breastfeeding in a Public Venue in Rural Newfoundland and Labrador

BACKGROUND

The acceptance and support of breastfeeding in public venues can influence breastfeeding practices and, ultimately, the health of the population.

OBJECTIVE

The primary aim of this study was to investigate whether posters targeted at the general public could improve acceptability of breastfeeding in public places.

METHODS

A convenience sample of 255 participants was surveyed at shopping centers in 2 rural communities of Newfoundland and Labrador. Experimentally, questions were posed to 117 participants pre- and post-exposure to 2 specific posters designed to promote public acceptance of breastfeeding in public.

RESULTS

Initially, we surveyed that only 51.9% of participants indicated that they were comfortable with a woman breastfeeding anywhere in public. However, context played a role, whereby a doctor's office (84.5%) or park (81.4%) were the most acceptable public places for breastfeeding, but least acceptable was a business office environment (66.7%). Of participants, 35.4% indicated previously viewing specific posters. We used a visual analog scale to test poster viewing on the acceptability of public breastfeeding in the context of a doctor's office and a restaurant. Results of pre- versus post-viewing of the promotional posters indicated significant improvements in both scenarios: in a doctor's office (P = .035) and in a restaurant (P = .021).

CONCLUSION

Nearly 50% of the surveyed population indicated discomfort with a mother breastfeeding in public. Both cross-sectional and interventional evidence showed that posters significantly improved the reported level of comfort toward seeing breastfeeding in public.

Who Uses the Internet as a Source of Nutrition and Dietary Information? An Australian Population Perspective

Background

The Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information.

Objective

The aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs.

Methods

Data were pooled from the Western Australian Department of Health’s 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected.

Results

The proportion of respondents using the Internet for nutrition information increased from <1% in 1995-2001 to 9.1% in 2004 and 33.7% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95% CI 2.07-3.88) and 2012 (OR 5.20, 95% CI 3.86-7.02, P<.001). Respondents using the Internet as a source were more likely to be female (OR 1.30, 95% CI 1.05-1.60, P=.02), live in a metropolitan area (OR 1.26, 95% CI 1.03-1.54, P=.03), born in countries other than Australia/UK/Ireland (OR 1.41, 95% CI 1.07-1.85, P=.02), more educated (university: OR 2.46, 95% CI 1.77-3.42, P<.001), and were less likely to be older (55-64 years: OR 0.38, 95% CI 0.25-0.57, P<.001). The majority of respondents agreed the following information would assist them to make healthier choices: more ways to prepare healthy foods (72.0%, 95% CI 70.7-73.3), quicker ways to prepare healthy foods (79.0%, 95% CI 77.8-80.1), how to choose healthy foods (68.8%, 95% CI 67.5-70.1), and knowing more about cooking (54.7%, 95% CI 53.3-56.1). Those using the Internet for nutrition information were more likely than nonusers to want to know quicker ways to prepare healthy foods (83.0% vs 78.1%, P=.005) and information on choosing healthy foods (76.3% vs 67.3%, P<.001).

Conclusions

Use of the Internet as a main source of nutrition information has grown rapidly since 2004; one-third of Western Australian adults reported using the Internet for this purpose in 2012. Information on preparing healthy foods (ideas, quicker ways), choosing ingredients, and knowing more about cooking would make it easier to eat a healthy diet. For Internet users, emphasis should be on quicker ways and choosing ingredients. These finding have implications for policy makers and practitioners and suggest that traditional health promotion tactics should continue to be used to reach the broader population.

A comparison of maternal attitudes to breastfeeding in public and the association with breastfeeding duration in four European countries: results of a cohort study

BACKGROUND

There is wide variation in the duration of breastfeeding across Europe which may in part be due to the between-country differences in mothers' and societal attitudes towards breastfeeding in public. The objective of this study was to quantify and compare the maternal attitudes to, and practice of, breastfeeding in public in four European centers and investigate the association with duration of breastfeeding.

METHODS

Participants (n = 389) were mothers recruited from maternity wards of hospitals in Glasgow (Scotland), Stockholm (Sweden), Granada (Spain), and Reggio-Emilia (Italy).

RESULTS

Among those who had breastfed, Scottish (adjOR 0.25 [95% CI 0.12-0.50]) and Italian mothers (adjOR 0.30 [95% CI 0.14-0.63]) were significantly less likely than Swedish mothers to have ever breastfed in public. Mothers who had a negative attitude toward breastfeeding in public were less likely to have ever breastfed in public (adjOR 0.05 [95% CI 0.02-0.17]), and those who had never breastfed in public were in turn more likely to discontinue breastfeeding earlier.

CONCLUSIONS

Perceived social norms may exert a stronger influence on breastfeeding outcomes than a woman's breastfeeding attitudes and knowledge. Differences between European countries in the duration of breastfeeding may be explained in part by differences in societal attitudes to breastfeeding in public.