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

The influence of bystander presence on evaluations of public breastfeeding among adults in the United States

BACKGROUND

In general, people tend to support private breastfeeding more than public breastfeeding, and discomfort surrounding public breastfeeding may contribute to sub-optimal rates of breastfeeding in the United States. Few studies have systematically examined situational factors that contribute to (negative) reactions to public breastfeeding. It is unclear whether the physical location or the presence of others is more influential in shaping people's evaluations of public breastfeeding. This study aimed to experimentally investigate the influence of location, bystander presence, bystander gender, and the breastfeeding woman's use of a cover on people's evaluations of breastfeeding images.

METHOD

A sample of adults residing in the United States was randomly assigned to view an image of a breastfeeding woman in an experimental study that examined four independent variables: breastfeeding location (public vs. private), bystander presence (present vs. not present), gender of bystander (male vs. female), and use of a cover (cover vs. no cover). Participants then reported their emotional reactions to, perceptions of, and behavioral intentions toward the breastfeeding woman. In addition, participants completed measures of sexism, traditional gender role endorsement, sexual comfort, body gaze, and breastfeeding knowledge and experience.

RESULTS

Hierarchical regressions revealed no differences between private and public breastfeeding images. Perceptions of the breastfeeding woman were more favorable when she was alone than with others, and when she was covered than when she was not covered. Evaluations tended to be more favorable among participants who scored lower on hostile sexism, higher on benevolent sexism, higher on sexual comfort, and higher on breastfeeding knowledge.

CONCLUSION

The presence of bystanders may be more consequential than the physical location in shaping reactions to public breastfeeding. These findings can be applied to improve support for public breastfeeding, which may contribute to higher breastfeeding rates and the associated public health benefits.

Women's perceptions of factors needed to encourage a culture of public breastfeeding: a cross-sectional study in Sweden, Ireland and Australia

BACKGROUND

Breastfeeding in the public sphere is known to be experienced as a problem for many women. It has been shown to arouse negative feelings among the public, depending on the attitude of those in the immediate surroundings. This contributes to the fact that many women hesitate to breastfeed in public and prepare themselves for potential adverse comments.

METHODS

An online survey was used for an international cross-sectional study including women living in Sweden (n = 1252), Australia (n = 7602) and Ireland (n = 1597). Women who had breastfed within the previous two years were invited to participate through Facebook. One key open-ended question was presented, inviting women to respond to: "What do you think is important or needed to encourage a breastfeeding culture where breastfeeding in public is seen as normal?" During 2018, data were collected during a four-week period. A thematic analysis of women's responses was conducted separately in each country and then comparison and negotiation occurred once similarities between themes and subthemes were confirmed. Frequencies of subthemes were then determined and compared between the three countries.

RESULTS

Seven subthemes developed from the data; 'Make breastfeeding visible in society'; 'Healthcare professionals support and knowledge regarding breastfeeding'; 'Education of the public'; 'Inviting environment'; 'Zero tolerance to other's unwanted opinions'; 'Focusing on the needs and rights of the breastfeeding dyad'; and 'Desexualize breastfeeding and women's' bodies in society'. Subthemes were integrated under two themes; 'Active supportive interventions needed for breastfeeding' and 'The obvious right of breastfeeding women and children to take a seat in the public sphere'.

CONCLUSION

The common experience that exists today regarding public breastfeeding requires change towards normalization. Further collaborative research is recommended to meet the expressed requirements from women who wish to breastfeed in public.

The Relationship of Race and Ethnicity to the Perception of Visual Images of Breastfeeding Mothers

Introduction: Breastfeeding biases, both implicit and explicit, can impact perceived norms of breastfeeding appropriateness in a variety of contexts and influence breastfeeding behaviors. The purpose of this research was to uncover breastfeeding biases, norms, patterns, and perceptions that potentially affect the decision to initiate or sustain breastfeeding and investigate how a diverse group of women perceive images of racially/ethnically similar and different women breastfeeding. Materials and Methods: Using a panel of nationally representative respondents (oversampling key racial/ethnic subpopulations), an online mixed-methods survey was completed by a sample of women who were primary caregivers of children under 3 in November 2020. The survey included diverse images of individuals breastfeeding in various settings and respondents were asked to generate word associations and indicate perceived appropriateness and ease of breastfeeding for each image in direct, timed comparisons. Results: Respondents (N = 144) racial/ethnic identity influenced perceptions of breastfeeding ease and norms surrounding breastfeeding in public settings or in front of others. Furthermore, respondents perceived breastfeeding to be more or less appropriate based on racial identity, in particular, respondents of color seeing breastfeeding as less appropriate among racially and ethnically similar others. Conclusions: While respondents readily acknowledged the health benefits of breastfeeding and were generally supportive of images of others breastfeeding, biases about breastfeeding in public or in front of others and by race/ethnicity were apparent. Community, policy, and societal interventions are necessary to dismantle breastfeeding biases that may inequitably impact mothers' and infants' health.

Article: "Too Old" and "Too Cold": Discomfort Towards Photographs of Breastfeeding Beyond Infancy and Public Breastfeeding in Nova Scotia, Canada

BACKGROUND

Social norms and public perception of breastfeeding are well-established predictors of breastfeeding outcomes; however, little is known about perceptions of breastfeeding beyond infancy or public breastfeeding among the public in Nova Scotia, Canada.

RESEARCH AIM

To explore public opinion about breastfeeding beyond infancy and public breastfeeding.

METHODS

In this cross-sectional study participants were recruited from public spaces in Nova Scotia, Canada. Using photo elicitation methods, participants (N = 229) viewed six photographs of breastfeeding children aged 2 weeks, 13 months, and 2.5 years, one photograph captured at home, and the other in a public space (a café, a store, or outdoors). Participants were asked to score their self-rated comfort with each photograph on a 10.0 cm visual analog scale and asked to share their feelings about each photograph (open-ended responses).

RESULTS

Mean (SD) visual analog scale comfort scores for photographs differed by location (private, 7.9 [2.2]; public, 7.3 [2.6]; p < .05) and child age (2 weeks, 8.5 [2.0]; 13 months, 7.5 [2.6]; 2.5 years, 6.9 [3.0]; p < .05). Participants who identified as women and parents self-reported significantly higher comfort with all photographs, while younger participants and urban dwellers were generally less comfortable. Open-ended responses varied considerably, but a higher proportion of negative comments were reported for older children feeding in public spaces (e.g., 2.5-year-old in public: "Inappropriate. Indecent. Abnormal.").

CONCLUSION

Given the importance of social norms in supporting breastfeeding, future public health campaigns should strive to normalize breastfeeding beyond infancy, and in public spaces.

Do Brelfies Help to Normalize Breastfeeding in Public: Lewd or Food?

Often, lack of support results in early termination of breastfeeding compromising infant health. Lactivists argue one way to normalize public breastfeeding is by posting brelfies on social network sites. An online experiment tested a 2 × 2 between-subjects factorial design. Participants (N = 296) were randomly assigned to one of the four experimental conditions varying the valence of comments or the control where no user comments were present. Most participants posted supportive comments. Compared to participants who only viewed brelfies, those who read any type of comment posted by other users showed negative attributions and emotions to brelfies. A number of other variables were also measured. Identification with other social media users was associated with approval for posting brelfies and supporting mothers. Emotional arousal and cognitive appraisal may be two sources of stigma about comments for brelfies even though people recognize that breastfeeding is an important health issue.

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.

A Pilot Study of the Impact of Brief Exposure to Images of Breastfeeding Mothers on Attitudes Toward Mother's Breastfeeding in Public

The wider societal attitudes held toward mothers' breastfeeding in public seem to impact infant feeding choices. The present study employed an online (N = 396) experimental pretest-posttest design set to examine whether a mere exposure effect of briefly viewing and rating the valence of four different images of public breastfeeding (i.e., mother and baby alone, females in background, males in background, and females and males in background) would impact on participants' attitudes toward a mother breastfeeding in public. There was a marginal increase in the positive attitudes toward public breastfeeding at Time 2 when compared with Time 1 following exposure to the four images. These findings support a potential positive mere exposure effect in enhancing attitudes toward breastfeeding in public. This suggests a greater use of promotional material using visual stimuli may improve societal acceptance of breastfeeding in public.

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.

A Comparison of Breastfeeding Exposure, Attitude, and Knowledge Between Collegiate African American and White Males with no Biological Children

BACKGROUND

Human milk is the preferred source of infant nourishment; yet, acceptance of human milk as the norm for infant feeding is debated. In the United States there is a disparity in breastfeeding rates, which are significantly lower in African Americans compared to Whites. Multiple variables appear to influence breastfeeding, including the male partner.

OBJECTIVES

To assess and compare breastfeeding exposure, attitude, and knowledge between African American and White college males with no biological children. A second objective was to explore the relationship between breastfeeding variables and educational attainment, academic major, and sibling presence.

METHODS

A subset of responses from a larger cross-sectional survey were analyzed. African American and White collegiate males aged 18-40 years without biological children were included in the study. The questionnaire included demographic, exposure, attitude, and knowledge items.

RESULTS

A total of 117 African American and 713 White males were included and represented all academic colleges on campus. African American participants documented less exposure to breastfeeding, a more positive attitude, and similar poor knowledge scores compared to their White counterparts. Sibling presence was linked with exposure, and exposure was linked to attitude. Both African American and White science majors scored higher on all factors than humanities or business majors.

CONCLUSIONS FOR PRACTICE

Breastfeeding exposure influences males' attitudes toward breastfeeding. Future research should consider types of exposure to identify the sources most influential. Furthermore, tailoring breastfeeding interventions to increase exposure and knowledge in core wellness courses may improve attitudes and social acceptance among collegiate males.

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review

Exclusive breastfeeding to 6 months with continued breastfeeding up to 2 years and beyond are well-established infant feeding recommendations based on evidence that breastfeeding has unparalleled maternal and infant health benefits as well as environmental and economic benefits. As with many high-income countries, breastfeeding rates remain suboptimal with only a quarter of Canadian and European infants receiving breast milk exclusively for the first 6 months. Breastfeeding promotion efforts have largely targeted caregivers in the prenatal and postnatal period; however, breastfeeding outcomes have been shown to be associated with broader sociocultural factors. Noncaregivers play an influential role in infant feeding at both an individual level (e.g., cues and input from health care practitioners and caregivers' social networks; as future parents) as well as a broader population level (sociocultural norms and policy decisions). This paper outlines recent research on breastfeeding knowledge and attitudes of noncaregivers by population subgroup. Positive correlations have been identified between breastfeeding attitudes, infant feeding knowledge, breastfeeding exposure, and breastfeeding intention among different subgroups; however, key knowledge gaps, lack of exposure to breastfeeding, and negative public perceptions of breastfeeding persist. Dietitians can advocate for breastfeeding promotion strategies that consider the role of noncaregivers to address sociocultural norms around breastfeeding.

Relationship among Breastfeeding Exposure, Knowledge, and Attitudes in Collegiate Males Residing in East Texas

BACKGROUND

Researchers exploring breastfeeding attitudes and knowledge among women suggest the decision to breastfeed is influenced by the male partner, yet few studies address males. Because collegiate males will soon enter fatherhood, assessment of their attitudes and knowledge may inform interventions aimed at increasing intention to breastfeed.

RESEARCH AIM

This study aimed to describe collegiate males' exposure to, attitude toward, and knowledge about breastfeeding.

METHODS

A cross-sectional online survey was used with males ≥ 18 years of age enrolled at a Texas public university. Attitude indices measured included social limitations, public displays of breastfeeding, and employer accommodations. Descriptive statistics, correlational and regression analyses were employed.

RESULTS

The participants' (N = 949) average age was 25.48 years; > 80% reported not being fathers. Exposure to breastfeeding was high; > 80% witnessed breastfeeding and/or had someone close breastfeed. High attitude scores indicated social acceptability of breastfeeding. Knowledge appeared limited: only 16% identified the recommendation of exclusive breastfeeding for the first 6 months of life; > 50% overlooked the reduced risk for overweight/obesity, ear infections, diarrhea, or food allergies. Correlations between knowledge, exposure, total attitude, and index scores were positive (p < .01) except for the public displays index. Stepwise multiple regression determined that breastfeeding exposure, knowledge scores, and father's educational level predicted total attitude score, (R² = 0.13, F (3,851) = 44.02, p < .01).

CONCLUSION

The positive attitudes outcome among this male population is promising for breastfeeding support and advocacy. Education efforts improving knowledge will likely increase behavioral intention, resulting in increased breastfeeding rates and duration.

Images of women breastfeeding in public: solitude and sociality in recent photographic portraiture

Contemporary images of women breastfeeding — from breastfeeding selfies to fine art — celebrate breastfeeding outside the home by displaying visual records of these occasions to a wider audience. From brelfies posted by celebrities and ordinary parents on social media, to the photography of Tara Ruby and Ivette Ivens, media coverage of lactivist nurse-ins, or fine-art works by Ashlee Jenkins and Sky Boucher, the repertoire of breastfeeding images in developed Western nations has grown and diversified exponentially in the past ten years. A subject that was once the province of religious painting, ethnography, public health advocacy or obscure corners of pornography, is increasingly made visible within the everyday, not only through self-portraiture on social media but also through the work of celebrated photographers and visual artists.

Despite this, there is still an absence of images of women breastfeeding in social circumstances, suggesting a reluctance to make the leap from understanding breastfeeding as a solitary activity, regardless of the space the mother inhabits at the time, to a companionable behaviour integral to our social landscape. Images predominate of women breastfeeding alone, or at best with other breastfeeding women, revealing a further binary dividing the acceptable from the unacceptable, where the private vs. public has been conflated with the solitary vs. social.

This article provides a textual analysis of contemporary photographic portraiture to interpret the meanings of key works, and their patterns of signification. It asks to what extent these images advance efforts to normalize breastfeeding and make it publicly commonplace, or reinforce unhelpful binaries, using an iconography based on the religious origins of portraiture itself: the virtuous, devoted mother, unaccompanied but for her child. I conclude that the lack of images where breastfeeding women are integrated into social occasions is partly due to the lack of opportunities for women to breastfeed socially, and few motives for these instances to be recorded, and that there is an unspoken proxemics of viewing space yet to be traversed.

Effect of the board game as educational technology on schoolchildren's knowledge on breastfeeding1

Objective:

to evaluate the effect of the board game as an educational technology on schoolchildren’s knowledge on breastfeeding.

Method:

cluster-randomized clinical trial, held in nine schools, with 99 children in the third grade of elementary school (control group = 51 and intervention group = 48). The pretest was conducted in both groups; intervention consisted in the application of the educational technology immediately after pretest to the intervention group; and the post-test was applied on the 7th and 30th days to both groups. For the analysis of children’s knowledge on breastfeeding, we considered the pre- and post-test score means, using the Mann-Whitney test - for comparing the means between groups - and the Wilcoxon test - within the same group.

Results:

there was no statistically significant difference between the groups in the pretest. In the follow-up, when comparing the groups, there were higher means in the intervention group, on the 7th (19.68 ±1.788) and on the 30th (20.16±1.260) days, with statistically significant difference. Within the intervention group, there was significant increase of the means in the pretest (15.89±3.082) for the 30th day (20.16±1.260).

Conclusion:

such educational intervention has significantly contributed to the increase in scores of children’s knowledge on breastfeeding for the intervention group. UTN: U1111-1184-7386.