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Scott SF, Bute JJ. "It Doesn't Have to Be All or Nothing": How Individuals Who Use Infant Formula Understand the Breastfeeding Master Narrative. HEALTH COMMUNICATION 2024:1-11. [PMID: 38644673 DOI: 10.1080/10410236.2024.2344284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Despite clinical recommendations, only 24.9% of infants in the United States are exclusively breastfed at 6 months of age, and women who use formula report facing stigma and feeling like a failure. Individual experiences are often influenced by master narratives such as "breast is best," and stories can reveal how the discourse may manifest unintended effects, potentially eliciting guilt and shame, which are known to result in negative maternal mental outcomes, including depression and anxiety. The purpose of this research was to use a narrative framework to analyze the stories of women who used formula and determine how they interpreted the master narrative of "breast is best." We conducted interviews with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women integrated "breast is best" into their stories, and that the master narrative influenced conceptions of themselves as mothers including the bonded mother, the good mother, the shameful mother, and, ultimately, the multitudinous mother. Participants who used formula within the first six months desired that messaging about breastfeeding, particularly in online spaces, move away from all-or-nothing framing and instead show the diversity of infant feeding experiences. It is important to consider how breastfeeding discourse evolves online, considering the unintended effect of stigma, its impact on mental health, and the potential for individuals interacting in these spaces to curate more nuanced narrative messaging about breastfeeding to improve maternal and infant health.
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2
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Grattan RE, London SM, Bueno GE. Perceived pressure to breastfeed negatively impacts postpartum mental health outcomes over time. Front Public Health 2024; 12:1357965. [PMID: 38638486 PMCID: PMC11024305 DOI: 10.3389/fpubh.2024.1357965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Positive maternal mental health is associated with improved outcomes for infants, and yet the consideration of maternal mental health is often neglected in breastfeeding interventions. Breastfeeding interventions typically focus on breastfeeding promotion, and do not always include supports for the mother. This may result in isolated perceived pressure to breastfeed, the mental health impacts of which are not well understood. Methods This mixed-methods, longitudinal study examined whether perceived pressure to breastfeed was associated with depression, suicide ideation, anxiety, birth trauma and stress concurrently and 4 weeks later for postpartum mothers. It also examined qualitative experiences of feeding. Results Perceived pressure to breastfeed was associated with increased anxiety, stress and birth trauma symptoms four weeks later. Thematic analysis suggested this may be due to difficulties living up to the "breast is best" ideal, believing breastfeeding was part of success as a mother, lack of choices and autonomy in feeding choices for infants and general lack of support. Discussion As such it appears we may be doing more harm than good by focusing our interventions for breastfeeding primarily on increasing pressure to breastfeed, and interventions should consider strategies for promoting positive maternal mental health alongside breastfeeding.
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Affiliation(s)
- Rebecca E. Grattan
- School of Psychology, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
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3
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Subramani S. Beyond Public Health and Private Choice: Breastfeeding, Embodiment and Public Health Ethics. Asian Bioeth Rev 2024; 16:249-266. [PMID: 38586574 PMCID: PMC10994897 DOI: 10.1007/s41649-023-00259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 04/09/2024] Open
Abstract
The key objective of this paper is to emphasize the importance of acknowledging breastfeeding as an embodied social practice within interventions related to breastfeeding and lactation and illustrate how this recognition holds implications for public health ethics debates. Recent scholarship has shown that breastfeeding and lactation support interventions undermine women's autonomy. However, substantial discourse is required to determine how to align with public health goals while also recognizing the embodied experiences of breastfeeding and lactating individuals. Presently, interventions in this realm predominantly revolve around health-related messaging and the promotion of individual behaviors, often neglecting the systemic and structural factors that influence choices and practices. I closely examine breastfeeding interventions in India, in particular Mothers' Absolute Affection health promotion program, along with breastfeeding narratives. I argue that for such interventions to evolve, they must acknowledge the intrinsic embodied social nature of breastfeeding during their design and implementation. Furthermore, it is important to emphasize that achieving equity and justice objectives necessitates moving beyond the confines of both conventional public health frameworks and frameworks solely centered on private choices. Instead, a more encompassing approach that embraces the concept of embodiment should be adopted.
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Affiliation(s)
- Supriya Subramani
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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4
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Carter SK, Bansal S. Racializing Motherhood and Maternity Care in News Representations of Breastfeeding. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241235143. [PMID: 38444117 DOI: 10.1177/00221465241235143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Racial inequalities in breastfeeding have been a U.S. national concern, prompting health science research and public discourse. Social science research reveals structural causes, including racism in labor conditions, maternity care practices, and lactation support. Yet research shows that popular and health science discourses disproportionately focus on individual and community factors, blaming Black women and communities for unequal breastfeeding rates. This study examines how scientific reports are communicated to the public through a critical analysis of 104 U.S. news articles reporting research on racial disparities in breastfeeding. Findings show that articles acknowledge unequal treatment within maternity care but justify it by presenting Black patients as overburdening the maternity care systems they use due to low socioeconomic status, welfare dependency, poor family support, and poor health. Through these representations, articles co-construct racialized motherhood and maternity care systems in ways that hide manifestations of obstetric racism and combat social support for systemic change.
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5
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Subramani S, Vinay R, März JW, Hefti M, Biller-Andorno N. Ethical Issues in Breastfeeding and Lactation Interventions: A Scoping Review. J Hum Lact 2024; 40:150-163. [PMID: 38087449 PMCID: PMC10799543 DOI: 10.1177/08903344231215073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/31/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Infant feeding interventions that promote and support breastfeeding are considered important contributions to global public health. As these interventions often target private settings (e.g., individuals' homes) and involve vulnerable populations (e.g., pregnant women, infants, and underprivileged families), a keen awareness of ethical issues is crucial. RESEARCH AIM The purpose of this scoping review was to capture the key elements of the current ethical discourse regarding breastfeeding and lactation interventions. METHOD A scoping review was conducted using Arksey and O'Malley's (2005) methodology to identify the ethical issues of breastfeeding and lactation interventions as they are reflected in the scholarly literature published between January 1990 and October 2022. Abstracts (N = 3715) from PubMed, ScienceDirect, JSTOR and the Cochrane Database of Systematic Reviews were screened. The final sample consisted of 26 publications. RESULTS The recurring ethical issues identified in these studies were: the normative assumptions of motherhood; maternal autonomy and informed choice; information disclosure, balancing risks and benefits, and counseling practices; stigma and social context; ethics of health communication in breastfeeding campaigns; and the ethical acceptability of financial incentives in breastfeeding interventions. CONCLUSION This review illustrated that, while a wide range of ethical arguments were examined, the emphasis has been primarily on accounting for mothers' experiences and lactating persons' choices, as well as achieving public health objectives relating to infant nutrition in breastfeeding interventions. To effectively and ethically implement breastfeeding and lactation interventions, we must consider the social, economic, and cultural contexts in which they occur. One key learning identified was that women's experiences were missing in these interventions and, in response, we suggest moving beyond the dichotomous approach of individual health versus population health.
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Affiliation(s)
- Supriya Subramani
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, University of Medicine, Camperdown, NSW, Australia
| | - Rasita Vinay
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Julian W. März
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Michaela Hefti
- Family Larsson-Rosenquist Foundation, Frauenfeld, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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6
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Baker P, Smith JP, Garde A, Grummer-Strawn LM, Wood B, Sen G, Hastings G, Pérez-Escamilla R, Ling CY, Rollins N, McCoy D. The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress. Lancet 2023; 401:503-524. [PMID: 36764315 DOI: 10.1016/s0140-6736(22)01933-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0-36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Julie P Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Amandine Garde
- Law & Non-Communicable Diseases Unit, School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | | | - Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.
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7
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Philip RK, Worobetz A, Byrt H, Beirne I, Zutshi R, Cassidy T, Dunne CP. A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement. MATERNAL & CHILD NUTRITION 2022; 19:e13424. [PMID: 36147028 PMCID: PMC9749595 DOI: 10.1111/mcn.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.
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Affiliation(s)
- Roy K. Philip
- Division of Neonatology, Department of PaediatricsUniversity Maternity Hospital LimerickLimerickIreland,School of MedicineUniversity of LimerickLimerickIreland
| | | | - Helen Byrt
- Lactation Division, Department of Nursing MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | - Irene Beirne
- Neonatal Nursing, Department of MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | | | - Tanya Cassidy
- Sociology and Anthropology, School of Nursing, Psychotherapy and Community HealthDublin City UniversityDublinIreland
| | - Colum P. Dunne
- School of MedicineUniversity of LimerickLimerickIreland,Centre for Interventions in Infection, Inflammation and Immunity (4i)University of Limerick School of MedicineLimerickIreland
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8
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Abstract
This article focuses on the practice of breastfeeding selfies, as a relational practice within online breastfeeding groups. I suggest that despite breastfeeding being upheld as the most superior infant feeding method, the practice has a paradoxical relationship to discourses of the “good mother” and the idealisation of motherhood more generally. This is due to the unashamed boldness of the practice, which flies in the face of notions of discretion, with their subsequent links to respectability. Breastfeeding selfies can be understood as gestures for something outside of the mother-infant dyad, therefore insisting on recognising the desire, needs and sociality of the mother. Furthermore, they move to position breastfeeding as a social, rather than an individual or solitary act. The desire for women to share their mothering experiences with other women challenges the individualising notion of the exclusive mother and, furthermore, can be understood as an invitation for intimacy with other women. Whilst the practice has the potential to be interpreted in a way which challenges much of the pernicious “good mother” discourses, it continues to be a practice marked in Whiteness, revealing the inequitable nature of online public spaces.
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9
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The Cult of the Child: A Critical Examination of Its Consequences on Parents, Teachers and Children. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11030141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The concept of the “cult of the child” highlights a radical change in child representation. Having been neglected and even disrespected for centuries, children are now valued, and their interests are placed above all others. This change in views of children, reflected in changes in laws, institutions and practices, has also spread to two pillars of our democratic societies, the family and the school, with a number of consequences for parents, teachers and children. The purpose of this article is to (1) describe the changes in thinking that have led to the cult of the child, (2) examine their consequences for children and parents, (3) examine their consequences for students and teachers, and (4) reflect on how to preserve the benefits of these changes while limiting the negative consequences.
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10
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Vallée-Ouimet S, Benoit M, Pariseau-Legault P. Normes sociales de l’allaitement : enjeux d’autonomisation pour les mères. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Kirksey K. A social history of racial disparities in breastfeeding in the United States. Soc Sci Med 2021; 289:114365. [PMID: 34592542 DOI: 10.1016/j.socscimed.2021.114365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022]
Abstract
Over the past five decades in the United States, White women have breastfed at higher rates than Black women. While a small but growing body of social historical research has examined racial disparities in breastfeeding over time, empirical research, particularly quantitative research, has focused on single historical snapshots, unintentionally treating the persistent racial disparities in breastfeeding as a static phenomenon, rather than one with distinct social mechanisms at different points in time. Further, few studies on racial disparities in health deconstruct difference both within and across racial groups. But what if we thought about persistent racial disparities instead as discrete trends with distinct social mechanisms at different points in time? In a binary logistic regression of breastfeeding initiation rates from 1973 to 2015 using the National Survey of Family Growth (NSFG), I found that the persistent racial disparities were actually comprised of three distinct types of changing racial disparities: (1) increases in racial disparities that derive from improvements for Whites not captured by Blacks (1973-1982); (2) decreases in racial disparities that stem from improvements for Whites captured even more strongly by Blacks (1995-2006); and, (3) leveling off of racial disparities (2006-2015). Placing results of this quantitative analysis within the context of public policy and social movement history, I identify three distinct mechanisms that drive the different trends in racial disparities in breastfeeding. This paper contributes to the literature on motherhood, race, and health a more nuanced understanding of the social historical mechanisms that pattern breastfeeding, and more broadly, racial disparities in health.
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Affiliation(s)
- Kristen Kirksey
- Department of Sociology, University of Connecticut, 344 Mansfield Road, Unit 1068, Storrs, CT, 06269, USA.
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12
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Integrating motherhood and employment: A 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580. [PMID: 32382650 PMCID: PMC7200309 DOI: 10.1016/j.ssmph.2020.100580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/06/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
The United States has one of the lowest exclusive breastfeeding rates among high-income countries. Most experts agree that there is a lack of mother-friendly workplace policies compared to other countries. Since 1995, 25 states have implemented workplace breastfeeding legislation allowing mothers to express and store breast milk in the workplace. There is heterogeneity in policy enforceability where 17 states have weak enforceability while eight states have strict enforceability and require employers to offer provisions to breastfeed at the workplace. Using difference-in-differences methods, we examine the impact of this policy on state-level breastfeeding rates and assess how that impact differs with policy enforceability. We use data from the Centers for Disease Control on breastfeeding, supplementing with socio-economic data from the Panel Study of Income Dynamics, Current Population Survey, the US Census Bureau and several other datasets over 22 years from 1990 to 2011. We find that states with legislation experienced a 2.3-percentage point increase in breastfeeding rates compared to states without legislation while states with weak enforceability experienced a 3.1-percentage point increase compared to states without legislation. We also find that policies do not start to have an impact until 1–2 years after they were signed into law. Considering the recent assault on breastfeeding from the current administration, our study is a timely and important contribution that strengthens the evidence base for the health benefits of workplace breastfeeding policies. Some US states have passed workplace breastfeeding policies to allow mothers to pump milk in the workplace. We assess the impact of such policies in the US on breastfeeding rates considering the heterogeneity of the policy. States with workplace breastfeeding policies experienced a 2.3-percentage point increase in breastfeeding rates. The policy impact differed by enforceability of the policy. Workplace breastfeeding policies can be an avenue to help stagnant breastfeeding rates.
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13
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Ray S, Hairston TK, Giorgi M, Links AR, Boss EF, Walsh J. Speaking in Tongues: What Parents Really Think About Tongue-Tie Surgery for Their Infants. Clin Pediatr (Phila) 2020; 59:236-244. [PMID: 31875407 DOI: 10.1177/0009922819896583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We evaluate maternal perspectives of frenotomy for ankyloglossia in newborns. We searched highly frequented forums like babycenter.com for comments related to frenotomy posted from 2012 to 2017. We applied modified grounded theory, reviewed posts for thematic synthesis, and calculated frequencies for each theme. High decisional conflict, low discussion of surgical complications, and an overall moderate positive experience were noted. Mothers posted about breastfeeding issues (n = 227, 74.7%) and overall experience (n = 229, 75.3%). Posts related to breastfeeding include discomfort ("I can no longer physically take the pain"; n = 93, 30.6%). Parents posted frequently about a satisfactory outcome ("It was so worth it to improve our nursing relationship"; n = 133, 43.8%), but dissatisfactory outcome ("I'm still having problems latching and am pumping. It's brutal"; n = 31) was present in 10.2%. These results aid in understanding parental thoughts of frenotomy. Physicians can use these self-reported maternal perspectives on frenotomy to guide counseling and improve shared decision making for parents.
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Affiliation(s)
- Shagnik Ray
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Mark Giorgi
- Morehouse School of Medicine, Atlanta, GA, USA
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14
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Nihlén Fahlquist J. Public Health and the Virtues of Responsibility, Compassion and Humility. Public Health Ethics 2019. [DOI: 10.1093/phe/phz007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
In contrast to medical care, which is focused on the individual patient, public health is focused on collective health. This article argues that, in order to better protect the individual, discussions of public health would benefit from incorporating the insights of virtue ethics. There are three reasons to for this. First, the collective focus may cause neglect of the effects of public health policy on the interests and rights of individuals and minorities. Second, whereas the one-on-one encounters in medical care facilitate a compassionate and caring attitude, public health involves a distance between professionals and the public. Therefore, public health professionals must use imagination and care to evaluate the effects of policies on individuals. Third, the relationship between public health professionals and the people who are affected by the policies they design is characterized by power asymmetry, demanding a high level of responsibility from those who wield them.
Against this background, it is argued that public health professionals should develop the virtues of responsibility, compassion and humility. The examples provided, i.e. breastfeeding information and vaccination policy, illustrate the importance of these virtues, which needed for normative as well as instrumental reasons, i.e. as a way to restore trust.
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15
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Abstract
OBJECTIVE To investigate mothers' infant feeding experiences (breastfeeding/formula milk feeding) with the aim of understanding how women experience cessation of exclusive breastfeeding. DESIGN Multimethod, qualitative study; questionnaire, focus groups and interviews. SETTING Northern and Southern Tasmania, Australia. PARTICIPANTS 127 mothers of childbearing age from a broad sociodemographic context completed a questionnaire and participated in 22 focus groups or 19 interviews across Tasmania, 2011-2013. RESULTS Mothers view breastfeeding as 'natural' and 'best' and formula milk as 'wrong' and 'unnatural'. In an effort to avoid formula and prolong exclusive breastfeeding, mothers will endure multiple issues (eg, pain, low milk supply, mastitis, public shaming) and make use of various forms of social and physical capital; resources such as father/partner support, expressing breast milk, bottles and dummies. The cessation of exclusive breastfeeding was frequently experienced as unexpected and 'devastating', leaving mothers with 'breastfeeding grief' (a prolonged sense of loss and failure). CONCLUSIONS AND IMPLICATIONS For many mothers, the cessation of exclusive breastfeeding results in lingering feelings of grief and failure making it harmful to women's emotional well-being. Reframing breastfeeding as a family practice where fathers/partners are incorporated as breastfeeding partners has the potential to help women negotiate and prolong breastfeeding. Proactive counselling and debriefing are needed to assist women who are managing feelings of 'breastfeeding grief'.
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Affiliation(s)
- Jennifer Elizabeth Ayton
- School of Medicine College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Tesch
- School of Creative Arts and Media, University of Tasmania, Hobart, Tasmania, Australia
| | - Emily Hansen
- School of Social Sciences, University of Tasmania, Hobart, Tasmania, Australia
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16
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Hairston IS, Handelzalts JE, Lehman-Inbar T, Kovo M. Mother-infant bonding is not associated with feeding type: a community study sample. BMC Pregnancy Childbirth 2019; 19:125. [PMID: 30975095 PMCID: PMC6458683 DOI: 10.1186/s12884-019-2264-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Bonding refers to emotions and cognitions towards one’s infant. Breastfeeding is believed to facilitate bonding, yet only a handful of studies have empirically tested this assertion. This study aimed to confirm whether a positive association between breastfeeding and bonding exists and whether breastfeeding may be protective against the negative consequences of mood and sleep disturbances on bonding. Method A cross-sectional survey was administered to a convenience sample of Israeli mothers of infants ages 1–9 months. The main outcome measures were breastfeeding history, bonding (Postpartum Bonding Questionnaire, PBQ), mood (Edinburgh Postnatal Depression Scale, EPDS) and sleep (Pittsburgh Sleep Quality Index, PSQI). Results Two hundred seventy-one mothers (21–46 years) completed the survey. 65.7% reported current breastfeeding, 22.1% past breastfeeding, 12.2% never nursed. The PBQ correlated with both the EPDS and PSQI. Breastfeeding was associated with greater daytime fatigue, but not with any other sleep problem, and was not associated with bonding. This negative result was confirmed with Bayesian analysis demonstrating that the probability for the null hypothesis was 4.5 times greater than the hypothesized effect. Further, hierarchical regression revealed a positive relationship between bonding, daytime fatigue and depression symptoms only among women who were currently breastfeeding. Conclusions These findings suggest that among healthy mothers, breastfeeding may not be a central factor in mother-infant bonding, nor is it protective against the negative impact of mood symptoms and bonding difficulties. Theoretical and methodological bases of these findings are discussed. Electronic supplementary material The online version of this article (10.1186/s12884-019-2264-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ilana S Hairston
- Department of Psychology, Academic College of Tel-Hai, 1220800, Qiryat Shemona, Israel. .,Psychiatry Department, University of Michigan, Ann Arbor, 48109, USA.
| | | | - Tamar Lehman-Inbar
- School of Behavioral Science, Academic College of Tel Aviv, Jaffa, Israel
| | - Michal Kovo
- Obstetrics & Gynecology, Edith Wolfson Medical Center, Ha-Lochamim 62, Holon, Israel.,Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Pagani V, Alla F, Cambon L, Claudot F. [Elaboration of prevention norms: Need for ethical reflection]. SANTE PUBLIQUE 2019; 30:321-331. [PMID: 30541261 DOI: 10.3917/spub.183.0321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Public health tries to modify existing social norms by setting up strategies to promote the emergence of norms that are more adapted to the objectives of good health and well-being. Prevention policies and the corresponding interventions concern health behaviours and are designed to modify the individual's habits, and contribute to defining new ways of being, acting and living. Prevention therefore involves numerous personal, cultural, social and collective values. An ethical reflection concerning the meaning, rationale and justice of these actions is therefore essential. The objective of this study is to characterize the ethical reflection at the time of creation of public health norms. METHODS A narrative review, based on the Web of Science database covering journals of the various disciplines concerned, was conducted to address this issue. RESULTS Thirty-four publications were selected, illustrating the numerous definitions and types of norms used in public health intervention strategies. Many stakeholders are involved in the creation of public health norms specialists, opinion leaders, and social stakeholders. Finally, although some publications stress that the use of prevention norms raises a number of ethical issues, no publication refers to the presence of a structured ethical reflection as part of this process. CONCLUSION Ethical reflection is an essential part of prevention interventions and tools. What is the best way of achieving the best results? How to resolve conflicts of interests? These issues must be addressed when developing policies or programmes and can more effectively guide public health strategies and help to improve their acceptability and efficacy in populations.
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18
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Nieuwoudt S, Manderson L. Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: a qualitative exploration of policy translation. Int Breastfeed J 2018; 13:20. [PMID: 29930693 PMCID: PMC5992713 DOI: 10.1186/s13006-018-0164-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Abstract
Background Mothers rely heavily on health worker advice to make infant feeding decisions. Confusing or misleading advice can lead to suboptimal feeding practices. From 2001, HIV positive mothers in South Africa were counseled to choose either exclusive breastfeeding or exclusive formula feeding to minimize vertical HIV transmission. On the basis of revised World Health Organization guidelines, the government amended this policy in 2011, by promoting exclusive breastfeeding and discontinuing the provision of free formula. We explored how health workers experienced this new policy in an HIV endemic community in 2015–16, with attention to their knowledge of the policy, counselling practices, and observations of any changes. Methods We interviewed eleven health workers, from four community health clinics, who had counseled mothers before and after the policy change. The transcribed interviews were analyzed thematically, using a hybrid coding approach. Results The scientific rationale of the policy was not explained to most health workers, who mostly thought that the discontinuation of the formula program was cost-related. The content of their counseling reflected knowledge about promoting breastfeeding for all women, and accordingly they mentioned the nutritional and developmental benefits of breastfeeding. The importance of exclusive breastfeeding for all infants was not emphasized, instead counseling focused on HIV prevention, even for uninfected mothers. The health workers noted an increased incidence of breastfeeding, but some worried that to avoid HIV disclosure, HIV positive mothers were mixed feeding rather than exclusively breastfeeding. Conclusions Causal links between the policy, counseling content and feeding practices were unclear. Some participants believed that breastfeeding practices were driven by finance or family pressures rather than the health information they provided. Health workers generally lacked training on the policy’s evidence base, particularly the health benefits of exclusive breastfeeding for non-exposed infants. They wanted clarity on their counseling role, based on individual risk or to promote exclusive breastfeeding as a single option. If the latter, they needed training on how to assist mothers with community-based barriers. Infant feeding messages from health workers are likely to remain confusing until their uncertainties are addressed. Their insights should inform future guideline development as key actors.
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Affiliation(s)
- Sara Nieuwoudt
- 1School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.,2Developmental Pathways Health and Research Unit, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa
| | - Lenore Manderson
- 1School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.,3Institute at Brown for Environment and Society, Brown University, 85 Waterman St, Providence, RI 02912 USA
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Al-Mutairi NF, Al-Omran YA, Parameaswari PJ. Breastfeeding practice and knowledge among women attending primary health-care centers in Riyadh 2016. J Family Med Prim Care 2018; 6:392-398. [PMID: 29302553 PMCID: PMC5749092 DOI: 10.4103/jfmpc.jfmpc_243_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Breast milk is the best natural essential nutrition to newborns and infants. However, the practice of breastfeeding (BF) has declined in Saudi Arabia. Objective: The objective of this study was to assess the knowledge and practice of BF with their determinants among mothers in Riyadh. Materials and Methods: In this cross-sectional study, 252 mothers attending the well-baby clinics in Riyadh from March 2016 to May 2017 were selected randomly with their consent and studied by a standardized questionnaire. Results: Of the 252 women, 69.4% were 25–35 years of age and 56.7% with a bachelor degree or higher education. Nearly 75% mothers had education on BF before our study. Mixed feeding was the most preferred method (51.6%) followed by artificial milk (29.4%). The most reported reason for discontinuing BF was breast milk insufficiency (37.3%) and of breastfeed continuation was their perceived benefit (36.6%). Excellent knowledge was observed among 12.7%, good knowledge in 57.1%, and unsatisfactory level in 30.2% mothers. The regression model shows that high school education improved the knowledge by 10.9 points (P = 0.024) and undergraduate by 18.7 points (P value = 0.001) when compared to women who were literate. Women with parity >5 improved knowledge score by 17.3 points (P < 0.001). Conclusion: We observed that majority (57.1%) of Saudi mothers had a moderate level of knowledge on BF benefits and 19% had practiced exclusive BF. There is a need for better educational programs to increase awareness on its benefits for the health situation in the country on the long term.
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The Relationship of Pregnancy Intentions to Breastfeeding Duration: A New Evaluation. ACTA ACUST UNITED AC 2017. [DOI: 10.1108/s0275-495920170000035002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Kalil IR, Aguiar ACD. Silêncios nos discursos pró-aleitamento materno: uma análise na perspectiva de gênero. REVISTA ESTUDOS FEMINISTAS 2017. [DOI: 10.1590/1806-9584.2017v25n2p637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo: Este artigo aborda os discursos da atual Política Nacional de Aleitamento Materno brasileira, enfocando sentidos pouco explorados em seus materiais educativos. As perspectivas teórico-metodológicas adotadas foram a Semiologia dos Discursos Sociais, que entende o discurso como constitutivo e constituinte das relações sociais de poder, e os Estudos de Gênero, que questionam a naturalização da dualidade feminino/masculino como estruturante de uma essência fixa do ser. A análise identificou como, em geral, os materiais continuam a enfatizar a importância do aleitamento materno para a saúde da criança, omitindo ou tratando de forma estereotipada as perspectivas das mulheres sobre a prática. A complexidade da amamentação é pouco abordada, e o desmame como transição subjetiva na relação entre mãe, criança e mundo social, silenciado.
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Newhook JT, Ludlow V, Newhook LA, Bonia K, Goodridge JM, Twells L. Infant-Feeding among Low-Income Women: The Social Context that Shapes their Perspectives and Experiences. Can J Nurs Res 2017; 45:28-49. [DOI: 10.1177/084456211304500303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stevens LM. Environmental Contaminants and Reproductive Bodies: Provider Perspectives on Risk, Gender, and Responsibility. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:471-485. [PMID: 27803265 DOI: 10.1177/0022146516671569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increasingly, leading health organizations recommend that women who are pregnant or considering pregnancy avoid certain toxic chemicals found in our products, homes, and communities in order to protect fetuses from developmental and future harm. In the contemporary United States, women's maternal bodies have been treated as sites of exceptional risk and individual responsibility. Many studies have examined this phenomenon through the lens of lifestyle behaviors like smoking, drinking, and exercise. However, we know little about how environmental hazards fit into the dominant framework of gendered, individual responsibility for risk regulation. I draw on in-depth interviews with 19 reproductive healthcare providers in the United States to explore how they think about their patients' exposure to environmental contaminants and sometimes subvert this gendered, individualized responsibility and adopt more collective frames for understanding risk.
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Tomori C, Palmquist AEL, Dowling S. Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K. Soc Sci Med 2016; 168:178-185. [PMID: 27664771 DOI: 10.1016/j.socscimed.2016.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 12/20/2022]
Abstract
Recent public health breastfeeding promotion efforts have galvanized media debates about breastfeeding in wealthy, Euro-American settings. A growing body of research demonstrates that while breastfeeding is increasingly viewed as important for health, mothers continue to face significant structural and cultural barriers. Concerns have been raised about the moralizing aspects of breastfeeding promotion and its detrimental effects on those who do not breastfeed. Far less, however, is known about the moral experiences of those who pursue breastfeeding. This study draws together research on breastmilk sharing (2012-2016) and nighttime breastfeeding from the U.S. (2006-2009), and long-term breastfeeding from the U.K. (2008-2009) from three ethnographic projects to address this gap. Comparative analysis of these cases reveals that while breastfeeding is considered ideal infant nutrition, aspects of its practice continue to evoke physical and moral danger, even when these practices are implemented to facilitate breastfeeding. Breastmilk sharing to maintain exclusive breastmilk feeding, nighttime breastfeeding and bedsharing to facilitate breastfeeding, and breastfeeding beyond the accepted duration are considered unnecessary, unhealthy, harmful or even deadly. The sexual connotations of breastfeeding enhance the morally threatening qualities of these practices. The cessation of these "problematic" breastfeeding practices and their replacement with formula-feeding or other foods is viewed as a way to restore the normative social and moral order. Mothers manage the stigmatization of these breastfeeding practices through secrecy and avoidance of health professionals and others who might judge them, often leading to social isolation. Our findings highlight the divide between perceptions of the ideal of breastfeeding and its actual practice and point to the contested moral status of breastfeeding in the U.S. and the U.K. Further comparative ethnographic research is needed to illuminate the lived social and moral experiences of breastfeeding, and inform initiatives to normalize and support its practice without stigmatizing parents who do not breastfeed.
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Affiliation(s)
- Cecilia Tomori
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Sally Dowling
- University of the West of England, Bristol, United Kingdom
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Símonardóttir S. Constructing the attached mother in the “world's most feminist country”. WOMENS STUDIES INTERNATIONAL FORUM 2016. [DOI: 10.1016/j.wsif.2016.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ryan AS, Hay WW. Challenges of infant nutrition research: a commentary. Nutr J 2016; 15:42. [PMID: 27103229 PMCID: PMC4840881 DOI: 10.1186/s12937-016-0162-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/18/2016] [Indexed: 02/07/2023] Open
Abstract
Considerable advances have been made in the field of infant feeding research. The last few decades have witnessed the expansion in the number of studies on the composition and benefits of human milk. The practice of breastfeeding and use of human milk represent today’s reference standards for infant feeding and nutrition. Additional research regarding the benefits of breastfeeding is needed to determine which factors in human milk and in the act of breastfeeding itself, singly or in combination, are most important for producing the beneficial effects on infant growth, body composition, and neurodevelopmental outcome. We examine evidence that breastfeeding confers health benefits and offer suggestions on how best to interpret the data and present it to the public. We also describe some examples of well-designed infant nutrition studies that provide useful and clinically meaningful data regarding infant feeding, growth, and development. Because not all mothers choose to breastfeed or can breastfeed, other appropriate feeding options should be subjected to critical review to help establish how infant formula and bottle feeding can confer benefits similar to those of human milk and the act of breastfeeding. We conclude with the overarching point that the goal of infant feeding research is to promote optimal infant growth and development. Since parents/families may take different paths to feeding their infants, it is fundamental that health professionals understand how best to interpret research studies and their findings to support optimal infant growth and development.
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Affiliation(s)
- Alan S Ryan
- Clinical Research Consulting, 9809 Halston Manor, Boynton Beach, FL, 33473, USA.
| | - William W Hay
- Perinatal Research Center, University of Colorado School of Medicine, Anschutz Medical Campus, Mail Stop F441, 13243 East 23rd Avenue, Aurora, CO, 80045, USA
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Infant feeding and maternal guilt: The application of a feminist phenomenological framework to guide clinician practices in breast feeding promotion. Midwifery 2015; 34:58-65. [PMID: 26612001 DOI: 10.1016/j.midw.2015.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 10/12/2015] [Accepted: 10/17/2015] [Indexed: 11/23/2022]
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Chaput KH, Adair CE, Nettel-Aguirre A, Musto R, Tough SC. The experience of nursing women with breastfeeding support: a qualitative inquiry. CMAJ Open 2015; 3:E305-9. [PMID: 26442229 PMCID: PMC4593410 DOI: 10.9778/cmajo.20140113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Breastfeeding difficulties are a common occurrence, are highly personal and can vary from one infant to the next for any mother. Multiple sources of support, help and advice for breastfeeding are available to nursing mothers. Evidence suggests that the experience of the quality of breastfeeding supports may play an important role in maternal mental health and well-being in the postpartum period. We sought to explore the experiences of nursing mothers with support they received for breastfeeding in order to better inform and optimize existing breastfeeding supports and interventions. METHODS We conducted a qualitative inquiry of nursing mothers' experiences with help, advice and support for breastfeeding. Participants were asked to provide open-ended, written accounts of their experiences with all sources of breastfeeding support received in the 6 months following the delivery of a healthy full-term infant in Calgary. We conducted qualitative thematic analysis, using constant comparison techniques. RESULTS The sample included 86 mothers. Our analyses uncovered 4 emergent themes that contributed to the perceived quality of breastfeeding support: knowledge, effectiveness, sensitivity/emotional support and accessible when sought. INTERPRETATION Our study provides a greater understanding of how mothers perceive the quality of the breastfeeding support that they receive, as well as what qualities of breastfeeding support are seen as beneficial or negative. The qualities contributing to the perception of breastfeeding support are important to inform and optimize perinatal care, and potentially reduce the risk of negative mental health outcomes for mothers.
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Affiliation(s)
- Kathleen H Chaput
- Department of Community Health, University of Calgary; and Alberta Health Services, Calgary, Alta. ; Department of Paediatrics, University of Calgary; and Alberta Health Services, Calgary, Alta
| | - Carol E Adair
- Department of Community Health, University of Calgary; and Alberta Health Services, Calgary, Alta. ; Department of Psychiatry, University of Calgary; and Alberta Health Services, Calgary, Alta
| | - Alberto Nettel-Aguirre
- Department of Community Health, University of Calgary; and Alberta Health Services, Calgary, Alta. ; Department of Paediatrics, University of Calgary; and Alberta Health Services, Calgary, Alta
| | - Richard Musto
- Department of Community Health, University of Calgary; and Alberta Health Services, Calgary, Alta. ; Cumming School of Medicine, University of Calgary; and Alberta Health Services, Calgary, Alta
| | - Suzanne C Tough
- Department of Community Health, University of Calgary; and Alberta Health Services, Calgary, Alta. ; Department of Paediatrics, University of Calgary; and Alberta Health Services, Calgary, Alta
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Abstract
Background: Breastfeeding is currently strongly recommended by midwives and paediatricians, and the recommendations are based on documents provided by the World Health Organization and public health authorities worldwide. Research question: The underlying question is, how are non-breastfeeding mothers affected emotionally when informed that breastfeeding is the safest and healthiest option? Research design: The method used is an anonymous web-based qualitative survey exploring the narratives of non-breastfeeding mothers, published on Thesistools.com . The aim is to achieve qualitative knowledge about the emotions of non-breastfeeding mothers. Participants and research context: Participants were based in Sweden, the United Kingdom and the Netherlands and were selected through a purposeful sample. Ethical considerations: The online survey anonymizes responses automatically, and all respondents had to tick a box agreeing to be quoted anonymously in scientific articles. The study conforms to research ethics guidelines. Findings: Respondents describe how they were affected, and the following themes emerged in studying their descriptions: depression, anxiety and pain, feeling failed as a mother and woman, loss of freedom/feeling trapped, relief and guilt. Discussion: The themes are discussed against the background of the ethics of care and a theory of ethically responsible risk communication. Conclusion: Three conclusions are made. First, the message should become more empathetic. Second, information should be given in an attentive dialogue. Third, information providers should evaluate effects in a more inclusive way.
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Braimoh J, Davies L. When 'breast' is no longer 'best': Post-partum constructions of infant-feeding in the hospital. Soc Sci Med 2014; 123:82-9. [PMID: 25462608 DOI: 10.1016/j.socscimed.2014.10.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
In this paper, we focus on the initial experiences of breastfeeding among mothers to examine the ways that infant-feeding is socially constructed in the hospital. Data comes from 51 in-depth interviews with 17 first-time mothers in Ontario, Canada. Analysis reveals 52 magnified moments that we categorize as Successful, Ultimately Successful and Unsuccessful. For mothers who describe Successful and Ultimately Successful moments, breastfeeding is understood as physiologically natural, and as something they must learn to do. Unsuccessful moments reveal that when health care providers interpret breastfeeding as not working, the breastfeeding discourse frequently shifts to one that incorporates formula as the means to achieve optimal infant health. In other words, in the hospital 'breast is best' holds true when breast 'works', otherwise mothers are often directed to give their babies formula. While formula appears to be compulsory in these moments, it is not typically understood as a "good or best" infant-feeding practice. For mothers in this situation, the shift from breast to formula is experienced as failures or evidence of inadequacy in their mothering. Paradoxically, our results suggest that formula may not, in and of itself, pose a threat to mothers' overall continued practice of breastfeeding. It appears that Successful and Ultimately Successful moments coincide with the current dominant 'breast is best' understanding. Unsuccessful moments, conversely, are insightful because they reveal when and how hospital practices disrupt mothers' understanding of their bodies and their role in providing the 'best' form of infant food. The implications for policy and practice are discussed.
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Affiliation(s)
- Jessica Braimoh
- Department of Sociology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
| | - Lorraine Davies
- Department of Sociology, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C2, Canada.
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Stockdale J, Sinclair M, Kernohan G, McCrum-Gardner E, Keller J. Sensitivity of the breastfeeding motivational measurement scale: a known group analysis of first time mothers. PLoS One 2013; 8:e82976. [PMID: 24391731 PMCID: PMC3876990 DOI: 10.1371/journal.pone.0082976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
Breastfeeding has immense public health value for mothers, babies, and society. But there is an undesirably large gap between the number of new mothers who undertake and persist in breastfeeding compared to what would be a preferred level of accomplishment. This gap is a reflection of the many obstacles, both physical and psychological, that confront new mothers. Previous research has illuminated many of these concerns, but research on this problem is limited in part by the unavailability of a research instrument that can measure the key differences between first-time mothers and experienced mothers, with regard to the challenges they face when breastfeeding and the instructional advice they require. An instrument was designed to measure motivational complexity associated with sustained breast feeding behaviour; the Breastfeeding Motivational Measurement Scale. It contains 51 self-report items (7 point Likert scale) that cluster into four categories related to perceived value of breast-feeding, confidence to succeed, factors that influence success or failure, and strength of intentions, or goal. However, this scale has not been validated in terms of its sensitivity to profile the motivation of new mothers and experienced mothers. This issue was investigated by having 202 breastfeeding mothers (100 first time mothers) fill out the scale. The analysis reported in this paper is a three factor solution consisting of value, midwife support, and expectancies for success that explained the characteristics of first time mothers as a known group. These results support the validity of the BMM scale as a diagnostic tool for research on first time mothers who are learning to breastfeed. Further research studies are required to further test the validity of the scale in additional subgroups.
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Affiliation(s)
- Janine Stockdale
- School of Nursing and Midwifery, University of Ulster, Belfast, Northern Ireland
- * E-mail:
| | - Marlene Sinclair
- School of Nursing, University of Ulster, Belfast, Northern Ireland
| | - George Kernohan
- School of Nursing, University of Ulster, Belfast, Northern Ireland
| | | | - John Keller
- Instructional Systems Faculty, Florida State University, Tallahassee, Florida, United States of America
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Torres JMC. Medicalizing to demedicalize: lactation consultants and the (de)medicalization of breastfeeding. Soc Sci Med 2013; 100:159-66. [PMID: 24444851 DOI: 10.1016/j.socscimed.2013.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 11/03/2013] [Accepted: 11/04/2013] [Indexed: 11/15/2022]
Abstract
This paper uses the domain of breastfeeding in the U.S. and the work of International Board Certified Lactation Consultants to refine the concept of medicalization-demedicalization. Given lactation consultants' origins and current role in maternity care, they provide a unique lens on these processes because they are positioned at the crossroads of medicalization and demedicalization. Using 150 h of ethnographic observation and 39 interviews conducted between 2008 and 2012, I identify aspects of medicalization-demedicalization in the work of lactation consultants according to four dimensions: medical definition, medical control, pathology, and medical technology. Lactation consultants work to demedicalize breastfeeding by challenging the construction of breastfeeding pathology and limiting intervention. At the same time, they hold a position of medical control and medicalize breastfeeding by reinforcing a medical definition and using medical technology to treat breastfeeding problems. However, lactation consultants are not only working toward demedicalization and medicalization simultaneously, but are also medicalizing to demedicalize. Their position of medical control over breastfeeding provides them with a certain measure of authority that they can use in their efforts to depathologize breastfeeding and limit medical intervention. These findings build upon previous research that has identified cases of medicalization and demedicalization occurring simultaneously and draw attention to the need for an understanding of medicalization-demedicalization as a continuous process. Furthermore, the concept of "medicalizing to demedicalize" provides a novel contribution to the literature.
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Affiliation(s)
- Jennifer M C Torres
- University of Michigan, 3001 LSA Building, 500 S. State St., Ann Arbor, MI 48109-1382, USA.
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Liverani M, Hawkins B, Parkhurst JO. Political and institutional influences on the use of evidence in public health policy. A systematic review. PLoS One 2013; 8:e77404. [PMID: 24204823 PMCID: PMC3813708 DOI: 10.1371/journal.pone.0077404] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/02/2013] [Indexed: 11/30/2022] Open
Abstract
Background There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making. Methods We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review. Findings 56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies. Conclusions This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.
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Affiliation(s)
- Marco Liverani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Benjamin Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Justin O. Parkhurst
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Why Breast Feeding is the Best Feeding? HEALTH SCOPE 2013. [DOI: 10.5812/jhs.10039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Manuals offering advice to new parents on the topic of infant feeding have recently begun to attend to the possible implications of pro-breast-feeding discourses for mothers’ subjective experiences, particularly with respect to guilt. In this article, we present a discursive analysis of focus groups with 35 Australian mothers in which we examine how mothers discuss their infant-feeding practices and their related subjective experiences. We focus on how the mothers draw upon notions of “guilt,” “choice,” and “emotional self-control” to attend to the possibility of moral judgment over their infant-feeding practices. We highlight a construction of choice that dramatically restricts permissible reasons for not breast-feeding one’s infant and a pervasive view that guilt is a natural and appropriate response for “good” mothers who do not breast-feed. We argue that the incorporation of advice to mothers that they should “not feel guilty” is unrealistic in a context in which breast-feeding is so heavily advocated and that, rather than providing relief or comfort, this advice can create an additional burden for mothers who do not breast-feed. Finally, we reflect upon the implications of our findings in relation to the provision of public health information to women making choices around how to feed their infants.
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Affiliation(s)
- Kate Williams
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Ngaire Donaghue
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Tim Kurz
- University of Exeter, Exeter, Devon, United Kingdom
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Ludlow V, Newhook LA, Newhook JT, Bonia K, Goodridge JM, Twells L. How formula feeding mothers balance risks and define themselves as ‘good mothers’. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2012.662635] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McDonald K, Amir LH, Davey MA. Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals. BMC Public Health 2011; 11 Suppl 5:S5. [PMID: 22168473 PMCID: PMC3247028 DOI: 10.1186/1471-2458-11-s5-s5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual's decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine. DISCUSSION Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. "Good" mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children's needs before their own - they should not allow toxins to enter the body. On the other hand, "responsible" women take and act on medical advice - they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies. SUMMARY The increased complexity involved when one body's actions impact the body of another - as in the pregnant and lactating body - has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.
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Affiliation(s)
- Karalyn McDonald
- Mother & Child Health Research, La Trobe University, 215 Franklin St., Melbourne, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin St., Melbourne, Australia
| | - Lisa H Amir
- Mother & Child Health Research, La Trobe University, 215 Franklin St., Melbourne, Australia
| | - Mary-Ann Davey
- Mother & Child Health Research, La Trobe University, 215 Franklin St., Melbourne, Australia
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Abstract
Extended breastfeeding is uncommon and accorded limited research attention in the United States. In this article I analyze in-depth interviews with 66 breastfeeding mothers in Northern California. Mothers reveal their understanding of extended breastfeeding through descriptions of the surveillance of breastfeeding and cautionary tales. I examine the form and content of cautionary tales, emphasizing the pervasive culture of surveillance that underpins their relevance to nursing mothers. I interpret the cautionary tales in light of the dyadic encounter of breastfeeding, maternal identity, and norms about older breastfeeding children. The analysis is relevant to future explorations of early weaning in other regions.
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Affiliation(s)
- Cindy A Stearns
- Department of Sociology, Sonoma State University, Rohnert Park, California 94928, USA.
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43
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Nihlen Fahlquist J, Roeser S. Ethical Problems with Information on Infant Feeding in Developed Countries. Public Health Ethics 2011. [DOI: 10.1093/phe/phr019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Ebert Wallace LJ, Taylor EN. Potential Risks of “Risk” Language in Breastfeeding Advocacy. Women Health 2011; 51:299-320. [DOI: 10.1080/03630242.2011.569857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Knaak SJ. Contextualising risk, constructing choice: Breastfeeding and good mothering in risk society. HEALTH RISK & SOCIETY 2010. [DOI: 10.1080/13698571003789666] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Abstract
For nearly two years, the U.S. Department of Health and Human Services spent $2 million on an ad campaign to promote breastfeeding by educating mothers about the risks of not doing so. Those risks were often communicated in provocative ways. One television ad, for example, showed a pregnant African American woman riding a mechanical bull, and then the message appears on the screen, “You wouldn't take risks before your baby is born. Why start after?”
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47
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Lyerly AD, Mitchell LM, Armstrong EM, Harris LH, Kukla R, Kuppermann M, Little MO. Risk and the pregnant body. Hastings Cent Rep 2009; 39:34-42. [PMID: 20050369 PMCID: PMC3640505 DOI: 10.1353/hcr.0.0211] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, not evidence.
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Affiliation(s)
- Anne Drapkin Lyerly
- Trent Center for Bioethics, Humanities and History of Medicine, Duke University, USA
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48
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Hausman BL. Motherhood and inequality: a commentary on Hanna Rosin's "The Case Against Breastfeeding". J Hum Lact 2009; 25:266-8. [PMID: 19666854 DOI: 10.1177/0890334409341180] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bernice L Hausman
- Department of English (0112), Virginia Tech, Blacksburg, VA 24061, USA
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49
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Feeding children and protecting women: The emergence of breastfeeding as an international concern. WOMENS STUDIES INTERNATIONAL FORUM 2009. [DOI: 10.1016/j.wsif.2009.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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50
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