Medicalization and women's knowledge: the construction of understandings of infant feeding experiences in post-WW II New Zealand

The Content and Sources of Breastfeeding Knowledge for New Mothers in the Netherlands

Background:

In the context of decreasing breastfeeding rates and unsuccessful breastfeeding promotion campaigns, a qualitative research project in the Northern part of the Netherlands was initiated.

Objectives:

As part of the overall project, the aim of this study was to explore the content and sources of breastfeeding knowledge among primiparous women. Identifying and categorizing the content and the sources of breastfeeding knowledge could guide professionals such as midwives and maternity nurses as well as others in the women’s surroundings to engage in disseminating knowledge and therefore support women in achieving their breastfeeding goals.

Methods:

We conducted 26 in-depth interviews from the emic perspective with 13 new mothers pre- and postpartum, up to saturation level. Transcripts were analysed applying thematic analysis. As sensitising concepts, the themes identified were divided into two categories: those gained from 'professional' sources and those obtained from 'popular' sources.

Results:

Five knowledge content themes were identified: (1) pros and cons of breastfeeding, (2) how breastfeeding works, (3) individual breastfeeding practice, (4) expressing milk, and (5) formula feeding. ‘Professional’ sources are perceived as more helpful than ‘popular’ sources, whereas ‘intuition’ was inductively identified as an important knowledge source.

Conclusion:

Limited breastfeeding practice exposure, along with the recommendations to breastfeed for six months and perceptions of breastfeeding as ‘natural’ at the same time, generates much pressure in women. Emphasizing all knowledge content in campaigns, addressing a variety of target groups in women’s social environment, and recognizing intuition as an adequate source of knowledge supported by professionals will facilitate women in making informed infant feeding decisions.

Performing Breastfeeding: Embodiment, Ethics and the Maternal Subject

Many feminist sociologists would agree that most breastfeeding research to date has been primarily undertaken from the perspective of medical and public health discourses. While there is evidence of a shift in research on breastfeeding to qualitative studies that focus on the lived experiences of breastfeeding women, this article addresses a number of concerns remaining in the literature surrounding breastfeeding. First, it questions the absence of breastfeeding as a legitimate philosophical topic, and, as a corollary, the invisibility of breastfeeding women as moral or ethical subjects. Second, by drawing on Michel Foucault's account of ethics and Judith Butler's notion of performativity, it is suggested that breastfeeding is best conceptualized as a gendered and embodied ethical practice rather than an aspect of one's being. Finally, this materialist approach to theorizing breastfeeding is discussed in relation to the Lucy Lawless poster that was released in Aotearoa New Zealand to launch World Breastfeeding Week in August 2002.

Resistance to breastfeeding: A Foucauldian analysis of breastfeeding support from health professionals

BACKGROUND

Despite widespread consensus regarding the health benefits of breastfeeding, the prevalence of six months exclusive breastfeeding is very low in developed countries including New Zealand.

AIM

This paper aims to evaluate the role that health professionals play in promoting exclusive breastfeeding in New Zealand.

METHODS

Qualitative research involving face to face postpartum interviews conducted four to six weeks after the birth with 30 new mothers who lived in New Zealand and had identified in a short antenatal questionnaire that they intended to practice exclusive breastfeeding for six months. Themes related to exclusive breastfeeding support from health professionals were extracted from the interview transcripts and interpreted using Foucault's ideas about governmentality and bio-power.

RESULTS

Four themes related to the quality of health care support were identified in the interview transcripts. 'Breastfeeding self-efficacy support from the community midwives', 'mothers need to know more about breastfeeding during pregnancy', 'experiencing difficulties breastfeeding' as well as 'pressure and resistance to breastfeeding'.

DISCUSSION

Most mothers in this research spoke about feeling pressured to breastfeed within the New Zealand health system. However, the participating mothers acknowledged the effective support that they had received from community midwives who respected their autonomy, strengthened their self-esteem and encouraged them to breastfeed.

CONCLUSION

Negative historical experiences related to the medicalization of infant feeding in Western countries suggests that health professionals need to provide effective skill support for breastfeeding mothers so that mothers do not consider it a form of "quiet coercion" or as an exercise of "power".

Calling, permission, and fulfillment: the interembodied experience of breastfeeding

Drawing on examples from in-depth interviews with 49 women, in this article we aim to open up a discursive space for women and health professionals to begin to explore the phenomenon of the interembodied experience of breastfeeding. Although acknowledging that social dimensions partially constitute the lived body, we further the view that the lived body's understanding is embedded in contexts far more complex than those that can be represented by language. We argue that women's narratives of their breastfeeding experience contained instances of the body "understanding" its emotional task at a prelogical, preverbal level. We identified three central, iterative dimensions of the phenomenon—calling, permission, and fulfillment—that occurred prereflexively in the protected space provided by the mother, a space that was easily disrupted by unsupportive postnatal practices. We offer this eidetic understanding and conceptual framework and suggest that it provides new (less damaging) subject positions and ways of behaving.

A meta-ethnographic synthesis of women's experience of breastfeeding

Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with 'moral' decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of 'expectation' and 'reality', while the emotional aspects of breastfeeding were expressed in 'connected' or 'disconnected' terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering.

The influence of the "they": an interpretation of breastfeeding culture in New Zealand

The society in which a woman breastfeeds has a significant effect on how she will interpret her breastfeeding experiences; however, only limited research has been conducted on the phenomenon of breastfeeding, despite the recognition that the majority of women do not breastfeed beyond 6 months. In this article I present the findings of a research study that explored the experience of breastfeeding for 19 women in New Zealand using an interpretive lifeworld methodology. The participants engaged in interviews about their experience of breastfeeding. The interviews were analyzed alongside Heidegger's exposition of the "they" as a dialogical partner. The findings are presented in themes that articulate how women experience societal culture when breastfeeding, and how this culture influences their interpretations of their breastfeeding experiences. This research contributes to expanding understandings about why women might wean their infants prematurely, and provides insights into how health care professionals might support women to prolong breastfeeding.

Moral work in women's narratives of breastfeeding

Women's narratives of their breastfeeding experiences are sites of construction and reconstruction of self as they undertake moral work in relation to feeding their baby. We engaged Foucault's 'technologies of the self' and his notion of ethics (the relationship with self) to examine that moral work (individual actions rather than adherence to universal moral codes) in relation to women's subjectivity constructed in interviews with 49 women from the UK. Four categories of moral work were identified: biographical preservation, biographical repair, altruism and political action. We describe each of these and conclude that women's embodied experience and sense of self are disciplined within current, limited, often punishing discourses by undertaking painful moral work in order to maintain or repair their subjective positions. We suggest the development of new subject positions around infant feeding practices.

Research methodologies to investigate the experience of breastfeeding: a discussion paper

This paper is a discussion of the importance of choosing appropriate methodologies to research the breastfeeding experience of women in the United Kingdom. Despite a plethora of research emphasising the benefits of breastfeeding to maternal and infant health, there is a relative dearth of research from the United Kingdom about women's experiences of breastfeeding. In order to understand the inherent complexities of successfully promoting and supporting breastfeeding, a mothers' breastfeeding experience must be examined within her specific context. This is increasingly recognised as a vital tool in providing effective support by health care professionals in extending breastfeeding duration. As such, this highlights the importance that appropriate methodologies are chosen through which to explore this phenomenon from the perspective of those experiencing it. This paper debates the importance of philosophical lines of enquiry in relation to breastfeeding research, and argues that engaging with ontological perspectives would offer opportunities for researchers to engage with women's understanding of breastfeeding in today's society. A hermeneutic phenomenological approach that is informed from feminist methodologies is deemed the most appropriate in researching mothers' views of breastfeeding.

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice

AIM

Part 2 of this paper aims to provide a methodological framework for the study of medication narratives, including a semi-structured interview guide and suggested method of analysis, in an attempt to aid the development of narrative scholarship within pharmacy practice research. Examples of medication narratives are provided to illustrate their diversity and usefulness.

METHODS

The framework is derived from the work of other researchers and adapted for our specific purpose. It comes from social psychology, narrative psychology, narrative anthropology, sociology and critical theory and fits within the social constructionist paradigm. The suggested methods of analysis could broadly be described as narrative analysis and discourse analysis. Examples of medication narratives are chosen from a variety of sources and brief interpretations are presented by way of illustration.

CONCLUSION

Narrative analysis, a neglected area of research in pharmacy practice, has the potential to provide new understanding about how people relate to their medicines, how pharmacists are engaged in producing narratives and the importance of narrative in the education of students. IMPACT OF THE ARTICLE: This article aims to have the following impact on pharmacy practice research: Innovative approach to researching and conceptualising the use of medicines. Introduction of a new theoretical perspective and methodology. Incorporation of social science research methods into pharmacy practice research. Development of narrative scholarship within pharmacy.