A qualitative study of attitudes toward public breastfeeding among young Canadian men and women

Encouraging Breastfeeding Without Guilt: A Qualitative Study of Breastfeeding Promotion in the Singapore Healthcare Setting

Introduction

In Singapore, the healthcare system strongly encourages mothers to breastfeed and breastfeeding initiation is near-universal. However, sustained breastfeeding rates remain low. Little is currently known about how breastfeeding information disseminated in the healthcare setting influences women's breastfeeding experiences. This study explored breastfeeding promotion and educational resources from the perspective of Singaporean mothers and healthcare workers.

Methods

Semi-structured interviews with 14 mothers of infants aged 1-5 months and who had used obstetric, maternity, and/or paediatric services in Singapore, and 20 health workers with experience in general, obstetric, maternal, or paediatric care recruited using purposive sampling methods. Interview transcripts were coded using an inductive method.

Results

Breastfeeding communications were viewed as too moralized and too focused on nudging women to breastfeed, with relatively little emphasis on timely, practical information or solutions for mothers unable to latch. Hence mothers tended to rely on alternative resources such as blogs. They lacked in-depth knowledge of the benefits of breastfeeding and viewed it as detrimental to maternal mental wellbeing due to the perceived stress and guilt when experiencing difficulties, notably with milk supply and latching, and from the inability to meet breastfeeding expectations. Husbands, older family members, confinement nannies, and employers were considered influential individuals to encourage breastfeeding, but they commonly discouraged breastfeeding due to social and cultural factors which led to supplementation with formula.

Conclusion

For better breastfeeding outcomes, future informational sources on breastfeeding should be morally neutral, practical, set realistic expectations for the demands of breastfeeding, and target influential individuals such as family members, confinement nannies and employers.

Development, psychometric assessment, and predictive validity of a breastfeeding subjective norms scale among an Australian prospective cohort of first-time parents

OBJECTIVES

Breastfeeding has a number of benefits for both mothers and their infants. Research has examined the psychosocial influences on breastfeeding, yielding important findings in relation to particular constructs that play a significant role in this vital health behaviour. One such construct is subjective norms. However, there are mixed findings in relation to the role of subjective norms in breastfeeding behaviours. This may be due to the lack of consistent measure of subjective norms across studies. Further, the influence of fathers' subjective norms on breastfeeding continuation remains unclear due to a lack of measurement. Thus, the aim of the current study was to develop and assess a reliable and valid subjective norms scale specific to breastfeeding for use among both mothers and fathers.

DESIGN/METHODS

Subjective norms items were developed by researchers in the domain and were tested among 949 couples.

RESULTS

Findings indicated that both subjective norms scales had excellent reliability, construct validity, and predictive validity. It was also found that both the mothers' and fathers' subjective norms scales tapped into two key structures: breastfeeding in general, and breastfeeding in public. Further, maternal subjective norms were predictive of breastfeeding behaviours but not paternal subjective norms.

CONCLUSIONS

These findings indicate that the developed subjective norms scales are reliable and valid and capture key elements of breastfeeding subjective norms among both mothers and fathers. Use of this measure in future research can help better understand the role of both mothers' and fathers' subjective norms in influencing breastfeeding behaviours.

Views and experience of breastfeeding in public: A qualitative systematic review

Breastfeeding rates in many Global North countries are low. Qualitative research highlights that breastfeeding in public is a particular challenge, despite mothers often having the legal right to do so. To identify barriers and facilitators, we systematically searched the qualitative research from Organisation for Economic Co-operation and Development countries relating to breastfeeding in public spaces from 2007 to 2021. Data were analysed using the Thematic Synthesis technique. The review was registered with PROSPERO (registration number: CRD42017081504). Database searching identified 3570 unique records. In total, 74 papers, theses, or book chapters, relating to 71 studies, were included, accounting for over 17,000 mothers. Overall, data quality was high. Our analysis identified that five core factors influenced mothers' thought processes and their breastfeeding in public behaviour: legal system; structural (in)equality; knowledge; beliefs and the social environment. Macro-level factors relating to legislation and inequality urgently require redress if breastfeeding rates are to be increased. Widespread culture change is also required to enhance knowledge, change hostile beliefs and thus the social environment in which mother/infant dyads exist. In particular, the sexualisation of breasts, disgust narratives and lack of exposure among observers to baby-led infant feeding patterns resulted in beliefs which created a stigmatising environment. In this context, many mothers felt unable to breastfeed in public; those who breastfed outside the home were usually highly self-aware, attempting to reduce their exposure to conflict. Evidence-based theoretically informed interventions to remove barriers to breastfeeding in public are urgently required.

Perception and practice of breastfeeding in public in Poland

BACKGROUND

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

RESEARCH AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Factors affecting attitude towards breastfeeding in public: a cross-sectional web-based study on Polish women

Aim

Breastfeeding is believed to be beneficial to both mother and child. Although the percentage of Polish mothers who start breastfeeding after childbirth is relatively high, most of them finish after 8–12 weeks. Many factors are involved in the decision to stop, including an unfavourable social attitude towards breastfeeding in public. Our cross-sectional web-based study was conducted to identify the factors predicting negative attitudes towards public breastfeeding among Polish women.

Subjects and methods

A population-based internet-administered public opinion survey was conducted among 663 women aged 19 to 50 years old regarding their attitude towards breastfeeding in public. The participants completed a questionnaire concerning demographic data, general beliefs about breastfeeding and attitudes towards breastfeeding in public.

Results

Overall, 46.6% of respondents had a negative attitude towards breastfeeding in public. Multivariable logistic regression analysis found that the beliefs that breastfeeding is not a natural activity [adjusted odds ratio (AOR) = 17.54; 95% CI = 1.44–21.95] and that breastfeeding is not emotionally moving (AOR = 8.73; 95% CI = 3.950–19.30) or not having any opinion (AOR = 2.31; 95% CI: 1.18–4.50) to play the most significant roles in shaping a negative attitude, as well as breastfeeding their own child for < 6 months (AOR = 13.93; 95% CI = 0.14–20.24).

Conclusions

As women’s beliefs about breastfeeding play a key role in choosing to breastfeed in public, there is a need to further explore attitudes regarding this activity.

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review

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

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

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Breastfeeding (Un)Covered: Narratives of Public Breastfeeding on Romanian Discussion Forums

PURPOSE

The aim of this study was to explore the construction of breastfeeding in public, as depicted in the stories and the opinions of women participating in discussions on public forums.

METHOD

There were 8 discussion forums selected, from which 769 messages were subjected to a narrative analysis further informed by recurrent themes identified in the literature and across messages. The emerging narratives were grouped based on their valence, and three broader categories of themes were formed, highlighting the predominant tone towards breastfeeding in public.

RESULTS

The three broader themes, 'public restraint of breast(feeding) as acknowledgement of the cultural status-quo', 'permission within boundaries' and 'breast(feeding) as a human right', depict various meanings and experiences associated with public breastfeeding. People seeing breasts as mainly a cultural symbol of sexuality were more against public breastfeeding and more in favour of covering up or striving to discretion. Those arguing that breastfeeding is no more than exercising a fundamental right and pleading for breast as a primary maternal symbol were more in favour of breastfeeding in public.

CONCLUSION

Aiming to understand personal and social perspectives on public breastfeeding is informative for understanding cultural differences in breastfeeding rates but also for designing effective interventions to promote it.

Psychometric Assessment and Precision Remodeling of the Iowa Infant Feeding Attitude Scale to Improve Clinical Use and Efficacy Among Prenatal Women in Canada

BACKGROUND

The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been widely used to assess maternal attitudes toward infant feeding and to predict breastfeeding intention. The IIFAS has been validated among prenatal women located in Newfoundland and Labrador in Canada, although its length may prove challenging to complete in a clinical setting. Research aim: The authors aimed to reduce the number of items from the original 17-item IIFAS scale while maintaining reliability and validity.

METHODS

A nonexperimental cross-sectional design was used among 1,283 women in their third trimester residing in Newfoundland and Labrador. Data were collected from August 2011 to June 2016. An exploratory factor analysis using principal component analysis was performed to explore the underlying structure of the IIFAS. The internal consistency of both the 17-item and reduced version was assessed using Cronbach's alpha and item-total correlation. The area under the curve and linear regression model were used to assess predictive validity of intention to breastfeed.

RESULTS

Our findings revealed that a 13-item IIFAS (Cronbach's α = .870) had relatively similar internal consistency to the original IIFAS (Cronbach's α = .868). Three themes were extracted from the factor analysis, resulting in the removal of four items. The reduced scale demonstrated an excellent ability to predict breastfeeding intention (area under the curve = 0.914).

CONCLUSION

The reduced 13-item version of the IIFAS is a psychometrically sound instrument that maintains its accuracy and validity when measuring maternal feeding attitudes during pregnancy and can be more time efficient in clinical settings compared with the 17-item IIFAS.

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

OBJECTIVE

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

DESIGN

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

SETTING

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

SUBJECTS

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

RESULTS

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

CONCLUSIONS

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

Breastfeeding as a public health responsibility: a review of the evidence

BACKGROUND

Although intention to breastfeed in Western culture is high, many women stop breastfeeding before they are ready. From a physiological perspective, rates of primary milk insufficiency or contraindications to breastfeed should be low. However, numerous women encounter numerous barriers to breastfeeding, many of which occur at the social, cultural and political level and are therefore outside of maternal control. This review identifies and examines the impact of these barriers and considers how public health services should play a central role in creating a supportive breastfeeding environment.

METHODS

A narrative review to synthesise themes in the literature was conducted, using Web of Science, PubMed and Science Direct. Barriers to breastfeeding at the societal rather than individual level were identified (e.g. in relation to health services, policies and economic factors). Only English language papers were included.

RESULTS

Many barriers to breastfeeding exist at the societal rather than individual level. These influences are typically outside mothers' control. Five core themes were identified; the need for investment in (i) health services; (ii) population level health promotion; (iii) supporting maternal legal rights; (iv) protection of maternal wellbeing; and (v) reducing the reach of the breast milk substitute industry.

CONCLUSIONS

Although individual support is important, breastfeeding must be considered a public health issue that requires investment at a societal level. Focusing solely on solving individual issues will not lead to the cultural changes needed to normalise breastfeeding. Countries that have adopted a multicomponent public heath strategy to increase breastfeeding levels have had significant success. These strategies must be emulated more widely.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Public Attitudes Toward Breastfeeding in Public Places in Ottawa, Canada

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Using breastfeeding images to promote breastfeeding among young adults

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

Views of fathers in Ireland on the experience and challenges of having a breast-feeding partner

OBJECTIVE

this study investigated the relationship between fathers and breast feeding in Ireland.

DESIGN AND METHOD

a cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions was posted to 1398 men with an Irish partner who had given birth 4-7 months previously. Fathers who specified that their partner breast fed their last or only child were questioned about their: influence on the breast feeding decision; ability to assist with breast feeding challenges; preferred type of information on breast feeding; perceived advantages and disadvantages to breast feeding; and views on breastfeeding in public. Data from closed-ended questions on breast feeding were presented using frequencies and associated percentages. Answers to open-ended questions on breast feeding were categorised into themes using content analysis. Each theme was assigned a numerical code and the themes developed were quantitatively counted and presented as frequencies and percentages.

FINDINGS

of the 583 respondents (42% response rate), 417 (71.5%) had a partner who had breast-fed their last or only child. Most of the 417 fathers were employed (95.7%, n399), college-educated (76.7%, n320) and married (87.8%, n366). Most (75.5%, n315) fathers were involved in the breast feeding decision. The majority (77.5%, n323) of fathers were unprepared for at least one aspect of breast feeding, most commonly that their partner encountered difficulties in establishing breast feeding. Of those fathers with a partner who experienced difficulties with breastfeeding (56.8%, n237), half (49.4%, n117) were unable to help their partner to overcome her breast feeding difficulties. Two-fifths (41.0%, n133) of fathers felt deprived of bonding time. Almost one in ten (9.4%, n39) fathers felt uncomfortable with an unrelated woman breast feeding in public, and this increased to three in ten or one third (34.3%, n143) if the woman in question was their partner.

KEY CONCLUSION

while fathers in a well-educated and socially advantaged sample are largely supportive of breast feeding, significant challenges remain in terms of their ability to support breast feeding in an informed and practical manner.

IMPLICATIONS FOR PRACTICE

women who are practically and emotionally supported by their partners are more likely to successfully breast feed, but the male perspective of breast feeding in Ireland has been given little attention. This study supports earlier and more effective engagement of fathers throughout the breast feeding process, and highlights areas of concern with respect to the role of fathers in breast feeding.

What Do Women Really Want? Lessons for Breastfeeding Promotion and Education

BACKGROUND

Promoting breastfeeding is a strategic priority, but breastfeeding rates remain low in the United Kingdom. Women value breastfeeding promotion and education, but a different strategy may be needed to continue to raise breastfeeding rates. New mothers, as the experts, are best placed to inform these changes. The current study explored new mothers' attitudes toward breastfeeding education and promotion, evaluating experiences and examining ideas for change.

MATERIALS AND METHODS

One thousand one hundred thirty mothers with a baby aged 0-2 years old who had planned to breastfeed at birth completed a questionnaire consisting of both closed and open-ended questions exploring their attitudes to breastfeeding promotion and support.

RESULTS

Overall, the findings showed that mothers valued breastfeeding information, but believed that changes needed to be made to current messages. Key themes included a move away from the perception that breastfeeding is best (rather than normal), emphasis on wider values other than the health benefits of breastfeeding, and a message that every feed, rather than just 6 months exclusive breastfeeding, matters. Mothers also highlighted the need for promotion and education to target family members and wider society rather than simply mothers themselves, all of whom influenced both directly or indirectly maternal decision and ability to breastfeed. Mothers suggested ideas for promotional campaigns or how specific groups or methods could be used to increase support, including education for children, TV adverts, and using established online sources of breastfeeding information.

CONCLUSIONS

The findings are important both for those supporting new mothers to breastfeed and those involved in breastfeeding policy and promotional messages.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

"#discrimination": The Online Response to a Case of a Breastfeeding Mother Being Ejected from a UK Retail Premises

BACKGROUND

Stigma is a significant barrier to breastfeeding. Internationally, mothers have reported stigma surrounding public breastfeeding. In the United Kingdom, the Equality Act 2010 gives women the right to breastfeed in public, including within private businesses. In April 2014, a woman who was breastfeeding in a UK sports shop was asked to leave, resulting in a localized protest by breastfeeding mothers. This resulted in the issue of public breastfeeding being highlighted in local, national, and social media.

OBJECTIVE

To examine online opinion regarding breastfeeding in public and protesting about the right to breastfeed in public within the context of a single case.

METHODS

Online user-generated content relating to the case of Wioletta Komar was downloaded from Twitter and the comments section of a UK online news source, Mail Online. Data comprised 884 comments and 1210 tweets, collected within 24 hours of the incident. Semiotic and thematic analysis was facilitated by NVivo 10.

RESULTS

Comments from Twitter were supportive (76%) or neutral (22%) regarding the protesting women and public breastfeeding. Conversely, Mail Online comments were mostly negative (85%). Mail Online posters questioned the legality of public breastfeeding, while Twitter comments acknowledged and supported women's legal right to breastfeed publicly. Many Mail Online commenters stated that they found it uncomfortable to watch breastfeeding or thought it was unnecessary to breastfeed in public.

CONCLUSION

If the UK government is serious about increasing breastfeeding, interventions to promote public support for public breastfeeding are urgently required.

Experiential Perceptions of Relactation: A Phenomenological Study

BACKGROUND

Relactation is the process of re-establishing a breast milk supply that has diminished or ceased.

OBJECTIVE

This study aimed to explore the lived experiences of women living in Montana who chose to attempt relactation.

METHODS

A phenomenological approach was used to understand the lived experiences of 10 women in Montana who attempted relactation. In-depth interviews were conducted, and a 21-item categorical and open-ended demographic and experiential questionnaire was completed.

RESULTS

An overarching theme that could have affected the initial breastfeeding experience, and furthered the need for relactation, was having a difficult baby. Examples of being difficult included colic, latching issues, or a lack of bonding felt by the participant.

CONCLUSION

When asked about the experience of relactation, participants reflected on the emotional aspects of the process rather than the physical process. The most common feelings expressed were rejection, anger, stress, and failure. Future studies could examine what factors are present with women who continue nursing versus factors that are absent in women who discontinue nursing difficult babies, which could help prevent the need for relactation.

Predictors of exclusive breastfeeding: observations from the Alberta pregnancy outcomes and nutrition (APrON) study

BACKGROUND

Despite growing evidence that supports the importance of 6-month exclusive breastfeeding, few Canadian mothers adhere to this, and early weaning onto solids is a common practice. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding to 3 and 6 months.

METHODS

This prospective cohort study was part of the Alberta Pregnancy Outcomes and Nutrition study (APrON). From an initial sample of 600 pregnant women recruited from Edmonton and Calgary, 402 mothers provided complete details at 3 months postpartum; 300 stayed on to provide information at 6 months postpartum. During pregnancy and at 3 and 6 months postpartum, data on maternal and infant socio-demographic, behavior, and feeding were collected.

RESULTS

Even though there was a high rate of "ever having breastfed" (98.6%), exclusive breastfeeding rates for 3 and 6 months were 54.0% and 15.3%, respectively. After controlling for potential confounders, the study showed that mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree (95% CI: 1.30-10.92; p = 0.015). In addition, mother of previous children were more likely to breastfeed exclusively for 6 months (OR: 2.21, 95% CI: 1.08-4.52; p = 0.031). Mothers who were in the highest quartile of the Iowa Infant Feeding Attitude Score were 4.29 and 5.40 times more likely to breastfeed exclusively for 3 months (95% CI: 1.31-14.08; p-trend < 0.001) and 6 months (95% CI: 2.75-10.60; P-trend < 0.001), respectively.

CONCLUSIONS

The 6-month exclusive breastfeeding rate in Alberta is considerably below national and international breastfeeding recommendations. Professional advice that focuses on prenatal maternal knowledge, attitudes, and misperceptions may promote adherence to World Health Organization breastfeeding guidelines. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, primiparous women may help health practitioners focus their support and education for this group.

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

BACKGROUND

Community attitudes toward breastfeeding in public influence how comfortable women feel about continuing breastfeeding. Knowledge of the social context helps target breastfeeding-promoting interventions.

OBJECTIVE

To examine trends in Western Australian adult attitudes toward breastfeeding in public places.

METHODS

As part of 5 cross-sectional surveys from the Western Australian Nutrition Monitor Survey Series conducted between 1995 and 2009, 5496 adults aged 18 to 64 years were asked whether it was acceptable for mothers to breastfeed their babies in public places, including shopping centers, workplaces, and restaurants, and on public transport. Descriptive statistics and multinomial regressions were used to describe factors associated with attitudes toward publicly breastfeeding.

RESULTS

There was no change in the acceptance of breastfeeding in shopping centers, restaurants, and workplaces and on public transport over time, but in 2009, significantly fewer people said that it was unacceptable to breastfeed in public compared with 1995. Women, people older than 44 years, those born outside Australia, and the less educated were those most likely to say that breastfeeding in public was unacceptable. In the years that the question was asked, more than 97% of respondents said that breastfeeding was acceptable if a separate room was provided.

CONCLUSIONS

Making breastfeeding acceptable and pleasant for mothers in public spaces is a key policy recommendation. Women, people older than 44 years, and those born outside Australia were most likely to respond that breastfeeding in public was unacceptable unless a room was provided. Given that, on average, 70% of the population said that breastfeeding in public was acceptable, investigation into why some women do not think so is warranted.

Adolescent fathers: knowledge of and involvement in the breast feeding process in Brazil

OBJECTIVE

to understand the ways in which adolescent fathers participate in the breast feeding process in the family environment in North-eastern Brazil.

METHODS

a descriptive, exploratory, qualitative study was undertaken involving 10 couples with infants aged 6-8 months living in a single community in Recife, Pernambuco, Brazil. Data were collected using semi-structured interviews with questions to guide the interviewer. Data were analysed using thematic content analysis, and interpreted under the theoretical reference of being an adolescent father within the context of breast feeding.

FINDINGS

from the data collected, three themes were identified: knowledge of the benefits of breast feeding for the child's health; discontinued participation of the father in breast feeding during the pregnancy-childbearing cycle; and exclusion of the adolescent father from the breast feeding process. The adolescent fathers knew about the benefits of breast feeding in terms of the child's health, but did not mention benefits for the mother, the family or society. For some adolescent fathers, their participation in the breast feeding process started during pregnancy, whereas for others, it was only initiated after the infant was born. One of the fathers was prevented, by his wife and mother-in-law, from participating in the breast feeding process.

CONCLUSIONS

the involvement of adolescent fathers in the breast feeding process oscillated during the pregnancy-childbearing cycle. This may be due to the patriarchal cultural heritage, Brazilian paternity laws, and the fact that these fathers were adolescents. This study showed that adolescent parents were knowledgeable about breast feeding. Finally, fathers want a new model of parenting in which the man participates in child care.

Breastfeeding among high-risk inner-city African-American mothers: a risky choice?

OBJECTIVE

This study identified barriers to breastfeeding among high-risk inner-city African-American mothers.

SUBJECTS AND METHODS

We used audiotaped focus groups moderated by an experienced International Board Certified Lactation Consultant, with recruitment supported by the community partner MomsFirst™ (Cleveland Department of Public Health, Cleveland, OH). Institutional Review Board approval and written informed consent were obtained. Notes-based analysis was conducted with use of a prior analytic structure called Factors Influencing Beliefs (FIBs), redefined with inclusion/exclusion criteria to address breastfeeding issues.

RESULTS

Three focus groups included 20 high-risk inner-city expectant and delivered mothers. Relevant FIBs domains were as follows: Risk Appraisal, Self Perception, Relationship Issues/Social Support, and Structural/Environmental Factors. Risk Appraisal themes included awareness of benefits, fear of pain, misconceptions, and lack of information. Self Perception themes included low self-efficacy with fear of social isolation and limited expression of positive self-esteem. Relationship Issues/Social Support themes included formula as a cultural norm, worries about breastfeeding in public, and challenging family relationships. Structural/Environmental Factors themes included negative postpartum hospital experiences and lack of support after going home.

CONCLUSIONS

Several findings have been previously reported, such as fear of pain with breastfeeding, but we identified new themes, including self-esteem and self-efficacy, and new concerns, for example, that large breasts would suffocate a breastfeeding infant. The FIBs analytic framework, as modified for breastfeeding issues, creates a context for future analysis and comparison of related studies and may be a useful tool to improve understanding of barriers to breastfeeding among high-risk inner-city women.