A Qualitative Study to Understand Nativity Differences in Breastfeeding Behaviors Among Middle-Class African American and African-Born Women

Abstract

Objective To explore nativity differences and the role of attitudes, social norms, and behavioral control perceptions surrounding breastfeeding initiation and duration among middle-class African-American (AA) and African-born (AB) mothers in the US. Methods Semi-structured individual interviews were conducted with 20 middle-class AA and AB mothers in central Ohio from December 2012 to February 2013. Interview questions were developed based on the Theory of Planned Behavior (TPB). Interviews were analyzed for salient themes by TPB constructs. Differences in themes were examined by nativity status. Results All study participants had initiated breastfeeding or bottle-feeding with expressed breast milk, noting the benefits it conferred as well as the persuasive encouragement they received from others. Persistent encouragement was often cited as a factor for sustaining breastfeeding. More AA mothers had discontinued breastfeeding by the time of the interview, which was often attributed to health, lactation, and work challenges. Inconsistent support from health providers, dissuasive remarks from others, ambivalent breastfeeding attitudes, and diminished family support led some mothers to begin formula supplementation. Analysis of maternal narratives revealed nativity differences across sources of encouragement. Specifically, important sources of encouragement were health providers for AA mothers and family, friends, partners and culture for AB mothers. Only AB mothers expressed concerns about difficulty they encountered with breastfeeding due to the lack of proximal family support. Conclusions Findings reveal that both groups of mothers may be susceptible to unsupportive breastfeeding norms in the US and also highlight the need for intervention in health care settings and workplaces to improve AA women's breastfeeding rates.

Racial and Ethnic Differences in Reasons for Breastfeeding Cessation Among Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

“…Qualitative work by Fabiyi et al identified different normative referents for breastfeeding: whereas African American women recalled bottle feeding and formula feeding during their youth, African women recalled more memories of breastfeeding . Additionally, the latter group reported more support from family members to continue breastfeeding and to breastfeed exclusively . Maternal perception that the infant is not satisfied by breastmilk is a common concern, and this study suggests that counseling should consider women's nativity.…”

“…Less is known about black women, particularly African‐born women, who compose a growing proportion of the population in the United States . Qualitative work by Fabiyi et al identified different normative referents for breastfeeding: whereas African American women recalled bottle feeding and formula feeding during their youth, African women recalled more memories of breastfeeding . Additionally, the latter group reported more support from family members to continue breastfeeding and to breastfeed exclusively .…”

Breastfeeding beliefs and experiences of African immigrant mothers in high‐income countries: A systematic review

“…Twelve of the included studies were qualitative (Castaldo, Mirisola, Costanzo, & Marrone, ; Fabiyi, Peacock, Hebert‐Beirne, & Handler, ; Gallegos et al, ; Hill, Hunt, & Hyrkäs, ; Hufton & Raven, ; Ingram, Cann, Peacock, & Potter, ; Kolanen, Valimaki, & Vehvilainen‐Julkunen, ; Steinman et al, ; Textor et al, ; Twamley et al, ; Tyler et al, ; Wandel et al, ), and 23 were quantitative studies (Brick & Nolan, ; Bulk‐Bunschoten, Pasker‐de Jong, van Wouwe, & de Groot, ; Busck‐Rasmussen, Villadsen, Norsker, Mortensen, & Andersen, ; de Hoog, van Eijsden, Stronks, Gemke, & Vrijkotte, ; Dennis et al, ; Farchi, Asole, Chapin, & Di Lallo, ; Fawzi et al, ; Goel, House, & Shanks, ; Grewal, Andersen, Sellen, Mosdol, & Torheim, ; Griffiths, Tate, & Dezateux, , ; Jones & Belsey, ; Kelly, Watt, & Nazroo, ; Meftuh, Tapsoba, & Lamounier, ; Merewood et al, ; Moore, Nanthagopan, Hammond, Milligan, & Goff, ; Neault et al, ; Nolan & Layte, ; Parker et al, ; Rio et al, ; Rubin, Inbar, & Rishpon, ; Treuherz, Cullinan, & Saunders, ; Wallby & Hjern, ). Ten studies were conducted in the United Kingdom (Goel et al, ; Griffiths et al, , ; Hufton & Raven, ; Ingram et al, ; Jones & Belsey, ; Kelly et al, ; Moore et al, ; Treuherz et al, ; Twamley et al, ); eight in the United States (Fabiyi et al, ; Hill et al, ; Meftuh et al, ; Merewood et al, ; Neault et al, ; Parker et al, ; Steinman et al, ; Textor et al, ); three in Australia (Gallegos et al, ; Tyler et al, ); two each ...…”

“…The majority of the participants under study were immigrant mothers from Somalia (Grewal et al, ; Hill et al, ; Ingram et al, ; Kolanen et al, ; Steinman et al, ; Textor et al, ; Wandel et al, ), Ethiopia (Meftuh et al, ; Rubin et al, ), and Morocco (Bulk‐Bunschoten et al, ; Busck‐Rasmussen et al, ; de Hoog et al, ). One study included African mothers from Burundi, Congo, Liberia, and Sierra Leone (Gallegos et al, ), whereas other studies (Brick & Nolan, ; Castaldo et al, ; Dennis et al, ; Fabiyi et al, ; Farchi et al, ; Fawzi et al, ; Goel et al, ; Griffiths et al, , ; Hufton & Raven, ; Jones & Belsey, ; Kelly et al, ; Merewood et al, ; Moore et al, ; Neault et al, ; Nolan & Layte, ; Parker et al, ; Rio et al, ; Treuherz et al, ; Twamley et al, ; Wallby & Hjern, ) described the study population as Africans or Black Africans, without specifying which African country the mothers included in the study originated from.…”

“…Twenty‐eight studies reported on breastfeeding practices (Brick & Nolan, ; Bulk‐Bunschoten et al, ; Busck‐Rasmussen et al, ; Castaldo et al, ; de Hoog et al, ; Fabiyi et al, ; Farchi et al, ; Fawzi et al, ; Gallegos et al, ; Goel et al, ; Grewal et al, ; Griffiths et al, , ; Hufton & Raven, ; Ingram et al, ; Jones & Belsey, ; Kelly et al, ; Kolanen et al, ; Meftuh et al, ; Merewood et al, ; Moore et al, ; Neault et al, ; Nolan & Layte, ; Parker et al, ; Rio et al, ; Steinman et al, ; Twamley et al, ; Wandel et al, ). Due to the variability in reporting across studies, it was not possible to pool quantitative data into a meta‐analysis.…”