Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach

Abstract

Breastfeeding has health benefits for both infants and mothers, yet Black mothers and infants are less likely to receive these benefits. Despite research showing no difference in breastfeeding intentions by race or ethnicity, inequities in breastfeeding rates persist, suggesting that Black mothers face unique barriers to meeting their breastfeeding intentions. The aim of this study is to identify barriers and facilitators that Black women perceive as important determinants of exclusively breastfeeding their children for at least 3 months after birth. Utilizing a Barrier Analysis approach, we conducted six focus group discussions, hearing from Black mothers who exclusively breastfed for 3 months and those who did not. Transcripts were coded starting with a priori parent codes based on theory-derived determinants mapped onto the Socioecological Model; themes were analysed for differences between groups. Facilitators found to be important specifically for women who exclusively breastfed for 3 months include self-efficacy, lactation support, appropriate lactation supplies, support of mothers and partners, prior knowledge of breastfeeding, strong intention before birth and perceptions of breastfeeding as money-saving. Barriers that arose more often among those who did not exclusively breastfeed for 3 months include inaccessible lactation support and supplies, difficulties with pumping, latching issues and perceptions of breastfeeding as time-consuming. Lack of access to and knowledge of breastfeeding laws and policies, as well as negative cultural norms or stigma, were important barriers across groups. This study supports the use of the Socioecological Model to design multicomponent interventions to increase exclusive breastfeeding outcomes for Black women.

A randomized controlled trial of pectoralis major myofascial release massage for breastfeeding mothers: breast pain, engorgement, and newborns’ breast milk intake and sleeping patterns

“…The rate of breastfeeding in Korea is high (95.6%) immediately after birth, but drops to 47.5% by 3 months of age, and fewer than two in 10 mothers continue to breastfeed for 6 months [9]. This information suggests that despite its many advantages, breastfeeding is associated with various problems [3]. These include discomforts such as breast pain, breast engorgement, nipple damage, lack of breast milk, fatigue from frequent feeding, and lack of sleep, which inhibit breastfeeding [10][11][12].…”

“…Breast milk has several benefits: it improves infant digestion, lowers morbidity rates, reduces atopy by minimizing exposure to allergens, and stimulates the development of an emotionally stable personality [ 2 ]. For mothers, uterine contractions help prevent postpartum bleeding and reduce the severity of anemia [ 3 ]. In addition, breastfeeding assists with weight loss by burning calories [ 4 ]; lowers the risks of premenopausal breast cancer, ovarian cancer, and osteoporosis; and ultimately helps establish an intimate bond between mother and child [ 5 , 6 ].…”

Decentering intensive mothering: More fully accounting for race and class in motherhood norms

“…Racialized inequalities are also reflected in the pattern of Black mothers being less likely to exclusively breastfeed compared to White mothers (Lee & Baker, 2021; Rippeyoung & Noonan, 2012). Black mothers across social class report encountering facets of institutional racism that interfere with breastfeeding, such as lack of access to resources, discrimination in health‐care settings, and stigma (Lee & Baker, 2021; Tran et al., 2022). Low‐income Black mothers may be especially likely to encounter difficulties accessing resources needed to circumvent breastfeeding difficulties, such as the services of a lactation consultant (Reno et al., 2018).…”

Considering the Influence of Social Determinants of Health on Parent Feeding Practices

“…As an example, a few studies show that Black mothers often report inaccessible lactation support as a major barrier to lactation success and are less likely to initiate and maintain lactation 35,36. This is further exacerbated by the reduced availability of galactagogues and lactation support in Black zip codes, which then likely contributes to antilactation attitudes and stigma surrounding lactation in these communities 36,37. Families who rely on formula for their infant's nutritional needs are also at a disadvantage when living in primarily Black zip codes as grocery stores in these areas have less availability of ready-to-feed liquid formula, which is sterile 37.…”

“…35,36 This is further exacerbated by the reduced availability of galactagogues and lactation support in Black zip codes, which then likely contributes to antilactation attitudes and stigma surrounding lactation in these communities. 36,37 Families who rely on formula for their infant's nutritional needs are also at a disadvantage when living in primarily Black zip codes as grocery stores in these areas have less availability of ready-to-feed liquid formula, which is sterile. 37 Though they may be able to use powder formula, there are implications to this substitution including increased infection risk due to the lack of sterility, especially for the vulnerable, high-risk infant.…”