BLACK WOMEN'S EXPERIENCE OF BREASTFEEDING: A Focus Group's Perspective

Journal of Multicultural Nursing & Health, Spring 2007 by McCarter-Spaulding, Deborah

OBJECTIVES: Rates of initiation and duration of breastfeeding for blacks are significantly lower than that of whites, and may be related to cultural and family characteristics. The purpose of this qualitative study was to learn about the experience of breastfeeding from black women who have breastfed a child. METHODS: Using a phenomenological approach, eight black women participated in a focus group using a structured interview format, discussing making the decision to breastfeed, challenges and difficulties, benefits and breastfeeding support. RESULTS: The experience of the participants could not be easily distinguished from other women similar in attitudes, education and lifestyle, suggesting that in this group, race was not a significant influence on the breastfeeding experience. CONCLUSIONS: Further study with black women of varied socioeconomic, ethnic and geographic categories than male alcoholics (Fried, et al., 1998; Freeza, et. al., 1990). Women who abuse alcohol have death rates 50% to 100% higher than men who drink excessively. Some studies show that alcoholism actually decreases a woman's life expectancy by 15 years (Roman, 1998).

KEY WORDS: Breastfeeding; Ethnicity; Qualitative Research; Race.

The benefits of breastfeeding to both infants and their mothers are well-accepted, and increasing the rates of initiation and duration of breastfeeding is an important public health goal (U .S. Department of Health and Human Services (DHHS), 2002). In spite of the recommendation to breastfeed exclusively for approximately six months, and then breastfeed with complementary foods up to one year (American Academy of Pediatrics (AAP), 2005), current breastfeeding rates in the early postpartum period do not meet the national goal of 75% and drop even more sharply below the national goal of 50% at six months (DHHS, 2002).

When breastfeeding rates are analyzed by demographic characteristics, significant racial disparities come to light. Non-Hispanic black infants are the least likely to be breastfed at all by 7 days postpartum, with the proportion of those breastfed to any extent at 49.1%, and by six months, only 19.7% are breastfed (Li, Darling, Maurice, Barker, & Grummer-Strawn, 2005) . If rates of exclusive breastfeeding are analyzed, black infants are still the least likely to be breastfed, and the proportion of those who are breastfed exclusively falls even lower, to 45.9% at 7 days postpartum, and 5.4% at six months postpartum (Li et al ., 2005). The purpose of this study is to learn about the experience of breastfeeding from black women who have breastfed an infant.

Variables Influencing Breastfeeding

In addition to race, other demographic variables appear to influence breastfeeding. Data from the 2002 National Immunization Survey showed that women were significantly more likely to breastfeed if they were married, 30 or more years old, college-educated and of higher socioeconomic status. Women who lived in the Pacific region of the country had the highest breastfeeding rates, following by the Mountain region and New England (Li et al., 2005).

In addition to demographic variables, maternal attitudes toward breastfeeding, prenatal intentions and breastfeeding confidence have been shown to influence breastfeeding (Dennis, 2002a). The amount of formal and informal social support a woman has also influences, either positively or negatively, her experience of breastfeeding (Dennis, 2002a & Raj & Plichta, 1998).

Demographic and psychosocial variables highlight populations of women more or less likely to breastfeed, but they do not explain how, or what that influence actually means in the lives of women making an infant-feeding decision. It is not clear why race makes a difference in breastfeeding rates, although cultural and family influences would be expected. Blacks are overrepresented in low income groups (Collins et al. 2002), making it difficult to separate the effects of socioeconomic status and race. However, Forste, Weiss and Lippincott (2001) found that after controlling for socioeconomic status, black women were still less likely to breastfeed. The most common reason reported (83%) for not breastfeeding was a preference for bottle feeding. Only 4% reported that they did not breastfeed because of job or schedule difficulties.

Breastfeeding in Black Women

Ludington-Hoe, McDonald, and Satyshur (2002) in a review of literature describe cultural beliefs about breastfeeding for African-American women. They define African-American as the off-spring of three of more generations of African descent who were born in America. They report that breastfeeding is not viewed positively, and that early formula and cereal supplementation is common. Breastfeeding in public is also perceived negatively. The most important people to influence breastfeeding are the other women in the social network, especially the maternal grandmother. Having breastfeeding role models increases breastfeeding rates significantly.

Corbett (2000) conducted a study using an ethnographic field design, conducting unstructured interviews to explore infant feeding style of black women from low-income households in the Southeastern United States. Formula feeding and early introduction of formula were seen as necessary because of the belief that milk alone could not satisfy an infant, and that crying was a sign that the baby was still hungry. Holding a baby when s/he cried was seen as "spoiling", so feeding was the strategy used to stop with crying without "spoiling". Breastfeeding was not considered positive, so the women who chose to breastfeed were attempting a new behavior, but did not have knowledge or support from their social environment. Bottles were also used when a mother needed to feed her infant when others were present, as breastfeeding was seen as a private behavior. No ethnic description was given for the black women participating in the study.