Feelings,Practices,and the Breastfeeding Discourse Among Women of Low Socioeconomic Status

Abstract

Background:

Breastfeeding, widely recognized for its significant health benefits, presents multifaceted challenges that contribute to low breastfeeding rates in many countries worldwide. In postmodern society, women’s decisions regarding breastfeeding are influenced by numerous factors, including socioeconomic status, work-related demands, social norms, digital media, and individual subjectivities.

Research Aim:

This study aims to identify and analyze the subjective factors that shape women’s perceptions of breastfeeding in low-income settings, including the impact of breastfeeding discourse.

Methods:

The research employed a qualitative approach, utilizing Cartography for data collection and Laurence Bardin’s Content Analysis for interpretation. Nineteen postpartum women from a public hospital participated in the study, sharing their emotions, perceptions, and objective factors influencing their breastfeeding decisions.

Results:

A complex interplay of positive and negative sentiments was observed. Bonding, defined as a feeling of connection to the baby, emerged as the most prominent positive emotion. On the other hand, fear and insecurity—primarily related to concerns about pain and insufficient milk supply—were identified as the dominant negative emotions. Additionally, participants expressed embarrassment about breastfeeding in public and emphasized the crucial role of information and support provided by healthcare professionals.

Conclusion:

Understanding the subjective factors influencing breastfeeding choices among underprivileged women is essential for providing effective information and support. Reframing the breastfeeding discourse to reinforce women’s confidence in their abilities, and emphasizing the societal responsibility for support, can help ensure a positive experience for all women and contribute to higher breastfeeding rates.

Keywords

barriers breastfeeding content analysis lactation perceptions socioeconomic status

Get full access to this article

View all access options for this article.

References

Bardin

(2002). Analise de conteudo. [Content Analysis] Edições 70. (Original work published 1977). ISBN: 978-972-44-1506-2

Baumgartner

Bhamidipalli

S. S.

Guise

Daggy

Parker

C. B.

Westermann

Parry

Grobman

W. A.

Mercer

B. M.

Simhan

H. N.

Silver

R. M.

Wapner

R. J.

Saade

G. R.

Reddy

U. M.

Haas

D. M.

(2020). Psychosocial and sociodemographic contributors to breastfeeding intention in first-time mothers. Maternal and Child Health Journal, 24(8), 1047–1056. https://doi.org/10.1007/s10995-020-02928-0

Beggs

Koshy

Neiterman

(2021). Women’s perceptions and experiences of breastfeeding: A scoping review of the literature. BMC Public Health, 21(1), Article 2169. https://doi.org/10.1186/s12889-021-12216-3

Bowlby

. (1984). Apego. [Attachment] ( Cabral

, trans, 1st Brazilian Edition). Martins Fontes. (Original work published 1969)

Bresnahan

Zhu

Zhuang

Yan

(2020). “He wants a refund because I’m breastfeeding my baby”: A thematic analysis of maternal stigma for breastfeeding in public. Stigma and Health, 5(4), 394–403. https://doi.org/10.1037/sah0000208

Caes

Abbott

Currie

(2021). Exploring women’s perceptions of pain when breastfeeding using online forums. International Breastfeeding Journal, 16(1), 84. https://doi.org/10.1186/s13006-021-00426-9

Chen

Cheng

Pan

(2019). Socioeconomic status and breastfeeding in China: An analysis of data from a longitudinal nationwide household survey. BMC Pediatrics, 19(1), 1–8. https://doi.org/10.1186/s12887-019-1551-2

Cohen

S. S.

Alexander

D. D.

Krebs

N. F.

Young

B. E.

Cabana

M. D.

Erdmann

Hays

N. P.

Bezold

C. P.

Levin-Sparenberg

Turini

Saavedra

J. M.

(2018). Factors associated with breastfeeding initiation and continuation: A meta-analysis. The Journal of Pediatrics, 203, 190–196.e21. https://doi.org/10.1016/j.jpeds

Cook

E. J.

Powell

Ali

Penn-Jones

Ochieng

Randhawa

(2021). Improving support for breastfeeding mothers: A qualitative study on the experiences of breastfeeding among mothers who reside in a deprived and culturally diverse community. International Journal for Equity in Health, 20(1), 1–14. https://doi.org/10.1186/s12939-021-01419-0

10.

Davie

Chilcot

Jones

Bick

Silverio

S. A.

(2021). Indicators of ‘good’ feeding, breastfeeding latch, and feeding experiences among healthy women with healthy infants: A qualitative pathway analysis using Grounded Theory. Women and Birth, 34(4), e357–e367. https://doi.org/10.1016/j.wombi.2020.08.004

11.

Davis

A. M. B.

Sclafani

(2022). Birth experiences, breastfeeding, and the mother-child relationship: Evidence from a large sample of mothers. The Canadian Journal of Nursing Research / Revue Canadienne de Recherche En Sciences Infirmieres, 54(4), 518–529. https://doi.org/10.1177/08445621221089475

12.

de Almeida

J. A. G.

Novak

F. R

. (2004). Amamentação: Um híbrido natureza-cultura. [Breastfeeding: a nature-culture hybrid] Jornal de Pediatria, 80(Suppl. 5), S119–S125. https://doi.org/10.1590/S0021-75572004000700002

13.

Dhami

M. V.

Ogbo

F. A.

Akombi-inyang

B. J.

Torome

Agho

K. E.

(2021). Understanding the enablers and barriers to appropriate infants and young child feeding practices in India: A systematic review. Nutrients, 13(3), Article 825. https://doi.org/10.3390/nu13030825

14.

Ejie

I. L.

Eleje

G. U.

Chibuzor

M. T.

Anetoh

M. U.

Nduka

I. J.

Umeh

I. B.

Ogbonna

B. O.

Ekwunife

O. I.

(2021). A systematic review of qualitative research on barriers and facilitators to exclusive breastfeeding practice in sub-Saharan African countries. International Breastfeeding Journal, 16(1), 1–13. https://doi.org/10.1186/s13006-021-00380-6

15.

Federal University of Rio de Janeiro. (2021). Prevalence of feeding indicators for children under 5 years of age. Brazilian National Survey on Child Nutrition (ENANI-2019). https://enani.nutricao.ufrj.br/index.php/relatorios/

16.

Ferreira

C. S.

Azeredo

C. M.

Rinaldi

A. E. M.

(2021). Trends in social inequalities in breastfeeding and infant formulas in Latin American countries between the 1990 and 2010 decades. Public Health Nutrition, 24(16), 5471–5480. https://doi.org/10.1017/S1368980021000392

17.

Gebrekidan

Fooladi

Plummer

Hall

(2020). Enablers and barriers of exclusive breastfeeding among employed women in low and lower middle-income countries. Sexual and Reproductive Healthcare, 25, 1–7. https://doi.org/10.1016/j.srhc.2020.100514

18.

Gianni

M. L.

Bettinelli

M. E.

Manfra

Sorrentino

Bezze

Plevani

Cavallaro

Raffaeli

Crippa

B. L.

Colombo

Morniroli

Liotto

Roggero

Villamor

Marchisio

Mosca

(2019). Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients, 11(10), Article 2266. https://doi.org/10.3390/nu11102266

19.

Habtewold

T. D.

Mohammed

S. H.

Endalamaw

Mulugeta

Dessie

Berhe

D. F.

Birhanu

M. M.

Islam

M. A.

Teferra

A. A.

Asefa

N. G.

Alemu

S. M.

(2020). Higher educational and economic status are key factors for the timely initiation of breastfeeding in Ethiopia: A review and meta-analysis. Acta Paediatrica, 109(11), 2208–2218. https://doi.org/10.1111/apa.15278

20.

Hairston

I. S.

Handelzalts

J. E.

Lehman-Inbar

Kovo

(2019). Mother-infant bonding is not associated with feeding type: A community study sample. BMC Pregnancy and Childbirth, 19(1), 125. https://doi.org/10.1186/s12884-019-2264-0

21.

Harlow

H. F.

(1958). The nature of love. American Psychologist, 13(2), 673–685. https://doi.org/10.1037/h0047884

22.

Hauck

Y. L.

Kuliukas

Gallagher

Brady

Dykes

Rubertsson

(2020). Helpful and challenging aspects of breastfeeding in public for women living in Australia, Ireland and Sweden: A cross-sectional study. International Breastfeeding Journal, 15(38), 1–14. https://doi.org/10.1186/s13006-020-00281-0

23.

Hernández-Vásquez

Vargas-Fernández

(2022). Socioeconomic determinants and inequalities in exclusive breastfeeding among children in Peru. Frontiers in Nutrition, 9, 1–12. https://doi.org/10.3389/fnut.2022.1073838

24.

IBGE. Brazilian Institute of Geography and Statistics. (2024). Síntese de Indicadores Sociais - Uma Análise das Condições de Vida da População Brasileira. [Synthesis of Social Indicators - An Analysis of the Living Conditions of the Brazilian Population]. IBGE, Coordenação de População e Indicadores Sociais. https://biblioteca.ibge.gov.br/visualizacao/livros/liv102144.pdf

25.

Leeming

Marshall

Hinsliff

(2022). Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research. Maternal and Child Nutrition, 18(1), Article e13270. https://doi.org/10.1111/mcn.13270

26.

Leurer

M. D.

Misskey

(2015). The psychosocial and emotional experience of breastfeeding: Reflections of mothers. Global Qualitative Nursing Research, 2(2), 1–9. https://doi.org/10.1177/2333393615611654

27.

Lima

S. P.

Santos

E. K.

Erdmann

A. L.

Farias

P. H.

Aires

Nascimento

V. F.

(2019). Percepção de mulheres quanto à prática do aleitamento materno: Uma revisão integrativa. Revista de Pesquisa Cuidado é Fundamental Online, 11(1), 248–254. https://doi.org/10.9789/2175-5361.2019.v11i1.248-254

28.

Linde

Lehnig

Nagl

Kersting

(2020). The association between breastfeeding and attachment: A systematic review. Midwifery, 81, Article 102592. https://doi.org/10.1016/j.midw.2019.102592

29.

Mantler

Jackson

K. T.

(2020). Understanding the relationship between breastfeeding-related pain and mothering using an agency framework. Studies in the Maternal, 12(1), 2. https://doi.org/10.16995/sim.265

30.

Morris

Schofield

Hirst

(2020). Exploration of the factors influencing attitudes to breastfeeding in public. Journal of Human Lactation, 36(4), 776–788. https://doi.org/10.1177/0890334419878119

31.

Neves

P. A. R.

Barros

A. J. D.

Gatica-Domínguez

Vaz

J. S.

Baker

Lutter

C. K.

(2021). Maternal education and equity in breastfeeding: Trends and patterns in 81 low- and middle-income countries between 2000 and 2019. International Journal for Equity in Health, 20(1), 1–13. https://doi.org/10.1186/s12939-020-01357-3

32.

Passos

Kastrup

da Escóssia

(2009). Pistas do Método da Cartografia - pesquisa intervenção e produção de subjetividade. [Clues of the Cartography Method - Research, Intervention, and Subjectivity Production] ( Gomes

L. A. P.

, Ed.; 1st ed.). Editora Sulina. ISBN: 978-85-205-0530-4

33.

Quinones

(2023). “Breast is best’’. . . until they say so. Frontiers in Sociology, 8, Article 1022614. https://doi.org/10.3389

34.

Rollins

N. C.

Bhandari

Hajeebhoy

Horton

Lutter

C. K.

Martines

J. C.

Piwoz

E. G.

Richter

L. M.

Victora

C. G.

(2016). Why invest, and what it will take to improve breastfeeding practices? The Lancet, 387(10017), 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2

35.

Russell

P. S.

Smith

D. M.

Birtel

M. D.

Hart

K. H.

Golding

S. E.

(2022). The role of emotions and injunctive norms in breastfeeding: A systematic review and meta-analysis. Health Psychology Review, 16(2), 257–279. https://doi.org/10.1080/17437199.2021.1893783

36.

Sankar

M. J.

Sinha

Chowdhury

Bhandari

Taneja

Martines

Bahl

(2015). Optimal breastfeeding practices and infant and child mortality: A systematic review and meta-analysis. Acta Pædiatrica: Nurturing the Child, 104, 3–13. https://doi.org/10.1111/apa.13147

37.

Santos

I. S.

Barros

F. C.

Horta

B. L.

Menezes

A. M. B.

Bassani

Tovo-Rodrigues

Lima

N. P.

Victora

C. G.

(2019). Aleitamento materno exclusivo e duração da amamentação tendências e desigualdades em quatro coortes de nascimento de base populacional de Pelotas, Brasil, 1982–2015. [Exclusive Breastfeeding and Duration of Breastfeeding: Trends and Inequalities in Four Population-Based Birth Cohorts in Pelotas, Brazil, 1982–2015] In Victora

C. G.

Barros

F. C.

Silveira

M. F.

Silva

A. A. M.

(Eds.), Epidemiologia da Desigualdade - quatro décadas de coortes de nascimentos [Epidemiology of Inequality - Four Decades of Birth Cohorts] (1st ed., pp. 1–184). Abrasco. ISBN: 978-85-85740-11-5

38.

Sheehan

Gribble

Schmied

(2019). It’s okay to breastfeed in public but. . . International Breastfeeding Journal, 14(1), 1–11. https://doi.org/10.1186/s13006-019-0216-y

39.

Taha

Garemo

El Ktaibi

Nanda

(2022). Breastfeeding practices in the United Arab Emirates: Prenatal intentions and postnatal outcomes. Nutrients, 14(4), Article 806. https://doi.org/10.3390/nu14040806

40.

Tran

Reese Masterson

Frieson

Douglass

Pérez-Escamilla

O’Connor Duffany

(2023). Barriers and facilitators to exclusive breastfeeding among black mothers: A qualitative study utilizing a modified barrier analysis approach. Maternal and Child Nutrition, 19(1), 1–11. https://doi.org/10.1111/mcn.13428

41.

Tristão

R. M.

Barbosa

M. P.

Araújo

Neiva

E. R.

Costa

K. N.

De Jesus

J. A. L.

Vargas

L. A.

Adamson-Macedo

E. N.

(2021). Breastfeeding success and its relation to maternal pain, behaviour, mental health, and social support. Journal of Reproductive and Infant Psychology, 41(3), 346–361. https://doi.org/10.1080/02646838.2021.2004300

42.

Victora

C. G.

Bahl

Barros

A. J. D.

França

V. A.

Horton

Krasevec

Murch

Sankar

M. J.

Walker

Rollins

N. C.

(2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387, 475–499. https://doi.org/https://doi.org/10.1016/S0140-6736(15)01024-7

43.

Wagner

L. P. B.

Mazza

V. A.

Souza

S. R. R. K.

Chiesa

Lacerda

M. R.

Soares

(2020). Fortalecedores e fragilizadores da amamentação na ótica da nutriz e de sua família. [Strengthening and Weakening Factors of Breastfeeding from the Perspective of the Nursing Mother and Her Family] Revista Da Escola de Enfermagem Da Universidade de São Paulo, 54, Article e03563. https://doi.org/10.1590/S1980-220X2020errata00303662

44.

Walter

M. H.

Abele

Plappert

C. F.

(2021). The role of oxytocin and the effect of stress during childbirth: Neurobiological basics and implications for mother and child. Frontiers in Endocrinology, 12, Article 742236, 1–10. https://doi.org/10.3389/fendo.2021.742236

45.

Walters

D. D.

Phan

L. T. H.

Mathisen

. (2019). The cost of not breastfeeding: Global results from a new tool. Health Policy and Planning, 34(6), 407–417. https://doi.org/10.1093/heapol/czz050

46.

Wang

S. C.

Liu

Jia

Wang

Parpura

Wang

Y. F.

(2022). Neural functions of hypothalamic oxytocin and its regulation. ASN Neuro, 14, 1–33. https://doi.org/10.1177/17590914221100706

47.

Weston

Anbari

A. B.

Bullock

(2023). The work of breastfeeding among women of low socioeconomic status: A qualitative metasynthesis. Global Qualitative Nursing Research, 10, 1–13. https://doi.org/10.1177/23333936231161130

48.

World Health Organization. (2018). Implementation guidance: Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: The revised Baby-friendly Hospital Initiative 2018. https://www.who.int/publications/i/item/9789241513807