What Should a Breastfeeding Place in Public Spaces Be Like? A Qualitative Study on Women’s Experiences

Abstract

Background:

Mothers need a place in public spaces where they can comfortably breastfeed and care for their babies. The availability and design features of these places are critical for meeting mothers’ safety and comfort needs while they are breastfeeding.

Aim:

This study was conducted to examine mothers’ experiences with breastfeeding places in public spaces.

Methods:

This study, which was planned as a phenomenological research, one of qualitative research designs, was conducted with mothers (n = 18) with breastfeeding experience in public places. Data were collected through in-depth interviews using a semi-structured questionnaire developed by the researchers. The thematic analysis method was employed to evaluate the data.

Results:

Study findings were examined under two main themes and 12 subthemes. Getting to the breastfeeding place was actually enough for many of the participants. Women who could not breastfeed for any reason in breastfeeding places stated that they came up with some solutions, such as breastfeeding in the car, feeding with formula, and not taking the baby with them. Participants’ basic expectations about the breastfeeding place were that it met cleanliness, hygiene, privacy, and ventilation conditions.

Conclusions:

It was found that women who tended to spend more time in public spaces recently encountered similar problems during the breastfeeding process. Breastfeeding environments should meet minimum standards such as cleanliness and privacy as well as having the necessary comfort, aesthetics, and decoration features.

Keywords

breastfeeding breastfeeding place public space women’s experiences

Background

Breastfeeding rates are a public health policy goal in many developed countries and women have a legal right to breastfeed (Grant et al., 2022). Breastfeeding is comprehensively supported by recommendations from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF, 2018; WHO, 2018). Many studies have shown that breast milk is the best source of nutrition for babies (Dağlı & Çelik, 2022; Dağlı & Topkara, 2022). Breastfeeding has many advantages for the mother, baby, and society (Dağlı et al., 2021; Hossain & Mihrshahi, 2022; Schmied et al., 2019). In addition to the health benefits, breastfeeding is ecologically sustainable and offers significant cost savings (Schmied et al., 2019). Exclusive breastfeeding for the first 6 months is life-saving and contributes to economic savings by reducing disease rates throughout individuals’ lives (Gallagher et al., 2023; Schmied et al., 2019; Thompson & Heflin, 2011). Despite its countless benefits, many factors negatively affect the continuation of breastfeeding (Yeşildere Sağlam et al., 2023). It is stated in the literature that inappropriate breastfeeding environments significantly affect breastfeeding (Ningsih et al., 2022).

Breastfeeding is not just an instinctive practice; it is a basic requirement for infant nutrition. The reasons why breastfeeding environments are necessary include factors, such as relieving discomfort in mothers’ breasts, maintaining milk production, and feeding the baby (Fernandes et al., 2017; Lee et al., 2019). Discomfort due to the idea of breastfeeding in public spaces is cited as the reason why some women avoid breastfeeding behavior or breastfeed for shorter periods (Amir, 2014). As breastfeeding women continue to spend time, work, learn, travel, and lead their lives in social environments, the need for breastfeeding places continues to increase. For this reason, it is an obligation rather than a desire for a woman to continue breastfeeding or expressing milk in any environment outside the home, such as hospitals, cafés, shopping malls, and workplaces (van Dellen et al., 2021). According to the Fair Labor Standards Act, breastfeeding rooms are required in workplaces with 50 or more female employees (U.S. Department of Labor, 2010). The regulation on shopping centers in Turkey specifies the necessity and characteristics of a baby care room. According to the regulation, baby care rooms must have a sufficient number of baby care rooms with a sink, diaper changing unit, breastfeeding chair and coffee table, and adequate air conditioning and hygiene conditions (Official Newspaper, 2016). However, there are inadequacies in the availability and organization of breastfeeding rooms in social spaces.

Making breastfeeding acceptable and enjoyable for mothers in public spaces outside the home is a priority public health policy (Meng et al., 2013). There is not enough evidence in the literature about how breastfeeding is done outside the home (shopping centers, cafés, restaurants, hospitals, etc.), what breastfeeding environments should be like, and their effects on breastfeeding practice (Coomson & Aryeetey, 2018). Mothers need a place in public areas where they can comfortably breastfeed and care for their babies. Therefore, the availability of breastfeeding environments and their design features are critical in meeting these needs (Henry-Moss et al., 2018; Wallenborn et al., 2018). Mother–baby rooms have been designed to address the problem of breastfeeding in public spaces. However, the usability and appropriateness of these rooms are still under debate (Grant 2021).

Internationally, lack of support and critical attitudes have affected women’s perceptions of breastfeeding in public spaces (Dykes et al., 2023). Breastfeeding in public spaces is reported to be a challenging experience for mothers (Hauck et al., 2021). Boyer (2012) reported that breastfeeding in public spaces causes loss of comfort (Boyer, 2012). Amir (2014) stated that breastfeeding in the presence of others may be a determining factor in breastfeeding maintenance (Amir, 2014). In Henderson’s study, men stated that it is safer to feed with formula instead of breastfeeding in public spaces (Henderson et al., 2011). Schmied et al. (2019) reported that breastfeeding is rarely seen in public spaces and that bottle feeding is a more common practice (Schmied et al., 2019). Hauck et al. (2020) state that women’s feelings of awkwardness and discomfort negatively affect and prevent breastfeeding in public spaces.

A review of the literature indicated that evaluations of breastfeeding places outside the home and studies on the examination of the experiences of mothers who frequently had to use these environments were inadequate. It has been reported that breastfeeding in public spaces may be a determining factor in breastfeeding continuation by affecting women’s comfort level. Therefore, a better understanding of women’s experiences will help to design interventions to support breastfeeding maintenance (Gallagher et al., 2023). In this context, the aim of the study is to examine breastfeeding mothers’ experiences with breastfeeding places in public spaces.

Method

A qualitative approach was employed in the study, and Standards for Reporting Qualitative Research were used to conduct the research and report the results. The interviews were held between April and August 2023.

Design

This is a phenomenological study conducted to examine the experiences of mothers about breastfeeding areas in public spaces. Qualitative methods offer the opportunity to understand events and experiences and to reveal participants’ perspectives and subjective experiences (Sandelowski, 2010). The focus of the phenomenological approach is on individual experiences and how individuals make sense of these experiences. The phenomenon examined in this research is the concept of “breastfeeding in public spaces” (Yıldırım & Şimşek, 2013). Participants described complex experiences of breastfeeding outside the home in public spaces thanks to qualitative methods. Since there was limited research into the examination of mothers’ experiences with breastfeeding environments in the literature, the use of qualitative methods in this study facilitated the discovery of a new topic.

Setting and Participants

The study included women who had breastfeeding experience in public spaces and lived in a province in the west region of Türkiye. There are public and private hospitals, a shopping mall, and various social areas in the city where the study was conducted.

The sample of the study was determined using the snowball sampling method. Inclusion criteria were being older than 18 years (I), having an infant younger than 2 years (II), having breastfeeding experience in public places (III), and agreeing to participate in the study (IV). Mothers who did not meet these criteria were not included in the study. Participants were coded as P1, P2, P3,…, and P18. The researchers contacted the first participant via one of their students. This participant met the research criteria, was a breastfeeding woman, and lived in the same province. The researchers had no acquaintance with her. The number of participants was increased by asking the first participant and then all subsequent participants whether they could recommend anyone in accordance with the sample selection criteria. Women were invited to the study by phone and an appointment was setup. The data saturation point is frequently used due to the lack of a statistical formula to calculate the sample size in qualitative studies (Yağar & Dökme, 2018). For this reason, the sample size was determined according to the “data saturation” principle, which is a usual practice in qualitative research. It was decided that the sample size would be considered enough when subsequent participants started repeating the same information and statements. The study sample consisted of a total of 18 women who met the inclusion criteria and participated in the interviews.

Data Collection

The interviews were conducted by researchers with education in qualitative methods who had studied in the relevant field. In this study, data were collected through face-to-face interviews. The interviews were held in a quiet environment where the participants would feel comfortable and at a time convenient for them. Data were collected by two researchers. One of the researchers conducted the interview while the other took notes on the observations. Data were collected using a descriptive information form and a semi-structured interview form, which were created by the researchers in line with the literature, and a voice recorder (Table 1). The descriptive information form consisted of 10 questions, prepared by the researchers, about the women’s sociodemographic and breastfeeding characteristics. The semi-structured interview form consisted of five questions about women’s description of an ideal breastfeeding environment and how breastfeeding environments in public spaces affected their breastfeeding behaviors, and probing questions to get in-depth information about the answers given. Each interview took an average of 20–35 min.

Table 1.

The Semi-Structured Interview Form.

Research Questions
Could you tell us about your experiences with your presence and breastfeeding in public places during the breastfeeding process? How do you think breastfeeding environments affect breastfeeding behavior? Could you please share what you think about breastfeeding rooms in public spaces? What are the positive and negative factors that have affected you in breastfeeding rooms in public spaces? What are your expectations about breastfeeding environments you use outside the home? What should an ideal breastfeeding environment be like?

Research Questions

Could you tell us about your experiences with your presence and breastfeeding in public places during the breastfeeding process?

How do you think breastfeeding environments affect breastfeeding behavior?

Could you please share what you think about breastfeeding rooms in public spaces?

What are the positive and negative factors that have affected you in breastfeeding rooms in public spaces?

What are your expectations about breastfeeding environments you use outside the home? What should an ideal breastfeeding environment be like?

Data Analysis

First, the audio recordings of the interviews were transcribed verbatim. The accuracy of the transcripts was checked by the researchers by comparing them with the original records. Data analysis was conducted in accordance with Graneheim and Lundman’s content analysis technique. (1) First of all, the transcripts were read and reviewed several times by the researchers in order to have information about the overall content. (2) The text within each content was divided into meaning units containing interconnected elements. (3) The meaning units were abstracted and labeled with codes. (4) The similarities and differences of the identified codes were checked and compared, and 12 subthemes were created. (5) In the final stage, two main themes were identified that combined the content of the subthemes. (6) For descriptive analysis, quotations were made from the remarkable statements of the interviewees based on the themes created. Independent data analysis was conducted by each researcher and a final consensus was reached on all themes. In addition to the researchers, the support of an expert with qualitative research experience and studies on breastfeeding was received for creating themes and subthemes, coding the data, and classifying the codes under themes and subthemes. To achieve validity in the study, the transcribed interview data were revised by other researchers.

Validity and Reliability of the Research

In qualitative research, the concept of “trustworthiness” is taken into consideration instead of validity and reliability. It has been reported in the literature that the issue of reliability should be carefully considered in qualitative research. The reliability of the study was evaluated according to four criteria (credibility, transferability, reliability, and confirmability; Speziale et al., 2011). Credibility was achieved by comparing the opinions of women who had different perspectives. Care was taken to ensure maximum diversity in the sample group as much as possible. The reliability of the data was increased by using observations and notes during the data collection process and adhering to the originality of the data. For transferability, participants, the sampling method, the setting of data collection, and the context in which the study was conducted were accurately described. For reliability, the coherence of relationships between the obtained themes and subthemes was checked. A researcher who was not involved in the data collection and data analysis processes examined and verified these processes and research results. For confirmability, all activities were recorded accurately, including study steps and how data were collected. Additionally, participant statements were quoted as they were.

Ethical Aspect

The study was conducted within the scope of the ethical principles of the Declaration of Helsinki. Ethics committee approval was obtained from the Non-Interventional Clinical Research Ethics Committee of a state university (approval date: March 10, 2023, and Decision No: 131/18). In addition, the participants were informed about the study before the interview and written informed consent was obtained from the participants.

Results

The distribution of the sociodemographic characteristics of the women who participated in our research is given in Table 2. The mean age of the women was 28.5 ± 5.46 (min.: 21, max.: 43). The majority of women had high school and university education.

Table 2.

Participants’ Sociodemographic Characteristics.

Participants	Age	Education	Job	Number of Children	Age of Children (Months)
P1	26	High school	Housewife	2	21
P2	28	University	Teacher	2	5
P3	24	Primary school	Housewife	1	8
P4	22	High school	Housewife	1	5
P5	31	University	Housewife	3	10
P6	22	University	Housewife	2	3
P7	30	High school	Housewife	2	8
P8	22	University	Housewife	1	18
P9	31	High school	Housewife	2	2
P10	26	University	Teacher	2	5
P11	29	University	Accountant	2	15
P12	32	University	Faculty member	2	12
P13	21	University	Nurse	2	4
P14	34	University	Housewife	1	14
P15	28	University	Teacher	2	18
P16	32	University	Nurse	1	4
P17	43	University	Teacher	2	10
P18	32	University	Faculty member	3	12

Note. P: Participant.

As a result of in-depth interviews with participants and analysis of their statements about their breastfeeding experiences, two main themes and 12 subthemes were determined (Table 3).

Table 3.

Themes and Subthemes.

Themes	Subthemes
The effect of the environment on breastfeeding behavior	Social isolation Tendency to use formula Separation from the baby
Features of breastfeeding environments	Location Cleanliness and hygiene Comfort Privacy The size and capacity of the place Quietness and calmness Lighting Ventilation Aesthetics and decoration

Theme 1: The Effect of the Environment on Breastfeeding Behavior

As a result of interviews with the participants, the effect of the environment on breastfeeding behavior theme was examined under three subthemes: social isolation, tendency to use formula, and separation from the baby.

Social isolation

Women expressed that they felt uncomfortable breastfeeding in public places and therefore preferred private and enclosed spaces. The mothers in the study stated that they had difficulty finding the opportunity to breastfeed in public places and therefore that their presence in social areas was affected. They stated that they could not go to social areas unless necessary because they had to breastfeed. This situation caused forced social isolation in mothers.

Women expressed that they felt uncomfortable breastfeeding in public places and therefore preferred private and enclosed spaces.

I would think about what I would do if my baby cried and how I could silence it outside because it used to stop crying only while breastfeeding. Since I could not breastfeed anytime and anywhere, I usually stayed at home. I could almost never go out to public places. (P6)

Especially for mothers who have had a baby for a short period of time, the fear of not being able to find a solution when their baby wants to breastfeed and not being able to find a breastfeeding environment has been the reason why mothers do not prefer out-of-home environments. Women used their personal cars where they felt safer or had to breastfeed in unsuitable conditions.

I didn’t often go to breastfeeding rooms. To ensure privacy while breastfeeding, I always preferred either closed spaces, small, narrow places, or the car. Also, I used a breastfeeding garment to cover my breasts. Since these hindered breastfeeding performances and the baby’s comfort, I reduced my out-of-home plans. I planned to go shorter distance places. (P17)

Tendency to use formula

Mothers who had to be in public places for some reason stated that since they did not prefer breastfeeding in outdoor environments, they left the house after breastfeeding their babies, planned to return home as soon as they completed their business, and prepared food for their babies. Due to the characteristics of outdoor environments, mothers stated that they preferred using formula because they could not feel comfortable in these environments. Mothers who have to spend long periods of time outdoors have had to opt for formula as breast milk cannot be stored in room conditions for long periods of time.

I do not want to breastfeed my baby in shopping malls or cafés. The conditions are not very favorable, and the places are uncomfortable. Since I go to work and my baby is given formula several times a day, I prefer giving formula to my baby in such environments for it is used to this food. (P2)

Separation from the baby

Mothers who thought that they could not provide appropriate breastfeeding conditions stated that they had to leave their babies at home to meet their needs. Mothers who stated that they were separated from their babies due to breastfeeding conditions described this as a negative situation.

Sometimes, I need to go somewhere urgently. If I have to go somewhere without a breastfeeding room, I do not take my baby with me. I prefer going alone. (P5)

The fact that women have to be separated from their babies affects their adaptation to their environment and causes them to experience breast fullness and discomfort because they cannot breastfeed their babies. Women stated that their minds were always on the baby they left at home.

I was bored at home and wanted to socialize. Since I knew that there was no breastfeeding room where I was going, I had to breastfeed my baby, express my milk, and leave it to my mother. But while I was sitting with my friends, I felt sensitivity in my breasts, and my milk leaked and soaked my clothes. Also, my baby was always on my mind…. (P13)

Theme 2: Features of Breastfeeding Environments

In the in-depth interviews with the participants, it was observed that the characteristics of breastfeeding places were frequently emphasized. Mothers stated that the characteristics of breastfeeding environments significantly affected breastfeeding their babies. The features of breastfeeding environments theme were examined under nine subthemes. These subthemes were location, cleanliness and hygiene, comfort, privacy, size and capacity of the environment, quietness and calmness, lighting, ventilation, and aesthetics and decoration.

Location

Location was an important feature of breastfeeding places according to the participants. In the study, some participants stated that there was no special place for breastfeeding, an unused room was converted into a breastfeeding area, or they used the prayer room, staff room, and similar places as a breastfeeding area and that they were uncomfortable with the location of breastfeeding rooms near toilets. Additionally, many participants stated that there were inadequate signs to direct them to breastfeeding areas in public places and that access to these places was difficult because the breastfeeding rooms were on the top floor/basement. It was important that breastfeeding rooms were nearby and accessible so that women could meet their needs in urgent situations and continue breastfeeding.

Breastfeeding rooms located in very remote areas are difficult to access. Especially if the shopping mall is big, you have to walk 15 min to get there and back with the baby…. You spend a lot of time until you find the place. Therefore, it does not make sense to use this area for breastfeeding. (P1)

According to women’s statements, the time allocated for breastfeeding is usually 15–20 min, and when this time is spent to reach the breastfeeding room, the location is very important for women. Women prefer to breastfeed and care for their babies instead of spending this time for access.

Unfortunately, breastfeeding rooms tend to stink because they are usually next to the toilet. In some places, when there is no breastfeeding area, they can direct us to places such as staff rooms or prayer rooms. This is quite disturbing…. (P17)

Cleanliness and hygiene

Participants specified cleanliness and hygiene as important factors for the breastfeeding places that they used. They stated that there was no sink in some of the breastfeeding places and that this was a significant deficiency. They added that a sink and running water, soap, paper towels, wet wipes, gel for hand disinfection, clean garbage bins, and disposable diaper changing covers needed to be available in breastfeeding places and that the place needed to be cleaned regularly. Moreover, they stated that they did not prefer these places as they might be a source of infection and threaten health if the necessary cleaning and hygiene conditions were not provided.

a significant deficiency. They added that a sink and running water, soap, paper towels, wet wipes, gel for hand disinfection, clean garbage bins, and disposable diaper changing covers needed to be available in breastfeeding places and that the place needed to be cleaned regularly.

You look into the baby’s eyes when breastfeeding in unclean and neglected places, expecting breastfeeding to end as soon as possible. Unfortunately, sometimes my baby would stop breastfeeding. We would immediately leave that environment and I would pray that I would never have to breastfeed there again…. (P10)

The lack of adequate cleanliness and hygiene in the environment where the baby is fed has been a source of concern. In these environments, women were concerned about the health of the baby and wanted to leave the environment as soon as possible or did not use this environment at all.

Comfort

Mothers reported that their stress decreased when they were provided with comfort and this had a positive effect on milk secretion. In the interviews, participants mentioned that there were breastfeeding rooms in many social areas they used, but these rooms were not comfortable enough for the needs of mothers and babies. They stated that there were difficulties in some breastfeeding places, such as the lack of a comfortable place to sit, the lack of a place to put their belongings, and not having space for baby care.

Mothers reported that their stress decreased when they were provided with comfort and this had a positive effect on milk secretion.

They had only one seat with no support for the back or arms in the breastfeeding room of the restaurant. I couldn’t feel comfortable at all because I couldn’t support my back and arms…. (P4)

Although women could find an environment for breastfeeding, they stated that this environment was not comfortable enough. This is because women stated that it is important that these environments meet both physical and psychological needs.

The breastfeeding room was very small and only had one chair. There was no table to change my baby’s diaper, and there wasn’t even a place to put the bag, so I left it on the floor. I had a hard time moving around and caring for my baby in this area…. (P9)

Privacy

A significant majority of the mothers in the study emphasized that privacy was an important factor in breastfeeding areas. They stated that the breastfeeding room needed to have a door that could be locked from the inside and that the environment would not be seen directly when the door was opened. While women may utilize one breastfeeding space at a time, they reported that this makes it difficult to maintain privacy. It was stated that in cases where single breastfeeding conditions could not be provided, it was important to install curtains/screens for privacy.

Once, while I was breastfeeding, the door suddenly opened. A woman with her husband came in. I was breastfeeding my baby, and I was caught unprepared. I was ashamed…. As mothers, we do not want anyone to see our private body parts during breastfeeding. It is actually our most natural right to breastfeed comfortably without any disturbance…. (P7)

I think privacy is the most important thing that mothers generally care about. To ensure privacy while breastfeeding, I always preferred either closed, small, and narrow spaces, or I did it inside the car. Also, I used a garment to cover my breasts while breastfeeding. I didn’t want to use these areas. Maybe curtains or screens can be placed between the breastfeeding chairs…. For example, it bothers me to be seen directly when the door is opened. That’s why there should definitely be a screen in front of the door. (P14)

The size and capacity of the place

Participants particularly specified two problems in this regard. First, breastfeeding rooms were small, and secondly, the places were overcrowded because they were used by many women at the same time. In fact, the women stated that they could not sometimes find a place in the breastfeeding room and came up with different solutions.

When we go out, there is usually only one breastfeeding room in shopping malls. It is difficult to meet the baby’s urgent nutritional needs when there are many women using the breastfeeding room. Mothers waiting in line outside. Once, the shopping mall was very crowded and I couldn’t find a place in the breastfeeding room. Finally, we went to a secluded table in the restaurant section, my husband covered me with a blanket and I was able to breastfeed my baby. (P3)

Mothers stated that breastfeeding is a special moment and that they cannot be alone with their babies in breastfeeding rooms. Mothers who expressed the insufficient size and capacity of these areas stated that they wanted to breastfeed and leave the environment as soon as possible.

There are breastfeeding rooms in shopping malls, but you may not be able to be alone with your baby at this special moment. The rooms are small, it is very difficult to move when there is more than one person, and you have to queue. Even worse, the baby wants to suckle and is crying at that moment…. (P18)

Quietness and calmness

Mothers reported that they could not find a quiet environment where they could focus on their babies and breastfeed, as shopping malls and cafés are often busy, noisy, and crowded. Mothers who participated in the study stated that they could not focus on their babies due to the noise in the environment while breastfeeding and that their babies were distracted and did not want to breastfeed.

The voices of other mothers’ children who came to breastfeed would distract my daughter and make her stop breastfeeding, which would cause her to start crying. (P16)

It was stated that mothers did not breastfeed in breastfeeding environments because their babies could not focus. It was stated that the presence of sound barriers, screens, and increasing the number of rooms are necessary for a healthier process.

My baby is hungry and crying, we go to the breastfeeding room, but when he hears the voices of other babies, he stops breastfeeding, he looks around, and we leave the room, but he wants to breastfeed. I don’t know how to find a solution to this, but the number of breastfeeding rooms can be increased, such as a few single soundproof rooms.…(P11)

Lighting

Participants generally stated that breastfeeding environments were located on lower floors or in hard-to-reach areas, did not have a window, and had too bright lighting. They stated that they could breastfeed their babies more easily if the lighting in the breastfeeding rooms had natural, dim, and relaxing lighting.

Breastfeeding rooms do not usually have a window. The lamps installed are also disturbing. If only there were rooms with windows…. I think the lighting should be dim, which does not tire the eyes and relaxes the baby. (P15)

Once I couldn’t find the lamp and I had to nurse my baby using the torch of my phone. Of course, even if there is a short-term breastfeeding process in these areas, it should be of high quality. I think every moment of breastfeeding is valuable. It should ensure comfort…. (P12)

Mothers stated that breastfeeding would be of better quality in environments that would make them and their babies comfortable.

…. Sometimes, I have to put my baby to sleep while breastfeeding. When bright lights are used in breastfeeding rooms, my baby gets restless, starts crying even if he is sleepy, and I can’t put him to sleep. It would be more comfortable if the light was dim or if we could adjust it. (P10)

Ventilation

It was stated that ventilation was inadequate in baby care rooms, which are often put to people’s use in crowded areas. Women, who generally did not encounter problems in controlling the temperature, stated that there were serious problems with the ventilation of the rooms and that this situation caused a decrease in the practical use of the rooms.

…I have never seen a window in breastfeeding rooms. Coated windows that do not show the inside should be used. The rooms should get fresh air and they should be ventilated. Natural ventilation instead of air conditioning would be preferable.…(P8)

Ventilation is a very important issue. After all, more than one person can breastfeed in the same environment at the same time. The bad smell of the environment is quite disturbing, and breastfeeding there truly feels distressing. The smell of sweat can also be a nightmare. There are usually no windows and air conditioning does not work. Especially when mothers change their babies’ diapers, it becomes difficult to breathe in the room. (P14)

Mothers stated that while breastfeeding and caring for their babies in the same environment, they inevitably smell bad odors when changing diapers and feel nauseous.

Aesthetics and decoration

Participants stated that physical features were the priority, and they mentioned that aesthetic features might have a secondary importance. Some of the participants stated that the decoration and aesthetics of the breastfeeding room were as important as physical features, cleanliness, hygiene, and privacy. Some of the participants stated that breastfeeding environments lacked aesthetic and decoration features and that these features gave them comfort and peace of mind.

It becomes more difficult for me to breastfeed in stressful environments due to the feeling as if my milk just doesn’t flow. I don’t know how but my baby is affected by this situation as if it feels everything. The decoration of the room where you breastfeed and the furniture in the room all seem to be very old. It would definitely be better if there were welcoming, spacious, and beautifully decorated rooms. (P16)

I used the breastfeeding room of a shopping mall. The color of the walls, the paintings on the walls, and the lighting accessories were so attractive. I felt special, and believe me, this feeling is very important for breastfeeding mothers.…(P18)

Discussion

A breastfeeding room is a necessity for mothers who spend time in social areas. In recent years, as mothers have started to spend more time in social environments, the creation of supportive environments that will encourage mothers to breastfeed their children has emerged as an important problem. A breastfeeding woman should breastfeed or express milk regularly throughout the day to maintain milk production and prevent complications that may arise from milk accumulation in the breast (van Dellen et al., 2021). The findings of the study, which was conducted to examine the experiences of women who use and breastfeed in breastfeeding rooms in social spaces, were analyzed under two main themes, “The effect of the environment on breastfeeding behaviour” and “Features of breastfeeding environments,” and 12 subthemes. The findings of this study provide important findings about women’s breastfeeding experiences in social spaces as well as women’s expectations regarding breastfeeding rooms in social environments.

The Effect of the Environment on Breastfeeding Behavior

It is also thought that the creation of special areas and rooms for women to breastfeed may have a negative impact on breastfeeding culture. However, it is an important requirement that breastfeeding mothers have the right to choose what is most suitable for them and their baby (Dykes et al., 2023). In addition to individual factors, socio-environmental factors also appear to have an impact on breastfeeding behavior in line with study findings and literature knowledge.

Socio-environmental factors can directly affect behavior. It can also have indirect effects by influencing perceptions, attitudes, or emotions, ultimately affecting behavior (van Dellen et al., 2021). The discomfort felt by the idea of breastfeeding in public spaces is shown as the reason why women breastfeed for shorter periods and postpone breastfeeding (Amir, 2014). Our study indicated that women avoided breastfeeding in social environments and tended to use formula, did not take their babies with them when going out, or avoided being in social environments. Similarly, it has been stated in the literature that mothers avoid breastfeeding when they are in social areas and bottle-feed their babies with expressed breast milk or formula (Amir, 2014; Coomson & Aryeetey, 2018; Scott et al., 2015).

Our study indicated that women avoided breastfeeding in social environments and tended to use formula, did not take their babies with them when going out, or avoided being in social environments.

Features of Breastfeeding Environments

The most important problem in maintaining safe breastfeeding is considered to stem from the lack of private breastfeeding areas for mothers in out-of-home environments or places with inadequate features (Lee et al., 2019). The presence of breastfeeding rooms in social environments allows mothers to breastfeed their babies and empty their breasts filled with milk. The location of breastfeeding rooms is an important criterion for women’s use. In our study, women stated that accessible breastfeeding rooms saved time as they might need to breastfeed several times a day. It was also stated that breastfeeding rooms were generally located in a hard-to-reach place, in the basement, or next to the toilet. In a study in the literature on the examination of students’ opinions on the breastfeeding room in an educational institution, participants stated that the location of the room was effective in the use of the breastfeeding environment. Location was found to be a hindering factor when used several times during the day between classes (Henry-Moss et al., 2018). Another study focused on the physical distance that the user had to take to get to the place (Froh & Spatz, 2016). Since toilets are generally not suitable in terms of cleanliness and hygiene, mothers do not welcome breastfeeding near a toilet. Placing breastfeeding areas in remote corners or in dark, windowless, unused places is also viewed negatively by women (Azhari et al., 2012). Since this situation reduces the usability of the rooms, planning breastfeeding areas in central locations will provide positive benefits in terms of breastfeeding.

The quality and features of breastfeeding rooms are critical components in providing positive experiences for mothers (Ningsih et al., 2022; Sturtevant et al., 2021). Although supporting breastfeeding mothers is a current topic, there are still no minimum standards, regulations, and rules for the creation of breastfeeding rooms in public places. Froh and Spatz (2016) stated that having special areas for breastfeeding and expressing milk was not enough for breastfeeding and that the features and design of the place also affected breastfeeding (Froh & Spatz, 2016). Van Dellen et al. (2021) stated that not only the availability but also the quality of breastfeeding rooms was important (van Dellen et al., 2021). When the literature was examined, it was seen that the evaluations regarding breastfeeding rooms in outdoor environments were inadequate and that studies on this subject were limited. Official rules and standards for the design of breastfeeding rooms often focus on hygiene, privacy, and basic functional aspects of the environment (van Dellen et al., 2021). When we look at our study findings in terms of the characteristics of breastfeeding rooms, ensuring cleanliness and hygiene conditions came first. Cleanliness and hygiene are important elements that women pay attention to for both their own health and the health of their babies.

When we look at our study findings in terms of the characteristics of breastfeeding rooms, ensuring cleanliness and hygiene conditions came first.

Inadequate capacity and insufficient size of breastfeeding rooms and waiting in line for breastfeeding were mentioned as important problems in our study. Mothers could not use the breastfeeding room when they wanted to breastfeed and waited for other mothers to breastfeed. Choosing a large room when determining breastfeeding areas and arranging a second room if user capacity needs to be increased will be important in solving this situation.

The privacy and comfort of breastfeeding environments can affect the quality of breastfeeding by reducing the mother’s stress. Considering our study findings, most of the women mentioned the necessity of a safe environment that provided privacy while breastfeeding in breastfeeding rooms in public places. They stated that breastfeeding was private and that they preferred single rooms whenever possible, but that privacy could be ensured by using curtains/screens in cases where there was more than one user. In addition, it was stated that the seats needed to be placed in a way that the inside would not be seen directly when the door was opened and that doors needed to have locks. Henry-Moss et al. (2018) stated that multiperson rooms were used with curtains to ensure privacy (Henry-Moss et al., 2018). It was also stated in the literature that mothers might feel embarrassed and vulnerable while breastfeeding in public places such as shopping malls and restaurants (Meng et al., 2013). It was observed that our study findings were compatible with the literature (Coomson & Aryeetey, 2018; Sturtevant et al., 2021; Zhao et al., 2017). Privacy should be considered as a basic requirement in planning breastfeeding rooms in public places.

In general, it has been stated that places that make women feel safe and comfortable and have natural, aesthetic, and recreational features reduce stress, which inhibits the letdown reflex (Henry-Moss et al., 2018; van Dellen et al., 2022; van Dellen et al., 2021). It has been stated in the literature that the spatial design and aesthetic features of breastfeeding rooms also affect breastfeeding (Froh & Spatz, 2016). Official guidelines for the design of breastfeeding rooms generally focus on basic functional aspects such as cleanliness, hygiene, ventilation, and privacy, but spatial design and aesthetic features do not come to the fore. In addition to the basic functional aspects that breastfeeding environments should provide, they should also be evaluated in terms of plants or flowers, music, radio, or similar aspects, which will provide psychological comfort for women, and mirrors, paintings, and colorful walls for their aesthetic aspects (Fotiou et al., 2018; van Dellen et al., 2021). With simple arrangements regarding the aesthetics and decoration of breastfeeding environments, the psychological and general comfort of mothers can be improved and more effective use of these areas can be achieved.

With simple arrangements regarding the aesthetics and decoration of breastfeeding environments, the psychological and general comfort of mothers can be improved and more effective use of these areas can be achieved.

That women cannot access breastfeeding areas in social environments, cannot use these areas for some reasons, and are prevented from breastfeeding means that they cannot use their basic human rights. For this reason, it will be important to determine standards in creating breastfeeding areas in social environments, create supportive environments that meet the needs of mothers and their babies, and encourage mothers to breastfeed their babies. There is a need to raise awareness to help women breastfeed comfortably and to maintain social support for breastfeeding in public places (Coomson & Aryeetey, 2018). There is still a lack of laws and regulations for monitoring the characteristics of breastfeeding rooms. It is recommended that shopping malls, restaurants, cafés, and other public spaces should be equipped with breastfeeding rooms where women feel comfortable, safe, and enjoyable and that the implementation should be continuously monitored.

Limitations

The generalizability of the findings is limited to the number of women participating in the study, and the results do not represent all women. The fact that the research was conducted in only one province prevents the results from being generalized to the whole country. This situation caused limitations in the external validity of the study. Moreover, although qualitative content analysis is a very suitable approach for application in areas where information is incomplete or cannot yet be obtained through quantitative approaches, it may be possible for individual quotes and opinions to lose their meaning as the data material is reduced during the creation of categories and subcategories. This is not uncommon when qualitative methods are used, and quantitative approaches do not adequately address this study’s research questions. Qualitative research in this area is scarce but may add value to the growing body of survey-based and ethnographic quantitative research. However, the data were analyzed by each of the researchers, and the findings were reviewed with the coauthors. This may have reduced this bias.

Conclusions

In this study, which was conducted to examine women’s experiences with breastfeeding in public places, two main themes and 12 subthemes were identified. It was determined that the breastfeeding environment of the mothers participating in the study in public areas affected their breastfeeding behaviors. The features that the participants stated as essential in breastfeeding areas were cleanliness, hygiene, privacy, and ventilation. However, for quality breastfeeding, other features such as location, capacity and size, comfort, aesthetics-decoration, and lighting were also stated to be necessary. Conducting studies to determine user needs and preferences regarding the subject may be significant for the quality of these spaces. It is extremely important that breastfeeding areas meet the minimum standard in terms of physical conditions, design, equipment, and distance.

Implications for Practice

It has been determined that the breastfeeding environment in social areas affects the breastfeeding behavior of mothers.

The features that the participants stated as essential in breastfeeding areas are cleanliness, hygiene, privacy, and ventilation.

For quality breastfeeding, other features such as location, environment capacity and size, comfort, aesthetics-decoration, and lighting are required.

It is extremely important that breastfeeding areas meet the minimum standard in terms of physical conditions, design, equipment, and distance.

Footnotes

Acknowledgment

The authors would like to thank the women who participated in the study.

Authors’ Contribution

All authors discussed their research aims, and questions and participated in the phases of this study, recruitment and data collection (H.Y.S., F.A.R., and E.D.), data analysis, interpretation (H.Y.S., F.A.R., and E.D.), and writing the article and critically reviewing the article (H.Y.S., F.A.R., and E.D.). All authors have read and approved the final article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Havva Yeşildere Sağlam, PhD

Elif Dağlı, PhD

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