A ‘give it a go’ breast-feeding culture and early cessation among low-income mothers
Introduction
Despite the well-documented positive effects of breast feeding on maternal, infant and life-long health and development, the UK has one of the highest rates of artificial feeding of newborn babies in the world. Only 69% of mothers initiated breast feeding in 2000, falling to 52% at two weeks, 42% at six weeks and 21% at six months (Hamlyn et al., 2002). These rates have barely changed since 1995, although there have been slight increases among lower-income groups. Nonetheless, stark social and geographical differences remain; 57% of mothers in social class V (unskilled occupations) initiate breast feeding compared with 91% of mothers in social class I (professional and managerial occupations) (Hamlyn et al., 2002), and in certain areas such as north-east England women in all social classes are less likely to breast feed than nationally (Foster et al., 1997). In the borough of North Tyneside, the location of the research reported here, a recent audit suggested that only 54% of new mothers initiate breast feeding (McNichol et al., 2000). There are wide variations between postcode areas (which roughly map onto residential neighbourhoods) in the Borough, reflecting geographical patterns of economic advantage and deprivation (McNichol et al., 2000).
Mothers living on low incomes are a large and heterogeneous group and their reasons for not initiating or sustaining breast feeding are likely to be diverse. Nonetheless, they are currently the focus of strategies to encourage breast feeding, as real and sustained rises within this group are likely to have the greatest benefits to child and maternal health (Inch and Fisher, 2000). Surveys tend to identify mothers’ age, level of education and social class as strongly associated with choice of baby feeding method (Hamlyn et al., 2002). However, qualitative research is increasingly drawing attention to the deep-rooted processes which these quantitative baby-feeding indicators mask (e.g., Carter, 1995; Hoddinott and Pill, 1999; Earle, 2002; Mahon-Daly and Andrews, 2002). Such studies highlight the impact of everyday lived cultures in shaping women's expectations and experiences of feeding babies. These cultures underpin the spatial and social differences in baby-feeding attitudes and practices (see, Pain et al., 2001; Austveg and Sundby, 1995; Stuart-Macadam and Dettwyler, 1995).
The cultural aspects of breast feeding are evident at a number of scales. Firstly, in terms of everyday lived experiences, breast feeding is underpinned by beliefs, attitudes and practices which are more or less prevalent in particular social networks and places. New mothers with friends and relatives who have breast fed, who have seen others breast feeding and/or who were themselves breast fed as babies are very likely to breast feed, and as breast feeders go on to share experiences and give and receive support and advice with others (Hoddinott and Pill, 1999; Hamlyn et al., 2002; Ingram et al., 2002; Mahon-Daly and Andrews, 2002).
Secondly, feeding decisions are made in the context of broader cultures which shape expectations and experiences. In western societies, these include competing notions of being a ‘good’ mother, woman and partner (Murphy, 1999; Stearns, 1999; Pain et al., 2001). The sexualisation of breasts in western cultures conflicts with the nurturing role of breast feeding (Young, 1990; Carter, 1995), and underpins the embarrassment which many mothers feel about breast feeding in front of others or in public places (Pain et al., 2001; Mahon-Daly and Andrews, 2002)—breast feeding is one of a number of female activities to be marginalised to the private sphere (Carter, 1995). The portrayal of breast feeding by the mass media tends to reinforce these cultural messages, representing breast feeding as something ‘ordinary’ families do not do (Henderson et al., 2000). Economic and political factors in Britain fortify these broad baby-feeding cultures, including the lack of specifically targeted funding for breast-feeding support, failure to fully implement changes to healthcare practices, the aggressive promotion of artificial milk, and relatively poor maternity leave provision and pay in comparison with countries with higher rates of breast feeding (Esterik, 1995; NCT, 1999; Wilson, 2001).
Thirdly, the cultures of health promotion and education within which health professionals operate can profoundly influence mothers’ decisions about how to feed babies. A majority of women initially plan to breast feed, but early experiences can be difficult and off-putting, and so facilitative support in the early days is crucial (Hoddinott and Pill, 1999; NCT, 1999; Bailey and Pain, 2001).
The aim of the research study reported in this paper was to examine how these influences come together to shape the experiences of breast feeding of low-income women. It focused on first-time mothers living in low-income areas in order to improve understanding of why many give up breast feeding in the early hours or days of their babies’ lives. The study followed the trajectories of 16 women who had expressed an intention to breast feed, and explored their attitudes, beliefs and experiences; the advice and support of partners, family and friends; and information and practical support from antenatal and postnatal contact with health care services.
In this paper, ‘bottle-feeding’ describes the feeding of artificial milk. ‘Mixed feeding’ is used where mothers give a combination of breast and artificial milk.
Section snippets
Approach
The aim of the research was not to generalise, but to raise and explore some of the key issues that have a bearing on the breast-feeding experiences of low-income women. An exploratory qualitative approach was adopted in order to elicit the range of influences on their breast-feeding decisions, and to consider the interrelationships between these influences.
Study area
The research was carried out in North Tyneside in north-east England, an area with low rates of breast-feeding initiation and significant
Characteristics of the sample
The 16 women who were interviewed all lived in low-income areas in North Tyneside. Fifteen of them had been in employment before becoming pregnant. All were expecting their first baby and living with the baby's father at the time of the research. One pregnancy was the result of IVF treatment. Between the two interviews, all of the women delivered healthy babies at a local hospital (one gave birth to twins), four of whom had emergency caesarean sections.
Feeding trajectories
While 14 of the 16 women in the sample
Limitations of study
With a sample of this size, the findings cannot be generalised to all new mothers who intend to breast feed. Nonetheless, taken together with the growing number of qualitative studies on feeding elsewhere, the research raises some important themes and issues of which researchers and practitioners might take note. These are likely to have transferability to women in similar contexts (i.e., living in low-income areas, without many relatives or friends who have successfully breast fed their
Acknowledgements
We would like to thank the women who took part, Northern and Yorkshire NHS Regional Office who provided funding for the research, and North Tyneside General Hospital Maternity Unit, Northumbria Health Care Trust for help in facilitating the study.
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