View Entire Collection
By Clinical Topic
Diabetes – Summer 2012
Future of Nursing Initiative
Heart Failure - Fall 2011
Influenza - Winter 2011
Nursing Ethics - Fall 2011
Trauma - Fall 2010
Traumatic Brain Injury - Fall 2010
Fluids & Electrolytes
Purpose: Examining prenatal breast-feeding self-efficacy and infant feeding decisions among African American women using a mixed-method approach. A black feminist philosophy was used to keep women's experiences as the central research focus.
Method: The Prenatal Breast-feeding Self-efficacy Scale was used to determine differences between intended breast-feeders and formula users among 59 women. Seventeen narrative interviews were conducted to analyze postpartum accounts of actual feeding practices.
Results: Both groups (intended breast- or formula-feeders) demonstrated confidence in their ability to breast-feed. Women planning to breast-feed (M = 82.59, SD = 12.53) scored significantly higher than anticipated formula users (M = 70, SD = 15.45), P = .001 (2-tailed). Four of the six themes emerging from narrative analysis were similar to categories of self-efficacy: performance accomplishments, vicarious experiences, verbal persuasions, and physiological reactions. In addition, themes of social embarrassment and feelings of regret were identified.
Conclusion: Although African American women in this study rated themselves overall as confident with breast-feeding, several narratives about actual feeding choices indicated ambivalence. Women planning to breast-feed need continued support from their healthcare providers throughout the childbearing year. Furthermore, prenatal and immediate postpartum opportunities may exist for nurses to encourage breast-feeding among individuals who initially plan formula use.
Since 1955 when national surveys representative of the US population were initiated,1 breast-feeding rates have fluctuated throughout history hitting a record low of 20% in 1970.2 The US rates have been rising since, ranging from 68% in 1999 to 74% in 2006.3 Even though these numbers are encouraging, racial disparities still exist. In particular, African American women have consistently maintained the lowest breast-feeding rates of any race. According to provisional reports from the 2007 National Immunization Survey,3 only 60% of African American women were initiating breast-feeding, which is notably below the national average of 75%. Duration rates among this population drop even lower during the first year of life with 28% of African American women breast-feeding at 6 months and 13% at 12 months.3
These statistics are disturbing because African American infant mortality rates are double that of the national rates4 and breast-feeding has been shown to reduce mortality rates among even high-risk infants.5 Breast milk has other dietary, cost-effective, sociological, and psychological benefits that are advantageous for vulnerable populations such as African Americans. Yet, the population who could gain the most from breast milk breast-feeds the least.
There are numerous reports in the literature of various factors related to African American women's infant feeding preferences.6-14 In studies that included at least 30% African Americans, the findings were conflicting. For example, researchers have found that knowledge deficit related to breast-feeding benefits contributed to choosing formula over breast milk.6,7 Others noted that African American women were indeed aware of the various benefits of breast-feeding, yet chose not to breast-feed.8,9 Reports have also shown that either support or lack of encouragement related to infant feeding choices from family members and healthcare providers are powerful influences on African American women's decision making.9-13 Yet in a small narrative interview based study, all 5 of the African American women who participated maintained that their choices to initiate breast-feeding were their decisions alone.14 Further research efforts are therefore needed to clarify these inconsistencies.
This study provided a mechanism for African American women to directly communicate their rationales for infant feeding preferences, including factors influencing choices. Placing African American women at the center of research related to their infant feeding practices may offer clarity to previous contradictions noted in the literature related to this population and infant feeding. The purposes of this study were 2-fold: (1) compare differences in prenatal breast-feeding self-efficacy between African American women who intend to breast-feed and those intending to use formula and (2) analyze postpartum narratives in which African American women discussed their actual infant feeding choices.
This study is unique in examining African American women and their infant feeding choices from a black feminist standpoint. The black feminist view takes general feminist principles about establishing equality for women and specifically applies them to the lives of African American women.15,16 Viewpoints from black feminist philosophy were used to listen to and learn from African American women to avoid assumptions that quantitative averages alone can elucidate African American women's decision making related to this phenomenon.
Self-perception of one's competence influences preference for and diligence in certain behaviors. Bandura's concept of self-efficacy17 is developed from his social cognitive theory. He states that individuals gauge their ability to perform a particular action based on previous experiences, support from external sources, role models, and personal physiological reactions.18
Self-efficacy has been investigated in research centered on breast-feeding. It has been shown to have an effect on infant feeding choice, though most of these studies were conducted with white women.19-23 Instruments such as the Breast-feeding Self-Efficacy Scale-Short Form24 and the Prenatal Breast-feeding Self-Efficacy Scale25 have been used to determine the effect of maternal breast-feeding confidence on infant feeding choice. Only 2 studies have been conducted examining the concept prenatally25 and during the postpartum period26 with samples in which the majority (74%-100%) of women were of African descent.
A sequential mixed-method approach was employed to meet the purposes of this study. Because the phenomenon of infant feeding preference among African American women is multifaceted, a design that took this complexity into account was chosen. The assumption was made that qualitative data would offer more depth of insight about the complexities in women's infant feeding method choices and enhance the interpretation of the quantitative findings.
Participants were recruited from 2 sites in the Midwest: a private obstetrician's office and a midwifery center. These were chosen because of the high numbers (50%-90%) of African American women seeking care at the sites. The primary researcher visited each site at least once a week for recruitment. The certified nurse-midwives and physicians informed the researcher of women who were eligible. The eligibility criteria were 28 to 40 weeks gestation, singleton pregnancy, aged 18 years or older with no high-risk complications (eg, preterm labor, gestational diabetes, or preeclampsia).
The institutional review board at Marquette University granted approval for the study with support letters received from both practice sites. While waiting for their prenatal visits, each eligible woman was given an informational brochure describing the study. Data collection occurred over 2 time periods: time 1 (third trimester) and time 2 (3-4 weeks postdelivery).
In addition to a demographic questionnaire, the participants completed the Prenatal Breast-feeding Self-Efficacy Scale.25 This 20-item, self-report tool measured breast-feeding self-efficacy during the prenatal period. More specifically, it assessed each mother's confidence in her ability to initiate breast-feeding. The Prenatal Breast-feeding Self-Efficacy Scale is rated on a 5-point Likert scale ranging from 1 (not at all sure) to 5 (completely sure). Total self-efficacy scores could range from 20 to 100. The scale has been reported as reliable and valid with a Cronbach's [alpha] = 0.89 and a content validity of 0.90.25
Up to 30 women were to be recontacted 2 weeks after delivery with the intent to have equal numbers of breast-feeders and formula users (10 each) interviewed. Participants were asked to meet for individual narrative interviews to discuss the infant feeding method each had chosen. Selection was based on the chronological order of the women's estimated dates of delivery. Face-to-face narrative interviews were conducted by the first author in a private room at the practice site. All narratives were audio-taped. Each participant was asked to describe how she decided on the particular infant feeding method chosen. Since this was a narrative interview, structured questions were not used. Instead, the opening statement, "Tell me all your thoughts, feelings, perceptions, experiences, and other influences that you recall that went into your infant feeding decision" was stated to initiate dialogue. Probes encouraging women to talk about familial and providers' input into their decisions, and any indecisiveness regarding their choices, were used when necessary to elicit further disclosure. The participants were given a final opportunity to add any other remarks regarding the topic as the interview concluded. After the narrative interview, each participant completed a brief Infant Feeding Form. The form collected information on actual feeding method initiated in-hospital and current method at 3 to 4 weeks postpartum. Each woman who was breast-feeding at the time of the interview chose the level of breast-feeding based on Labbok and Krasovec's27 definitions: exclusive (no other liquids or solids), almost exclusive (water, vitamins, and/or other liquids given infrequently in addition to breast milk, but no formula), high partial (less than 1 bottle of formula per day), medium partial (at least 1 full bottle of formula per day), and low partial (at least half are formula feedings).
Quantitative data were analyzed using the Statistical Package for Social Science (SPSS), 16.0 version. Demographic data, including infant feeding intent, were summarized using descriptive statistics. To compare mean scores from the Prenatal Breast-feeding Self-Efficacy Scale between women who had intended to breast-feed and those intending to use formula, an independent-sample t test was used. An independent-sample t test was also utilized to determine mean differences of the itemized statements of the self-efficacy scale between the 2 groups. To determine the predictability of prenatal breast-feeding self-efficacy on intended infant feeding choice, logistical regression, and odds ratio analysis was used. Statistical significance was determined at P < .05 with a 95% confidence interval.
Narrative interviewing28 was the qualitative methodology used in this study. The interviews were transcribed and analyzed by the primary investigator. To ensure accuracy, the transcriptions were compared against the audiotaped interviews. Analysis began during data collection.29 During the interviews, observational notes were made logging use of verbal inference and nonverbal cues made by the participants.30 Notes were added to the transcriptions by the interviewer to describe expressions and body language displayed by participants. Giving attention to repetition as well as outliers, the transcripts were systematically coded for women's statements related to infant feeding choice. After reading and rereading the transcriptions, common and unique phrases were identified.29 To avoid redundancy in reporting the findings, like ideas were categorized. During the process of analysis, similarities between participants' narratives and Bandura's sources of self-efficacy were noted and the latter were used as themes to the extent that they fit the categorized data. After further deliberation, other major themes were developed from the categorized ideas to best represent the data. Review of the qualitative coding and thematic decisions were discussed with an experienced qualitative researcher (the second author) to ensure trustworthiness, completeness, and clarity.
Finally, the results from the quantitative and qualitative data were examined for patterns of convergence and discrepancy. This form of triangulation sought a more comprehensive assessment of the findings.30 Conclusions were drawn from infant feeding intent and actual practices of the women in the study.
Sixty-four women were approached to participate in the study. Fifty-nine completed the demographic questionnaire and the Prenatal Breast-feeding Self-Efficacy Scale (92% recruitment rate). Four declined and 2 withdrew from the study before completing the questionnaires. Table 1 summarizes the participants' sociodemographic information.
Overall, there was a significant difference in the prenatal breast-feeding self-efficacy scores for mothers intending to breast-feed (M = 82.59, SD = 12.53) and mothers with intentions to use formula (M = 70, SD = 15.45), P = .001 (2-tailed). The size of the variances in the mean scores (mean difference = 12.51, 95% CI = 5.21-19.81) was large (Cohen d = .896). In particular, there were significant differences between groups on 45% (9 of 20) of the items on the Prenatal Breast-feeding Self-Efficacy Scale. Items from the breast-feeding self-efficacy scale for which there were significant mean differences are shown in Table 2. Participants who planned to breast-feed perceived themselves to be efficacious in their ability to seek breast-feeding information, manage breast-feeding obligations, and feed in the presence of others compared with participants intending to use formula.
A logistical regression was performed to measure the effect of age, marital status, educational level, household income, and prenatal breast-feeding self-efficacy on women's intended feeding method. The model with all predictors was statistically significant, [chi]2 (5, N = 58) = 14.879, P = .011, demonstrating that the model was able to discern between participants who reported intention to breast-feed and those intending to use formula. Overall, the model explained between 22.6% (Cox and Snell R2) and 30.4% (Nagelkerke R2) of variance in infant feeding intention. As shown in Table 3. prenatal self-efficacy scores were the only significant predictor of women intending to breast-feed. The higher a woman's prenatal self-efficacy score, the more likely she was to report an intention to breast-feed (OR = 0.93; 95% CI = 0.88-0.98).
A total of 17 women were interviewed about their infant feeding decisions by the first author (11 who had intended to breast-feed and 6 who had planned to use formula), yielding an 85% sample from the target of 20. Among the 17 women interviewed, there was a non-significant difference in mean prenatal breast-feeding self-efficacy scores between mothers with breast-feeding intentions (M = 79.55, SD = 16.07) and those intending to use formula (M = 69.17, SD = 14.55) P = .21 (2-tailed). Of the 11 women interviewed who had intended to breast-feed, 8 (73%) initiated breast-feeding in the hospital and 3 chose to use formula. All 6 of the women interviewed who planned to initiate formula-feeding did so.
Of the mothers who initiated breast-feeding in-hospital, only 1 had discontinued by the 3- to 4-week postpartum interviews. Using Labbok and Krosovec's schema of breast-feeding levels,27 participants who had continued self-reported their degree of breast-feeding. Five (72%) of the breast-feeding mothers reported using less than 1 bottle of formula per day and the remaining 2 were exclusively breast-feeding (no other liquids or solids).
When recounting how they arrived at their infant feeding choices and recalling factors that influenced their options, the women, despite their actual feeding method, generally shared common themes. Four of the themes related to women's rationales for choosing their individual infant feeding methods and these were consistent with Bandura's 4 sources of self-efficacy: performance accomplishments, vicarious experiences, verbal persuasions, and physiological reactions.18 In addition, 2 more distinct themes, social embarrassment and feelings of regret, were identified. Embarrassment was expressed when women were discussing breast- versus formula-feeding, while regrets were only reported among those choosing formula. Despite sharing similar themes, the women who were using formula expressed negativity in 5 of the 6 themes, all except for verbal persuasion, which they experienced as positive. In contrast, the women who breast-fed were generally positive or neutral about most of the themes, except for negative expressions about the 2 themes: physiological reactions and social embarrassment.
According to Bandura, individuals who successfully master a skill are more apt to perform that behavior again.18 Women who were breast-feeding at the time of the interview reported they did so because of previous positive experiences with breast-feeding such as "I know I can do it, I breast-fed all three [of her other children]," "It was something that I was going to do whenever I had another baby because it's what I did with my other two." The breast-feeding participants felt compelled, not in a negative manner, to breast-feed the current child because of prior breast-feeding experiences. When speaking of her second child, one mother stated, "I feel like I didn't have a choice."
Mothers who opted to use formula cited unsuccessful attempts with breast-feeding their other children as reasons not to try again.
My first pregnancy I tried the breast-feeding and it hurt and he bit me; so, that's how I came to bottle-feeding.
That first experience I don't know if I was doing it right; he wasn't latching on. I don't want to go through that again. I'd rather for him just to take the bottle.
One mother whose baby weighed 4 pounds at birth recalled briefly contemplating breast-feeding but elected not to because "all the flashbacks [of previous negative breast-feeding experiences] started coming back." Also the lack of experience was a deterrent to initiate breast-feeding for one mother: "It's [being a parent] my first experience, my only experience. I'm basically feeling my way through this."
In addition from having breast-feeding experience, women who were currently breast-feeding had role models to whom they sought guidance and saw as examples of what to do. One woman stated, there are "a lot of women in my family and they're all big on breast-feeding." She recalled watching her cousin breast-feed and "being able to ask questions." Having witnessed others, especially individuals who share similar characteristics, successfully perform a certain task, affects one's own self-efficacy.18 The participants cited having "mothers, sisters, cousins, and friends" who all breast-fed. Another proclaimed, "We have a saying in our family: the breast kind is the best kind!"
Lack of breast-feeding role models was a major barrier for mothers using formula. Some of the formula-using participants reported not seeing anyone who looked like them breast-feed. "I haven't seen any black women do it. I see white women do it. They do it all the time. I mean I can go to a restaurant and a white woman is sitting there with the baby on the [breast]." Even on TV, formula users noted seeing "more white women doing it." Another commented that if she "saw black women doing it; maybe I would have tried it." These mothers also reported friends who bottle-fed and encouraged them to "do the bottle; [because] it would be easier."
Receiving verbal support from others, especially those seen as reputable, may influence one's perceived self-efficacy.31 All women spoke of receiving encouragement to breast-feed from outside sources. However, how the women accepted the support varied by feeding method. Having "everybody cool with it," made the choice to breast-feed easier for some of the women. Women who breast-fed spoke of how family members "were so proud of [them]" and how "that made [them] feel even better." They spoke of being prompted to breast-feed because breast milk "is always a good thing for babies." One woman noted that her husband had 6 sisters who breast-fed; so, her mother-in-law "saw the impact it had" and encouraged her to do the same.
Healthcare providers spoke to the fact that the "baby is healthier when breast-fed." Providers informed the women of both physical and psychological benefits of breast-feeding. Both breast- and formula-feeders described instances where their providers, including Women, Infant, and Children Program (WIC) personnel, offered infant feeding recommendations. Woman reported that providers talked about the potential to bond because "when you got the baby to the breast you feel more connected." When telling the nurses of her choice to breast-feed, she reported a nurse replied, "Good mom. Good decision." The participant recognized this positive reinforcement as "a little push/boost" to her confidence.
Despite reporting positive conversations regarding infant feeding and being informed that breast milk is superior, mothers who chose bottle over breast reported the discussions with healthcare providers or family members had little to no effect on them. They acknowledged, "She [CNM] tried to get me to breast-feed; but, I still chose bottle." Providers were reported saying, "Think it over; you should try it; it's better for the baby; you'll have smarter kids." One participant stated she was given "basic information about breast-feeding; but bottle-feeding sounded easier." Another chose to use formula even though her "mother thought I should breast-feed because she breast-fed us."
Others recalled receiving no advice from providers. One mother admitted that she did not have a "conversation [about infant feeding] because I had already kind of had my mind made up that I was going to bottle-feed." The lack of conversation about infant feeding weighed heavily on one mother's decision:
If I would have been persuaded; like if my doctors or the hospital would have said this is why you should breast-feed, I probably would have taken a chance and did it. But no one said this is how you do it. No one gave me any advice. [The nurses] just jammed a bottle in her mouth. They didn't say do you want to try to breast-feed her.
Both breast- and formula-feeders said their infant feeding decisions were ultimately their own, regardless of receiving verbal encouragement or not. "It's basically my choice. I don't have anybody's opinion but my own." Others explained, "It really wasn't a lot of people influencing me" and they were "going to breast-feed anyway" and could not see anything "getting in the way" of their decisions. Another woman concluded, "Couldn't nobody persuade me to breast-feed."
According to Bandura,18 people may determine their ability to carry out a specific behavior based on somatic cues expressed through physiological conditions. In this study, women reported that physiological demands of breast-feeding affected their decisions. Breast-feeding mothers commented on the fact that breast-feeding is "not the best feeling; it's uncomfortable, especially when the milk comes in." They also described breast-feeding as a "struggle at times" with concerns of "not producing enough milk." Despite the pain and sometimes difficulty with breast-feeding, the women spoke of having to "tough it out" because of their desire to "do what was right" for the baby. One mother in particular described being pleasantly surprised that she began "liking it too." The fact that their infants were "benefitting from it [breast milk]," permitted these women to "do what [they] had to do."
For women who chose to use formula, this theme seemed to be a principal factor that deterred them from breast-feeding. There was an inability to get past the physical demands of breast-feeding. "It's too much you have to do to breast-feed. You got to watch your food; can't drink [alcohol] or smoke." Understanding that breast-feeding is best, one participant claimed, "the bottle is a lot easier because with breast-feeding you have to deal with buying a certain kind of bra and other stuff." Perceived or actual pain was another physical issue the formula using mothers did not want to endure: "I didn't breast-feed because it hurt and I just can't do that."
Embarrassment about breast-feeding in public was a common psychological issue that was unequivocally expressed among both breast- and formula feeders. In an effort to avoid "people getting the wrong impression of me" some breast-feeding women reported resorting to going "to the car or to the bathroom into a stall" to feed their baby if necessary. A breast-feeding woman spoke about not wanting "to expose myself" and not "wanting anybody looking at me." This was especially true in regards to males, whether they were family members or not. Another mother talked about her first experience breast-feeding in public:
The first time I was a little shyer about where I would do it; but that just made it more stressful for me. Now I'm like whatever, baby's got to eat. Some people would go into a bathroom; but, I'm like it's funky in there. I don't want to be in there. So I pretty much do it anywhere as long as I have a blanket.
Mothers using formula unanimously reported they "didn't want to pull [their] breast out in public." They felt that "you are not supposed to [breast] feed in public." They, like the breast-feeding women, were reluctant to breast-feed in front of family members. One mother recalled attempting to breast-feed in front of the father of the baby and thought, "wait, he's not supposed to see me do this."
Three of the ten mothers who were formula-feeding at the time of their interviews spoke of feelings of regret for not breast-feeding. One mother tearfully explained, "I should have did it and found time to just do it. I'll probably be thinking that way for the rest of my life: should of, could of, would of." As another participant reflected on her decision, she stated, "Now that I think about it, I wish I would have breast-fed." One woman spoke of feeling left out and judged by others who have breast-fed. "Everyone I talked to said they breast-fed and I felt left out. I didn't feel judged before [in the hospital]; but, now I do."
These women attempted to breast-feed once they got home, but were met with what they perceived as resistance from their infant. "When I got home I tried to breast-feed. I tried it for that week and then I just gave up. He'd do it [latch to the breast] for little bit and then he'd turn his head like he didn't want it." She recalled being impatient with the baby not latching on instantly. Retrospectively, one woman agreed that it was important in the future to "give breast-feeding a fair chance before switching."
Regardless of their infant feeding preference, African American women in this study reported similar factors that had impacts on their choices to breast- or formula-feed. The manner in which each source affected infant feeding selection varied between groups.
The findings from this study suggest that breast-feeding self-efficacy has an impact on infant feeding intentions for African American women. Over half of the participants had intentions to breast-feed and the sample's average prenatal self-efficacy raw score was on the higher end of the scale (total possible = 20-100). These findings are similar to results found in the literature in which participants who had intentions to breast-feed had higher prenatal self-efficacy scores than those planning to use formula.25 Other researchers who measured the concept of self-efficacy in breast-feeding women found that participants with high self-efficacy scores breast-fed for longer periods of time compared with women with lower scores.19-23 However, the samples in these studies were comprised of predominantly white women. Researchers examining women of African descent found that women in this population who had high self-efficacy scores breast-fed for similar durations when compared with white women.26 Therefore, in regard to breast-feeding, the more self-efficacious a woman is, the more likely she is to intend, initiate, and continue to breast-feed.
As the women talked openly about all their thoughts, feelings, and influences that went into their infant feeding choices, factors reported in prior research surfaced. For example, past breast-feeding experiences prompted mothers to initiate breast-feeding with their current infants.9,32,33 Having no breast-feeding role models was found to be a disincentive for women in this sample who chose to formula-feed. This finding was supported in other studies in which formula-feeding women had no exposure to women who had breast-fed.7,11,33
Healthcare providers' and family members' support and encouragement did not have consistent impacts in this population. Some women embraced suggestions from family members and providers' while others reported no influences on their infant feeding decisions. This variation in the findings is found elsewhere in the literature where differences in breast-feeding initiation and duration were related to the effects of external influences.34 Women who discontinued breast-feeding by month 3 reported needing ongoing encouragement from providers and family members during the postpartum period. Alternatively, women who had continued breast-feeding relied on internal motivations (ie, positive bonding, infant health) to persist with breast-feeding.
Embarrassment over feeding in public or in front of family continued to be an obstacle for African American women and their disinclination to choose breast-feeding over formula. Even mothers who were breast-feeding commented on not wanting to expose themselves in public. This self-consciousness also was found to weigh heavily on infant feeding practices for African American women in other studies.12
Grounding this study in black feminist philosophy was done purposefully to provide an opportunity for African American women to disclose how their own realities affected their infant feeding choices and systematically analyze their responses. In this study, the women's collective narratives provided a bridge between prenatal self-efficacy, infant feeding intentions, and actual feeding behaviors. The narratives enhanced and provided clarification for some of the statistical findings by giving a voice to the numbers. There was an association between prenatal self-efficacy scores and the individual postpartum narratives. Many women who intended to breast-feed and had high self-efficacy scores disclosed why they felt able to initiate and continue to breast-feed. The same was not true for women who formula-fed.
Although narrative interviews added depth to this study, the small postpartum sample size likely contributed to the inability to demonstrate predictability of prenatal self-efficacy on actual maternal infant feeding choices. More research that allows African American perspectives to be voiced is needed, including those with larger sample sizes. Many women in this study were multiparous; therefore, having previous infant feeding experiences was a limitation. Future studies could focus on primiparas' feeding choices. Also, because there is no critical value (specified cutoff point that differentiates between high and low scores) for prenatal self-efficacy, it is not possible to determine at what point women will actually initiate breast-feeding successfully. Determining this critical value could help to improve the usefulness of this tool.
The Healthy People 202035 objectives continue to emphasize the importance of improving national breast-feeding rates. Also critical will be the need to increase rates among vulnerable populations where breast-feeding disparities exist. This study is unique in that it explored self-efficacy, a modifiable maternal characteristic, in a sample of exclusively African American women whose perspectives and life experiences continue to need greater attention. More narrative work is warranted in the future to promote listening to African Americans and learning directly from them about how their health decisions are made.
It is critical for nurses and other providers to continue to dialogue regarding infant feeding choices throughout the prenatal course for each woman. The women in this study explained that although they thought they were committed to their infant feeding choices to use formula prenatally, they reported there were still opportunities for them to be influenced to breast-feed and three strongly emphasized regrets that they had not initiated breast-feeding. Nurses in outpatient and inpatient situations, including advanced practice nurses caring for pregnant women, are in unique positions to discuss breast-feeding and address questions about perceived barriers. Furthermore, nurses, caring for women during labor, birth, and postpartum, encounter opportune times to encourage breast-feeding even in those who initially planned to use formula.
None of the women reported having policies or provisions in place at work to accommodate breast-feeding. Several reported returning to work as reasons they chose not to breast-feed. Many of the breast-feeding mothers were still apprehensive about feeding in public and only willing to do so if absolutely necessary. Thus, more policy work is necessary to change laws and public opinion about breast-feeding in public and at work.
Understanding why vulnerable populations make healthcare choices that do not seem to be most beneficial for them is critical when trying to close health disparities gaps. More research from a black feminist perspective is needed to listen to marginalized persons describe how their life experiences affect their choices, including the use of more narrative studies and other qualitative approaches. Their perspectives will inform nurses and other providers and foster cultural awareness. Mixed method research may provide guides for developing culturally appropriate interventions on healthcare issues that affect vulnerable populations.
1. Coates MM, Riordan J. Tides in breastfeeding practice. In:Riordan J, ed. Breastfeeding and Human Lactation. 4th ed. Sudbury, MA: Jones & Bartlett; 2005:3-29. [Context Link]
2. Feinstein JM, Berkelhamer JE, Gruszka ME, Wong CA, Carey AE. Factors related to early termination of breast-feeding in an urban population. Pediatrics. 1986;78:210-215. [Context Link]
3. Centers for Disease Control and Prevention. Breastfeeding among U.S. Children Born 1999-2007, CDC National Immunization Survey. http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed March 4, 2011. [Context Link]
4. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2005 period linked birth/infant death data set. Natl Vital Stat Report. 2008;57(2):1-32. [Context Link]
5. Smith MM, Durkin M, Hinton VJ, Bellinger D, Kuhn L. Initiation of breastfeeding among mothers of very low birth weight infants. Pediatrics. 2003;111(6):1337-1342. [Context Link]
6. Dix D. Why women decide not to breastfeed. Birth. 1991;18(4):222-225. [Context Link]
7. Corbett KS. Explaining infant feeding style of low-income Black women. J Pediatr Nurs. 2000;15(2):73-81. [Context Link]
8. Raisler J. Against the odds: breastfeeding experiences of low income mothers. J Midwifery Womens Health. 2000;45(3):253-263. [Context Link]
9. McCarter-Spaulding D. Black women's experience of breastfeeding: a focus group's perspective. J Multicult Nurs Health. 2007;13(1):18-27. [Context Link]
10. Hannon PR, Willis SK, Bishop-Townsend V, Martinez IM, Scrimshaw SC. African-American and Latina adolescent mothers' infant feeding decisions and breastfeeding practices: a qualitative study. J Adolesc Health. 2000;26(6):339-407.
11. Cricco-Lizza R. Infant-feeding beliefs and experiences of Black women enrolled in WIC in the New York Metropolitan area. Qual Health Res. 2004;14(9):1197-1210. [Context Link]
12. Cricco-Lizza R. Black non Hispanic mothers' perceptions about the promotion of infant-feeding methods by nurses and physicians. J Obstet Gynecol Neonatal Nurs. 2006;35(2):173-180. [Context Link]
13. Meier ER, Olson BH, Benton P, Eghtedary K, Song WO. A qualitative evaluation of a breastfeeding peer counselor program. J Hum Lact. 2007;23(3):262-268. [Context Link]
14. Robinson K, VandeVusse L. Exploration of African-American women's infant feeding choices. J Natl Black Nurses Assoc. 2009;20(2):32-37. [Context Link]
15. Barbee EL. A Black feminist approach to nursing research. West J Nurs Res. 1994;16:495-506. [Context Link]
16. Taylor JY. Womanism: a methodologic framework for African American women. ANS Adv Nurs Sci. 1998;21(1):53-64. [Context Link]
17. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191-215. [Context Link]
18. Bandura A. Self-Efficacy: The Exercise of Control. New York: WH Freeman; 1997. [Context Link]
19. O'Campo P, Faden R, Gielen A, Wang M. Prenatal factors associated with breastfeeding duration: recommendations for prenatal interventions. Birth. 1992;19(4):195-201. [Context Link]
20. Dennis C, Faux S. Development and psychometric testing of the breastfeeding self-efficacy scale. Res Nurs Health. 1999;22(5):399-409.
21. Blyth R, Creedy DK, Dennis C, Moyle W, Pratt J, De Vries SM. Effect of maternal confidence on breastfeeding duration: an application of breastfeeding self-efficacy theory. Birth. 2002;29(4):278-284.
22. Noel-Weiss J, Rupp A, Cragg B, Bassett V, Woodend AK. Randomized control trial to determine the effects of prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration. J Obstet Gynecol Neonatal Nurs. 2006;35(5):616-624.
23. Kingston D, Dennis C, Sword W. Exploring breast-feeding self-efficacy. J Perinat Neonatal Nurs. 2007;21(3):207-215. [Context Link]
24. Dennis C. The breastfeeding self-efficacy scale: psychometric assessment of the short form. J Obstet Gynecol Neonatal Nurs. 2003;32(6):734-744. [Context Link]
25. Wells KJ, Thompson NJ, Kloeblen-Tarver AS. Development and psychometric testing of the prenatal breast-feeding self-efficacy scale. Am J Health Behav. 2006;30(2):177-187. [Context Link]
26. McCarter-Spaulding D, Gore R. Breastfeeding self-efficacy in women of African descent. J Obstet Gynecol Neonatal Nurs. 2009;38(2):230-243. [Context Link]
27. Labbok M, Krasovec K. Toward consistency in breast-feeding definitions. Stud Fam Plann. 1990;21(4):226-230. [Context Link]
28. Duffy M. Narrative inquiry: the method. In: Munhall PL, ed. Nursing Research: A Qualitative Perspective. Sudbury, MA: Jones & Bartlett; 2007:401-421. [Context Link]
29. Carpenter DR. What is nursing knowledge? In:Streubert HJ, Carpenter DR, eds. Qualitative Research in Nursing: Advancing the Humanistic Imperative. Philadelphia, PA: Lippincott; 1995:15-28. [Context Link]
30. Pope C, Mays N, eds. Qualitative Research in Health Care. Malden, MA: Blackwell; 2006. [Context Link]
31. Bandura A. Social Foundation of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986. [Context Link]
32. Humphreys AS, Thompson NJ, Miner KR. Intention to breastfeed in low-income pregnant women: the role of social support and previous experience. Birth. 1998;25(3):169-174. [Context Link]
33. Meyerink RO, Marquis GS. Breastfeeding initiation and duration among low-income women in Alabama: the importance of personal and familial experiences in making infant-feeding choices. J Hum Lact. 2002;18(1):38-45. [Context Link]
34. Racine EF, Frick KD, Strobino D, Carpenter LM, Milligan R, Pugh LC. How motivation influences breastfeeding duration among low-income women. J Hum Lact. 2009;25(2):173-181. [Context Link]
35. US Department of Health and Human Services. Maternal, infant, and child health objectives. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topic. Accessed March 4, 2011. [Context Link]
For more than 15 additional continuing education articles related to obstetrics, go to http://NursingCenter.com/CE
African American women; breast-feeding; narrative inquiry; self-efficacy
Back to Top