Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers

Abstract

Objectives To explore African American women’s breastfeeding thoughts, attitudes, and experiences with healthcare professionals and subsequent influences on their breastfeeding interest and behavior. Insight was also sought about the most effective practices to provide breastfeeding support to African American women. Methods Thirty-eight pregnant or lactating African American women and racially diverse health professionals were recruited and participated in one of six membership specific focus groups in the metro Detroit area. An experienced focus group facilitator who was African American woman served as the primary group facilitator, using a semi-structured guide to discussions. Focus groups explored perceptions of personal and professional roles and behaviors that support African American women’s breastfeeding behavior. Discussions were digitally recorded and audiotapes were transcribed. Thematic content analysis was conducted in combination with a review of field notes. Results Participants generally agreed that breastfeeding is the healthier feeding method but perceived that healthcare providers were not always fully supportive and sometimes discouraged breastfeeding. Non-breastfeeding mothers often expressed distrust of the information and recommendations given by healthcare providers and relied more on peers and relatives. Health professionals lacked information and skills to successfully engage African American women around breastfeeding. Conclusions for Practice Breastfeeding initiation and duration among African American mothers may increase when postpartum breastfeeding interventions address social and cultural challenges and when hospital breastfeeding support with the right professional lactation support, is void of unconscious bias and bridges hospital, community, peers, and family support. Professional lactation training for healthcare professionals who are in contact with expectant and new mothers and an increase in the number of IBCLC of color could help.

Racial and Ethnic Differences in Reasons for Breastfeeding Cessation Among Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

“…Maternal perception that the infant is not satisfied by breastmilk is a common concern, and this study suggests that counseling should consider women's nativity. Hence, nonnative populations may benefit from health care professionals who are trained to respond to concerns regarding infant satisfaction with breast milk . Marital status and education also predicted reasons for breastfeeding cessation, which has previously been recognized among this WIC population .…”

Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature

“…Two studies examined the perceptions of health care providers . The perspectives of both African American women and health care personnel were examined in one study . The presentation of the findings is organized using these same categories.…”

“…Participants recalled receiving inadequate breastfeeding support, and lack of trust in the health care provider was a prominent theme. Examples of this included the absence of lactation support when latch issues arose and their breastfed newborns receiving formula in the nursery . The authors found that women identified breastfeeding as optimal but reported prenatal and postpartum health complications as barriers.…”

“…The perceptions of the health professionals regarding lactation support were congruent with the women's views. Health personnel acknowledged a lack of culturally appropriate lactation support needed in caring for African American women . Furthermore, health personnel reported that the women they cared for had other issues (eg, poverty, poor health) that took precedence over discussing breastfeeding …”

“…Specifically, this bias decreased referrals for lactation support and made breastfeeding African American women a lower priority . Both women and health care providers reported that other issues (eg, poverty, physical and mental health concerns) took precedence over breastfeeding support . In addition, these studies found that African American women who initiated breastfeeding in hospital received limited lactation support when problems arose and received care counterproductive to breastfeeding .…”