Views and experience of breastfeeding in public: A qualitative systematic review

Abstract

Breastfeeding rates in many Global North countries are low. Qualitative research highlights that breastfeeding in public is a particular challenge, despite mothers often having the legal right to do so. To identify barriers and facilitators, we systematically searched the qualitative research from Organisation for Economic Co‐operation and Development countries relating to breastfeeding in public spaces from 2007 to 2021. Data were analysed using the Thematic Synthesis technique. The review was registered with PROSPERO (registration number: CRD42017081504). Database searching identified 3570 unique records. In total, 74 papers, theses, or book chapters, relating to 71 studies, were included, accounting for over 17,000 mothers. Overall, data quality was high. Our analysis identified that five core factors influenced mothers' thought processes and their breastfeeding in public behaviour: legal system; structural (in)equality; knowledge; beliefs and the social environment. Macro‐level factors relating to legislation and inequality urgently require redress if breastfeeding rates are to be increased. Widespread culture change is also required to enhance knowledge, change hostile beliefs and thus the social environment in which mother/infant dyads exist. In particular, the sexualisation of breasts, disgust narratives and lack of exposure among observers to baby‐led infant feeding patterns resulted in beliefs which created a stigmatising environment. In this context, many mothers felt unable to breastfeed in public; those who breastfed outside the home were usually highly self‐aware, attempting to reduce their exposure to conflict. Evidence‐based theoretically informed interventions to remove barriers to breastfeeding in public are urgently required.

Breastfeeding experiences and women's self-concept: Negotiations and dilemmas in the transition to motherhood

“…In this case, the discomfort caused by breastfeeding does not stem from the child's age, but from the idea that breastfeeding should be done in private, with modesty, because it is something that breaks the rules of social interaction, largely due to the sexual connotation of the woman's breasts. In every paper of their systematic literature review, Grant et al ( 2022 ) identified discourses suggesting that breastfeeding was viewed as an antisocial act to be conducted in private only. Such discourses were largely related to the sexualization of breasts.…”

Rethinking breastfeeding management

“…Although support is available for breastfeeding mothers, low-income Black women have reported lack of social, workplace, and cultural support as barriers to breastfeeding 3,29. These barriers may be exacerbated by a lack of cultural acceptance of breastfeeding, especially in public 29,33…”

“…The need to increase rates of breastfeeding among Black women is especially relevant considering the recent baby formula shortage. However, there is a need for cultural change to reduce the stigma associated with breastfeeding 33. The role of educating the public in this capacity cannot be overstated.…”

“…3,29 These barriers may be exacerbated by a lack of cultural acceptance of breastfeeding, especially in public. 29,33 Educating Black women about the new AAP guidelines is critical for increasing rates of breastfeeding and extended breastfeeding among this population. The need to increase rates of breastfeeding among Black women is especially relevant considering the recent baby formula shortage.…”

“…However, there is a need for cultural change to reduce the stigma associated with breastfeeding. 33 The role of educating the public in this capacity cannot be overstated. Using a patient-centered approach is necessary for promoting breastfeeding beyond the fi rst year of life.…”