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Grandmother Breastfeeding Support: What Do Mothers Need and Want?

Abstract

Grandmothers are an important source of support for new mothers. Their infant feeding experience and knowledge can influence mothers' decisions to initiate and continue breastfeeding. The objective of this study was to explore mothers' perceptions of grandmothers' breastfeeding knowledge and support, as part of a larger study to design an intervention that facilitates the development of grandmothers' support of breastfeeding. METHODs: Thirty mothers participated in one of four focus groups held in a North Texas metropolitan area. We analyzed the text of each focus group interview using the content analysis method and identified five themes within and across groups that described mothers' perceptions of grandmother breastfeeding support. The essence of what mothers needed and wanted from grandmothers could be summarized as grandmother breastfeeding advocacy, which is defined by the two themes, "valuing breastfeeding" and "loving encouragement." Three other themes, "acknowledging barriers,"confronting myths," and "current breastfeeding knowledge," reflected mothers' perceptions of what grandmothers need to become their advocates, particularly if they did not breastfeed their own children. Breastfeeding occurs within the context of an extended family in which grandmothers bring their own infant feeding practices and beliefs to their support of new mothers. Mothers need and want grandmothers' support, but their advice and concerns may reflect cultural beliefs that do not protect breastfeeding. Including grandmothers in conversations about breastfeeding practices can be one way for health caregivers to enhance grandmothers' knowledge and support of breastfeeding.
Grandmother Breastfeeding Support:
What Do Mothers Need and Want?
Jane Grassley, PhD, RN, ICCE, IBCLC, and Valerie Eschiti, PhD, RN, CHTP, AHN-BC
ABSTRACT: Background: Grandmothers are an important source of support for new mothers.
Their infant feeding experience and knowledge can influence mothers’ decisions to initiate and
continue breastfeeding. The objective of this study was to explore mothers’ perceptions of
grandmothers’ breastfeeding knowledge and support, as part of a larger study to design an
intervention that facilitates the developmentofgrandmothers’supportofbreastfeeding.Methods:
Thirty mothers participated in one of four focus groups held in a North Texas metropolitan area. We
analyzed the text of each focus group interview using the content analysis method and identified five
themes within and across groups that described mothers’ perceptions of grandmother breastfeeding
support. Results:The essence of what mothers needed and wanted from grandmothers could be
summarized as grandmother breastfeeding advocacy, which is defined by the two themes, ‘‘valuing
breastfeeding’’ and ‘‘loving encouragement.’ Three other themes, ‘‘acknowledging barriers,’ ‘‘con-
fronting myths,’ and ‘‘current breastfeeding knowledge,’ reflected mothers’ perceptions of what
grandmothers need to become their advocates, particularly if they did not breastfeed their own
children.Conclusions: Breastfeeding occurs within the context of an extended family in which
grandmothers bring their own infant feeding practices and beliefs to their support of new mothers.
Mothers need and want grandmothers’ support, but their advice and concerns may reflect cultural
beliefs that do not protect breastfeeding. Including grandmothers in conversations about breastfeeding
practices can be one way for health caregivers to enhance grandmothers’ knowledge and support of
breastfeeding. (BIRTH 35:4 December 2008)
Key words: breastfeeding, grandmother, mother, advocacy
Grandmothers’ infant feeding practices influence new
mothers’ decisions to initiate and continue breastfeed-
ing. Grandmothers who breastfed transmit not only
their practical knowledge of how to breastfeed but
also their confidence that breastfeeding is the normal
way to feed an infant (1–4). From their qualitative
interviews with a group of low-income women in Lon-
don, Hoddinott and Pill (3) concluded that observing
family members or friends breastfeed increased
a woman’s confidence in her breastfeeding ability.
They hypothesized that this embodied knowledge
might be more predictive of women’s decisions to ini-
tiate breastfeeding than providing women with theo-
retical knowledge about its benefits.
If a grandmother has not breastfed, she may offer
advice that reflects experience with bottle-feeding and
thus undermine her daughter’s confidence and ability
to successfully establish breastfeeding (2,5). Grassley
Jane Grassley is an Assistant Professor in the College of Nursing, Texas
Woman’s University, Denton, Texas; and Valerie Eschiti is an Associate
Professor at the University of Oklahoma College of Nursing, Oklahoma
City, Oklahoma, USA.
This study was funded by a Faculty Research Enhancement Grant from
Texas Woman’s University, Denton, Texas, and by a Virginia Larsen
Research Grant from the International Childbirth Education Associa-
tion, Minneapolis, Minnesota, USA.
Address correspondence to Jane Grassley, PhD, RN, ICCE, IBCLC,
College of Nursing, Texas Woman’s University, 304 Administration
Drive, ASB 216, P.O. Box 425498, Denton, Texas 76204, USA.
Accepted May 12, 2008
Ó2008, Copyright the Authors
Journal compilation Ó2008, Wiley Periodicals, Inc.
BI RT H 35:4 December 2008 329
and Nelms (2) found that grandmothers who had not
breastfed or who had limited knowledge of breast-
feeding approached their daughters’ decisions to
breastfeed in one of two ways. One group of grand-
mothers did not openly oppose breastfeeding even
though they were unable to offer practical support,
whereas the other group was described by their
daughters as unsupportive because they either tried
to dissuade them from breastfeeding or quickly rec-
ommended feeding formula when breastfeeding was
not going well. Other studies have found that grand-
mothers’ advice can undermine breastfeeding. Tar-
rant et al (6), studying the contextual factors
influencing women’s breastfeeding experience in
Hong Kong, concluded that lack of breastfeeding
knowledge and experience limited female family mem-
bers’ ability to support new mothers; these family
members often advised new mothers to supplement
breastfeeding with formula when a problem occurred.
In Brazil, Susin et al (7) found that daily contact with
the maternal grandmother increased the risk of early
supplementation with formula and early cessation of
breastfeeding.
Although researchers recognize the importance of
grandmothers’ support and recommend including
them in breastfeeding promotion, they offer little
guidance as to effective strategies for facilitating
grandmothers’ knowledge and support of breastfeed-
ing. Mothers, as the recipients of grandmothers’ sup-
port, can provide insights into planning interventions
that reflect their perspectives of what they need from
grandmothers. In this study, mothers’ perceptions of
grandmothers’ breastfeeding knowledge and support
were explored, as part of a larger study to design an
intervention that facilitates the development of grand-
mothers’ support of breastfeeding.
Methods
The study was approved by the Institutional Review
Boards of Texas Woman’s University, Presbyterian
Hospital of Dallas, and the Texas Department of
Health. A convenience sample was recruited using
a study flyer, which was distributed in an online mother
support group sponsored by La Leche League (a com-
munity-based, mother-to-mother breastfeeding support
group) at a local hospital and at a WIC (Women,
Infants, and Children Supplemental Feeding Program)
clinic. Inclusion criteria for the study required that
mothers have a child who had breastfed within the past
3 years, be able to speak and read English, and obtain
their own transportation to the focus group meeting.
Participants gave written informed consent before par-
ticipating in the focus group.
Four focus groups that lasted 60 to 90 minutes were
conducted, with 5 to 11 mothers in each group.
Groups 1 and 2 were conducted in a quiet conference
room at a local hospital, and groups 3 and 4 took
place at a WIC clinic. The purpose of the groups
was to elicit mothers’ perceptions of grandmothers’
breastfeeding knowledge and support. Questions were
designed to progress from a general discussion of
breastfeeding to specific perceptions of what mothers
needed from grandmothers.
To help the mothers become comfortable talking
with one another, we first asked them to share their
perceptions of breastfeeding, its benefits and disad-
vantages. This discussion quickly turned to their
thoughts about grandmothers’ views of breastfeeding.
The group conversations were guided by the research-
ers, who asked the following questions:
dWhen you think about breastfeeding babies, what is
the first thing that comes to mind?
dWhat do you see as the advantages and the disad-
vantages of breastfeeding?
dWhat do you think is the best way for grandmothers
to support and learn about breastfeeding?
dWhat do you wish your mother or mother-in-law
had known about breastfeeding before your child
was born?
During the discussion, we used reflective listening
prompts, such as ‘‘Can you tell me more about that?’’
‘What I am hearing you say is ...’ ‘‘What do others of
you think?’’ ‘‘Anyone else?’’ These prompts were used
for clarification and to encourage each participant to
share her views. The focus group interview questions
stimulated conversation among the mothers and rich
descriptions of their experiences and perceptions of
grandmothers’ support.
To ensure consistency in conducting the focus
group interviews, each session was audiotaped as rec-
ommended by Morgan (8), and one researcher mod-
erated the group, while the other took notes and
monitored the tape recording. Immediately after each
focus group, we evaluated the process of the interview
and made notes of our observations. A professional
transcriptionist transcribed the interviews verbatim.
Both researchers reviewed the interview transcripts
while listening to the tapes to ensure their accuracy.
Confidentiality was protected by using grouped data
in study reports.
We analyzed the text of each transcript for themes
using the content analysis method (9). We read and
coded each transcript by identifying repeating words
or phrases that we organized and grouped into cate-
gories. We met several times to discuss individual
findings and agree on categories, which we integrated
330 BI RT H 35:4 December 2008
into themes within and across groups. Transferability
of findings was evaluated through our discussions and
consulting with the literature.
Results
Thirty mothers participated in one of four focus
groups that were held in a North Texas metropolitan
area (Table 1). The median age was 30 years (range =
18–41 yr). Most participants (n= 22) had been
breastfed by their mothers for a median time of 6 to
9 months and a range of less than 3 months to 36
months. Most of the women in groups 1 and 2 had
been recruited from Le Leche League, were white, and
had completed a university degree. Groups 3 and 4
were more racially diverse, and most women were
Hispanic and had completed high school or some col-
lege. Although the study sample was diverse, the
mothers within each group were similar. Most were
not working at the time of the interviews possibly
because the WIC groups took place during a week
day and that women involved in Le Leche League
tended to be women who were not working outside
the home while breastfeeding.
The data analysis identified five themes that
described the type of breastfeeding support mothers
wanted from grandmothers and what they perceived
grandmothers needed so that they could offer this
support. The essence of what mothers needed and
wanted from grandmothers could be summarized as
grandmother breastfeeding advocacy. Advocacy is
defined as involving acting or speaking on behalf of
another to promote and safeguard the well-being and
interests of that person (10). In other words, mothers
wanted grandmothers to promote and protect their
choice to breastfeed particularly within the extended
family. The first two themes that were identified, val-
uing breastfeeding and loving encouragement, defined
grandmother breastfeeding advocacy. Three other
themes were identified, acknowledging barriers,con-
fronting myths,andcurrent breastfeeding knowledge,
which reflected mothers’ perceptions of what grand-
mothers needed to become their advocates, particu-
larly if they did not breastfeed their own children.
Each theme is discussed below.
Valuing Breastfeeding
An important aspect of grandmother breastfeeding
advocacy was valuing breastfeeding. Value is defined
as pertaining to the worth, desirability, or usefulness
of something (10). Mothers wanted grandmothers to
acknowledge breastfeeding as important and desir-
able, and to affirm rather than criticize or question
their decisions. One mother described the importance
of knowing that grandmothers valued breastfeeding:
I would love it if I knew my mom and mother-in-law were
talking to everybody, ‘‘My daughter or daughter-in-law is
breastfeeding. Breastfeeding is great,’’ you know, instead of
maybe being embarrassed by it. (group 1)
Other participants talked about how their mothers
communicated to them as children the value of breast-
feeding. One woman recalled, ‘‘My mom would say,
‘That’s the best thing that you can do’ and that she
really enjoyed breastfeeding her kids ... she always
encouraged me to do it’’ (group 3). Another woman
said, ‘‘I used to feed my baby dolls and she [my mom]
would encourage me to do it and [say], ‘One day you
will grow up, you will be a Mom, and you will be
breastfeeding your kids’’ (group 3).
Table 1. Demographic Characteristics of the Participants
(n= 30)
Characteristic No. (%)
Age (yr)
18–20 2 (7)
21–29 12 (40)
30–39 13 (43)
> 40 3 (10)
Education
Graduate degree 6 (20)
Bachelor’s degree 5 (17)
Some college 5 (17)
High school diploma/GED* 10 (33)
No diploma/GED* 3 (10)
Missing 1 (3)
Race
White 11 (37)
African American 3 (10)
Hispanic 11 (37)
Native American 1 (3)
Other 4 (13)
Employment
Full time 3 (10)
Part time 8 (27)
No 18 (60)
Missing 1 (3)
Parity
One child 10 (33.3)
Two children 16 (53.3)
Three children 3 (10)
Four children 1 (3.3)
Number of children breastfed
One 13 (43)
Two 12 (40)
Three 2 (7)
Four 1 (3)
Missing 2 (7)
Breastfed by own mother
Yes 22 (73)
No 8 (27)
*General Education Development: a credential earned in lieu of a high
school diploma through testing in North America.
BI RT H 35:4 December 2008 331
Loving Encouragement
Grandmothers communicated that they valued breast-
feeding when they offered loving encouragement, the
second theme. Participants did not expect grand-
mothers to be breastfeeding experts but wanted them
to be their advocates, especially when overcoming ini-
tial difficulties establishing breastfeeding. One mother
shared, ‘‘I had my Mom, she said, ‘You need to nurse
a lot more.’ Because I’m not lactating like I’m supposed
to. She made sure I kept up the nursing’’ (group 4).
Acknowledging Barriers
Mothers thought that grandmothers needed to
acknowledge and discuss their perceptions of breast-
feeding as a barrier. A barrier is defined as an obstacle
or fence that prevents access (10). Grandmothers may
view breastfeeding as an obstacle to mothers getting
enough rest. One mother described how she felt pres-
sured to give formula to her infant as the solution to
getting more sleep:
My mother and mother-in-law both said, ‘‘This is not good
for you to be up every 3 hours. You can give the baby some
formula. Let me do that so you can sleep, because it’s not
good for you.’’ (group 1)
The underlying message was that breastfeeding was
too hard; formula was an easy solution. One mother
heard:
‘‘Oh this is too difficult; this is a pain for you because you’re
not getting any sleep, because you can’t get any relief. Why
would you put yourself through difficulty when there is an
easy alternative.’’ (group 1)
Although some mothers saw this as grandmothers
wanting to be helpful, others thought grandmothers
saw breastfeeding as a barrier to their ability to bond
and care for their new grandbabies. One mother
observed, ‘‘With my mother-in-law, one disadvantage
that she saw was that she couldn’t be with the baby
when I wasn’t there’’ (group 1). Another was told by
her mother, ‘‘I need to hold the baby and I need to
feed the baby’’ (group 1).
Mothers identified cultural images of the sexualized
breast as a barrier to breastfeeding, particularly in the
presence of extended family members. One mother
shared, ‘‘My mother told me breastfeeding was gross.
Like, she almost said it in a nasty, sexual sense ‘gross,’
like it was inappropriate’’ (group 1). Mothers felt pres-
sure to leave the room when their babies needed to be
breastfed, even in their own homes. One mother men-
tioned how grandmothers could support breastfeed-
ing in the extended family. She said, ‘‘I wish that
grandmothers [would] allow you to be very comfort-
able breastfeeding in front of them and in front of
other family members’’ (group 1).
Confronting Myths
Mothers discussed the necessity of grandmothers con-
fronting myths about breastfeeding. A myth is a pow-
erful message that explains and legitimizes a belief
about a present situation (10). Myths tended to be
generational, as exemplified by this mother’s
comment:
I know my mother-in-law, my husband was born in ’62, was
taught that breastmilk is bad and it’s not going to be nutri-
tionally enough for your child and that was just how she was
raised and how she raised her children. (group 2)
Related to this myth of the inadequacy of breast-
milk was the belief that most women could not pro-
duce enough milk. One mother heard, ‘‘Oh, nobody
can really breastfeed. It just doesn’t work anymore. I
know you’re going to try this, but, you know, you’re
going to run out of milk. I did’’ (group 2).
Mothers heard myths about diet and infant fussi-
ness. One mother told how her mother scared her with
horror stories about how she was going to give her
baby colic if she did not carefully watch her diet. A
woman whose grandmother had lived in Mexico chal-
lenged this myth:
I have a grandmother, she had 12 girls and she breastfed them
all. And it comes from her that nothing you could eat could
possibly hurt you. Because back then when people didn’t have
much to eat, you will still eat whatever you got. (group 3)
Current Breastfeeding Knowledge
Mothers identified that grandmothers may lack cur-
rent knowledge about best practices for successful
breastfeeding, which can influence their ability to
offer appropriate support. One mother said, ‘‘All the
things they want to do usually are undermining what
you are doing’’ (group 2). Another shared the follow-
ing example of advice she was given:
They have all of these antiquated notions about everything. I
heard the water thing, ‘‘To get her to stretch out her feedings,
you’ve got to give her water in between. Cut the nipple, put
the cereal in.’’ My mother-in-law must have told me to do
that a hundred times. ‘‘If you just give her some food in that
bottle and she will sleep through the night.’’ (group 1)
Another mother described the effect of this kind of
advice: ‘‘That’s what makes that so frustrating is that
at your weakest moment you are getting the worst
information and that will tear you down in a skinny
moment’’ (group 2).
332 BI RT H 35:4 December 2008
Mothers thought grandmothers needed information
about the importance of supply and demand and the
expected feeding and sleeping patterns of breastfed
infants. Because mothers had felt pressured to wean
their infants by 6 months or to introduce cereal by 2
or 3 months, they wanted grandmothers to know and
understand current guidelines about the recommended
length of time to breastfeed and when to introduce
water and other foods. Mothers mentioned the impor-
tance of educating grandmothers about the benefits of
breastfeeding and breastmilk for women and children
and about the hazards of formula as a way of helping
them value breastfeeding. One mother said,
The number one thing I wish both of them, my mother-in-
law and my mother, understood was how important the
health benefits are. That is so unbelievably minimized by
the two of them. My mother-in-law is a nurse and she just
thinks, ‘‘Oh, they’ll be fine without it. There is no reason you
need it. Formula is just, it’s good enough.’’ (group 1)
The findings of this study showed that these moth-
ers wanted grandmothers who would be their advo-
cates, and who would value and affirm their decisions
to breastfeed rather than question their infant feeding
practices. They wanted grandmothers who under-
stood and trusted the process of breastfeeding and
would offer them loving encouragement when they
experienced difficulties rather than pressuring them
to supplement their breastfeeding with formula.
Discussion
The findings of this study illuminated mothers’ per-
ceptions of grandmothers’ breastfeeding knowledge
and support. Supportive grandmothers communi-
cated to their daughters the value of breastfeeding.
The Hispanic mothers, in particular, described how
their mothers had influenced them through sharing
their own positive experiences of breastfeeding, which
has been reported in the literature (11). Although an
unsupportive grandmother did not influence whether
or not these mothers continued to breastfeed, lack of
support affected their breastfeeding experience. Sev-
eral women described the enormous amounts of
energy they expended protecting their decisions to
breastfeed. Other women may be more vulnerable to
advice from grandmothers that may undermine their
breastfeeding. A group of mothers in India were not
sure they could incorporate infant feeding practices
that were contrary to those of grandmothers, even if
they knew grandmothers’ advice might hinder breast-
feeding (12). In a rural community in the United
States, mothers relied most often on grandmothers
for feeding advice, which included the common use
of cereal in the first month of life (13). The findings
of these studies reflect grandmothers’ transmission of
their own infant feeding practices (7). However,
grandmothers want to be helpful and can learn to
offer support that protects rather than undermines
breastfeeding (14–16).
Although other studies have investigated grand-
mothers’ breastfeeding knowledge and infant care prac-
tices, our study showed mothers’ perceptions of the
support they needed from grandmothers. These find-
ings and the literature offer insights into planning inter-
ventions that may facilitate grandmothers’ support.
Facilitating Grandmother’s Support
First, grandmothers may need information about cur-
rent best practices. Their information about breast-
feeding may be inadequate even if they breastfed
their own children (15). For example, supplementing
breastfeeding with water or other culturally preferred
foods is a common practice in many parts of the
world, including communities where women breast-
feed into the second year. In a focus group study in
Nigeria, grandmothers, mothers, and health workers
all expressed the belief that exclusive breastfeeding
was never sufficient and that infants needed water to
stay healthy (17). Other studies reported similar find-
ings about grandmothers’ infant feeding practices in
India (12) and the Cameroon (18). Although wide-
spread, not all grandmothers adhere to the need to
supplement breastfeeding. Among the Tamang in
Nepal, grandmothers do not advocate giving water
or culturally preferred foods to young infants (19).
Therefore, before offering information, health care
practitioners need to ask grandmothers about their
infant feeding beliefs and practices. The ‘‘Three Step
Best Start Counseling Strategy’’ developed in the U.S.
offers guidelines for eliciting women’s breastfeeding
concerns. The three steps include 1) ask open-ended
questions to elicit knowledge and concerns, 2)
acknowledge concerns about breastfeeding, and 3)
address concerns and provide education (20).
Second, as well as being given information about
breastfeeding, grandmothers may need to acknowl-
edge perceived barriers or obstacles related to breast-
feeding. Study participants thought grandmothers
saw breastfeeding as an obstacle to getting adequate
rest and to grandmothers’ ability to bond with their
grandchildren. Practitioners can help grandmothers
find ways other than feeding to support new mothers
and to bond with their grandchildren.
Participants described breastfeeding in front of
extended family members as an obstacle, a finding
supported in the literature (6,21). In a study of the
contextual factors that contribute to women’s
BI RT H 35:4 December 2008 333
breastfeeding experiences in Hong Kong, the
researchers concluded that ‘‘breastfeeding is an activ-
ity that participants felt needed to be hidden away
from families and friends’’ (6, p. 188). Study partici-
pants thought that grandmothers could assist family
members to feel more comfortable with breastfeeding
by giving mothers permission to breastfeed in family
gatherings.
Third, grandmothers may need to confront and
understand the cultural sources of their infant feeding
practices and beliefs about breastfeeding. For exam-
ple, grandmothers’ concerns about the frequency of
breastfeeding, particularly during the night, are
deeply embedded in the North American cultural
belief that infants need to be placed on a strict sched-
ule from birth so as to learn self-control and indepen-
dence. For over 100 years, many mothers were
advised to feed their infants no more than every 4
hours for no longer than 20 minutes and to offer only
one night feeding. This feeding schedule in conjunc-
tion with hospital childbirth and postpartum practices
led to an epidemic of lactation failure in the U.S. and
the belief that women have difficulty producing
enough milk to satisfy and nourish their infants ade-
quately (22,23). Practitioners can address this myth
through providing information and by reassuring
grandmothers that they made the best decision with
the information they had at the time, particularly if
they had a sad experience with breastfeeding (24).
Fourth, grandmothers can change their beliefs about
infant feeding practices when information is presented in
culturally appropriate ways that acknowledge their per-
spectives (25). Researchers in Senegal developed an in-
tervention for grandmothers that used discussion and
traditional songs and stories to improve infant feeding
practices (26). They concluded that grandmothers
could and would incorporate new information into
their support of new mothers and positively influence
infant health. A public health initiative among a
Canadian First Nation sought to raise the commun-
ity’s awareness of the value of breastfeeding (12). By
involving grandmothers in talking circles led by one of
their peers to discuss their breastfeeding concerns and
to inform them of ways they could best support new
mothers, they became breastfeeding advocates. Breast-
feeding initiation and duration rates rose dramatically
in this community.
Fifth, focus groups can be an effective strategy for
developing interventions that address grandmothers’
breastfeeding concerns. Focus groups allow partici-
pants to exchange ideas with one another instead of
focusing on pleasing the discussion leader (19). In our
study, the focus group interviews yielded rich descrip-
tions of mothers’ perceptions of effective grand-
mother breastfeeding support. Focus groups have
been used to explore women’s infant feeding beliefs
and practices in cultures as diverse as Mexican Amer-
icans (11), India (12), Nigeria (17), Cameroon (18),
Nepal (19), and African Americans (27), and to
develop an informational intervention for South
Asian grandmothers living in London (16).
Health care practitioners can use this study’s find-
ings to design and evaluate interventions that facili-
tate grandmothers’ breastfeeding advocacy within
their cultures. Grandmothers may need to confront
and understand the cultural sources of their infant
feeding practices and beliefs about breastfeeding.
Practitioners can help grandmothers become breast-
feeding advocates through asking them about their
infant feeding perspectives and by providing educa-
tional materials written for them (28,29).
Study Limitations
The size and demographics of the study sample pres-
ent some limitations. Breastfeeding is a culturally sen-
sitive social practice. Hispanic mothers comprised
over one third of the sample and tended to have grown
up with breastfeeding as their cultural norm.
Although acculturation has been shown to influence
breastfeeding initiation (11), we did not ask for this
information, since it was not the focus of the study.
Most participants (n= 22) had been breastfed by their
mothers, for a range of less than 3 months to 36
months, so one would expect these grandmothers to
value and support breastfeeding. However, paternal
grandmothers were a significant presence in study par-
ticipants’ breastfeeding experiences, and we did not
elicit information about their infant feeding choices.
We did not ask mothers to provide details about being
breastfed, such as how long they were exclusively
breastfed. Mothers reported that grandmothers, even
those who had breastfed, tended to advocate early
introduction of cereal to help infants ‘‘sleep through
the night.’’ Information about current best practices
in infant feeding, therefore, seemed to be a universal
need for grandmothers even if they had breastfed.
The quality of support would seem to depend on the
quantity and quality of mothers’ contact with grand-
mothers. We did not ask participants how often they
saw their infants’ grandmothers or to define their rela-
tionships with these grandmothers. From the inter-
views, most seemed to have fairly frequent contact
with either or both the maternal and paternal grand-
mothers. Most women were not working at the time of
the interviews. Mothers who combine breastfeeding
with full-time employment may have different percep-
tions of grandmothers’ knowledge and support. Repli-
cating this study with a focus group composed of
334 BI RT H 35:4 December 2008
working mothers might enhance application of the
findings. Finally, mothers’ perceptions were gathered
from a small, but diverse, group of women living in the
U.S. where breastfeeding has not been the infant feed-
ing norm within the dominant culture for several gen-
erations. The study results, however, were supported
by similar studies set in diverse cultures.
Conclusions
Breastfeeding is a cultural practice that takes place
within the context of an extended family that includes
both the maternal and the paternal grandmothers.
Grandmothers bring their own infant feeding practices
and beliefs to their support of new mothers. Mothers
need and want grandmothers to be their advocates, to
affirm rather than question their breastfeeding deci-
sions, to understand and value the benefits of breast-
feeding, and to have updated information. However,
grandmothers’ advice and concerns may reflect cultural
beliefs and infant feeding practices that do not protect
breastfeeding. Including grandmothers in conversa-
tions about breastfeeding practices can be one way
for health care practitioners to enhance grandmothers’
knowledge and support of breastfeeding.
Acknowledgments
We thank the women who shared their perceptions.
We also thank Presbyterian Hospital of Dallas, the
Dallas WIC program, and the Dallas chapter of La
Leche League for their assistance in recruitment and
providing a site for the focus groups.
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... Malnutrition hinders the development of human potential in both social and economic development, especially in developing countries. Grassley and Eschiti (2008) explain that African countries have made fighting malnutrition a high priority especially through the adoption of technology in agriculture [25]. Deficiencies of the micronutrients, such as iron, zinc, and vitamin A, are the most devastating among the East Africa countries [46]. ...
... Malnutrition hinders the development of human potential in both social and economic development, especially in developing countries. Grassley and Eschiti (2008) explain that African countries have made fighting malnutrition a high priority especially through the adoption of technology in agriculture [25]. Deficiencies of the micronutrients, such as iron, zinc, and vitamin A, are the most devastating among the East Africa countries [46]. ...
... While Gragnolita and Marini (2003) explained that iron-bio fortified beans reduce the underweight as that the household health is so integral for their own wellbeing as well as their agricultural activities [24]. Johnson et al., (2015) explain that cover crops improve soil quality through increasing biomass by improving soil aggregates and stability [25]. Similarly, green manuring increases the biomass returned to the soil thus enhancing improved beans production with high nutrient content to managed stunting. ...
... 79 The advice women receive from their mother and mother-in-law is also very important. 77,90 However, this advice can often reflect cultural beliefs that aren't necessarily supportive of breastfeeding and may include outdated guidelines. 90 The breastfeeding rates in the UK were even lower 30-40 years ago, 51% of women initiated breastfeeding in 1975 and 62% in 1990. ...
... 77,90 However, this advice can often reflect cultural beliefs that aren't necessarily supportive of breastfeeding and may include outdated guidelines. 90 The breastfeeding rates in the UK were even lower 30-40 years ago, 51% of women initiated breastfeeding in 1975 and 62% in 1990. 79 As such the UK has a generation of grandmothers with less experience with successful breastfeeding than their daughters. ...
Article
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Women in the UK have a 15% lifetime risk of developing breast cancer. Like other high‐income countries, women in the UK are having children later in life which increases their risk. The risk of breast cancer is reduced by 4.3% for every 12 months of breastfeeding, this is in addition to the 7.0% decrease in risk observed for each birth. Breastfeeding reduces the risk of Triple‐Negative Breast Cancer (20%) and in carriers of BRCA1 mutations (22–55%). The mechanisms of reduced risk as a result of pregnancy are related to changes in RNA processing and cellular differentiation. The UK has a low rate of breastfeeding (81%) and this is contrasted to countries with higher (Sweden, Australia) and lower rates (Ireland). The low UK rate is in part due to a lack of experience in the population, todays grandmothers have less experience with breastfeeding (62%) than their daughters. An estimated 4.7% of breast cancer cases in the UK are caused by not breastfeeding. The UK only has 43% of maternity services with full Baby‐Friendly accreditation which promotes compliance with the WHO ‘Ten Steps to Successful Breast Feeding’. Legislation in the UK and Europe is far short of the WHO Guidance on restricting the advertising of formula milk. Expansion of the Baby‐Friendly Hospital Initiative, stricter laws on the advertising of formula milk and legislation to support nursing mothers in the workplace have the potential to increase breastfeeding in the UK. Women with a family history of breast cancer should particularly be supported to breastfeed as a way of reducing their risk.
... From an evolutionary perspective, being genetically related to both mother and grandchild, maternal grandmothers have a vested interest in the wellbeing of both parties, while also gaining fitness benefits (Hamilton, 1964). Therefore, knowing if the grandmother supports breastfeeding is important in light of its many health benefits, both short and long term, for the mother and baby (Chung et al., 2007;Eidelman et al., 2012;Emmott & Mace, 2015;Grassley & Eschiti, 2008). In our study, differences by grandmaternal groups were found in attitudes to breastfeeding, and its actual duration. ...
... Moreover, grandmothers may perceive breastfeeding as an obstacle to their daughters obtaining adequate rest, and as a barrier to their own bonding with their grandchildren (Grassley & Eschiti, 2008). ...
Article
Abstract Objectives Breast-feeding is sensitive to somatic, hormonal, behavioral and psychological components of maternal capital. However, through grandmothering, older women may also influence breast-feeding by transferring informational resources to their daughters. We hypothesized that mothers with prolonged instrumental support from their own mother are more likely to have received advice and to have favorable attitudes/practices regarding breastfeeding, compared to those lacking such support, with implications for the grandchild's somatic capital. Methods We recruited 90 mother-infant dyads (52 with grandmaternal support, 38 without) in Merida, Yucatan, Mexico. All children were first-borns, aged ~2 years. Anthropometry and body composition were assessed. Data on grandmother's breastfeeding advice and maternal breastfeeding duration were obtained by questionnaire. Maternal attitudes to breast-feeding were assessed using the Iowa Infant Feeding Attitude Scale. Results Women with instrumental support were more likely to have received grandmaternal advice during pregnancy/infancy on exclusive breast-feeding duration (60% vs. 37%, p = 0.033) and the type of first complementary food (81% vs. 47%, p = 0.001). However, women with support had a less favorable attitude to breastfeeding than those without and breastfed their children for less time (median 5 vs. 10.5 months, p = 0.01). No group differences were found in children's length, weight, skinfolds or lean mass z-score. Discussion Although grandmothers providing instrumental support provided advice regarding breastfeeding, their attitudes may reflect issues beyond nutritional health. Advice of maternal grandmothers did not promote extended breastfeeding, however the differences in breastfeeding attitudes were not associated with the children's nutritional status. Grandmothers should be included in public health interventions promoting breastfeeding.
... Aber auch die Einstellung spielt eine große Rolle. Mütter legen Wert darauf, von ihrer eigenen Mutter akzeptiert und ermutigt zu werden [135]. ...
... Großmütter, die zu wenig darüber wissen, wie das Stillen funktioniert und welchen Schaden ein Stillen nach "Zeitplan" verursachen kann, schlagen ihrer Tochter möglicherweise vor, dem Baby die Flasche zu geben, wenn es häufig trinkt, nicht schläftoder einfach als Mittel, der Tochter mehr Pausen vom Füttern zu verschaffen. Das zusätzliche Geben der Flasche kann sich jedoch nachteilig auf die Milchbildung der Mutter auswirken [135]. ...
... Young mothers below age 19 were mainly less socially independent and tend to be influenced more than their older counterparts. Research has shown that a single person who wields much influence on a decision regarding infant feeding in Africa is the infant's paternal grandmother (Reinsma et al., 2012;Rochat, 2016) whose experience, support, and advocacy are often needed by new breastfeeding mothers (Grassley & Eschiti, 2008). This appears to be so because in highly patriarchal societies, decisions related to childbirth and breastfeeding are often determined by mothers-in-law (Carter, 2002). ...
... Unlike their male counterparts, grandmothers were found to be very supportive and influential on how infants are breastfed (Kerr & colleagues 2008;Thet et al. 2016). Similar studies have also reported the advocacy function of grandmothers (Grassley & Eschiti, 2008) who manage indigenous knowledge (Aubel, 2006). Besides their influence, grandmothers had also been moderately informed about exclusive breastfeeding recommendations. ...
Article
Full-text available
Exclusive breastfeeding has been recognised as an important public health concern for the primary prevention of child morbidity and mortality. Consequently, the WHO and UNICEF have recommended exclusive breastfeeding for the first six months after delivery, followed by the introduction of complementary foods and continued breastfeeding for 24 months or more. Even so, exclusive breastfeeding is not adequately practiced in Ghana. This study sought to understand and explain the family influence on exclusive breastfeeding practices in rural northern Ghana. An exploratory qualitative research design was used to explore the central phenomenon of breastfeeding in rural northern Ghana. Individual interviews were conducted. The participants were 25 and included breastfeeding mothers, paternal grandmothers, paternal grandfathers , fathers of babies, traditional birth attendants, and a breastfeeding support group leader. All interviews were audio-taped, transcribed, and analysed using content analysis. Four main themes emerged in relation to the forms of family influences on exclusive breastfeeding: family knowledge of exclusive breastfeeding; primary and secondary participants in child care; family beliefs and practices; and learning to breastfeed. It emerged that infant feeding and care is a family responsibility rather than being individually centred. A family's knowledge, belief systems, and way of participation in infant care heavily influence a woman's ability to practise and sustain exclusive breastfeeding. The implication is that at any point in time, family players should be considered in any campaign on exclusive breastfeeding.
... On one hand, since fathers are shouldering the main financial responsibility of the whole family, they need to do farm work as well as some part-time job into cover the daily expense which may make them too exhausted to provide their support on breastfeeding [21]. On the other hand, old generation, particularly the infant's grandmothers, are regarded as a main source of breastfeeding family support, especially when lacking of learning materials and community consultants [22][23][24]. However, father's co-residence may crowd out the support from grandmothers who are more experienced, thus impair the exclusive breastfeeding practices. ...
Article
Full-text available
Background China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father’s co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father’s co-residence and breastfeeding family support as well as maternal decision-making power. Methods A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding. Results The exclusive breastfeeding (0–6 months) rate was 16% in rural western China. Fathers’ co-residence was associated with a lower exclusive breastfeeding rate ( OR = 0.413, 95% CI = 0.227–0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally ( β =0.109, P = 0.105; β =0.011, P = 0.791, respectively) and it reduced maternal decision-making power ( β = − 0.196, P = 0.007). Conclusions Fathers’ co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father’s education to help them better involvement and show more respect to mothers’ decisions.
Article
Background Informal mHealth is widely used by community health nurses in Ghana to extend healthcare delivery services to clients who otherwise might have been excluded from formal health systems or would experience significant barriers in their quest to access formal health services. The nurses use their private mobile phones or devices to make calls to their clients, health volunteers, colleagues or superiors. These phone calls are also reciprocal in nature. Besides, the parties exchange or share other health data and information through text messages, pictures, videos or voice clips. There are some ethical dimensions that are inherent in these practices that ought to be critically scrutinised by bioethicists. Objective The author has argued in this paper that informal mHealth at large scale adoption in Ghana is associated with some bioethical challenges. Methods This essay was largely based on an analysis of an empirical study published by Hampshire et al in 2021 on the use of informal mHealth methods in Ghana. Results Widespread adoption of Informal mHealth in Ghana is associated with privacy invasion of both the nurses and their clients, breaches confidentiality of the parties, discredits the validity of informed consent processes and may predispose the nurses to some other significant aggregated harms. Conclusion The author affirms his partial support for a formalised adoption process of informal mHealth in Ghana but has reiterated that the current ethical challenges associated with informal mHealth in Ghana cannot escape all the debilitating bioethical challenges, even if it is formalised.
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Workplace stress, a complex, physical and psychological reaction that occurs in an individual worker as a result of inability to cope with the demands from the workplace, has negative effects on workers’ performance. In spite of the adequate literature on the nexus between workplace stress and performance, situational analysis of the experiences between male and female maternal healthcare workers in General Hospitals in the Federal Capital Territory, Abuja is yet to be fully covered. This therefore makes intervention for performance enhancement difficult. The aim of this study was therefore, to explore gender differences influencing workplace stress on performance of maternal healthcare workers in Abuja. The study adopted descriptive cross-sectional design involving the use of primary data. The primary data were collected using structured questionnaire. Proportionate sampling was used to select a total of 377 maternal healthcare workers (124 males and 253 females) comprising doctors, nurses and midwives across the four hospitals surveyed.The quantitative data were analysed using descriptive statistics and independent t-test. The result showed significant difference between gender and effect of stress on performance among maternal healthcare workers. The mean score on effect of stress was high among the Male Maternal health care workers (M=52.98 ± SD=18.7) compared to their female counterpart (M=48.71 ± SD=11.6). The study demonstrated the effect of high level of stress on the performance of male maternal healthcare workers relative to their female counterparts. It is therefore recommended that stress training be made compulsory for all maternal healthcare workersWorkplace stress, a complex, physical and psychological reaction that occurs in an individual worker as a result of inability to cope with the demands from the workplace, has negative effects on workers’ performance. In spite of the adequate literature on the nexus between workplace stress and performance, situational analysis of the experiences between male and female maternal healthcare workers in General Hospitals in the Federal Capital Territory, Abuja is yet to be fully covered. This therefore makes intervention for performance enhancement difficult. The aim of this study was therefore, to explore gender differences influencing workplace stress on performance of maternal healthcare workers in Abuja. The study adopted descriptive cross-sectional design involving the use of primary data. The primary data were collected using structured questionnaire. Proportionate sampling was used to select a total of 377 maternal healthcare workers (124 males and 253 females) comprising doctors, nurses and midwives across the four hospitals surveyed.The quantitative data were analysed using descriptive statistics and independent t-test. The result showed significant difference between gender and effect of stress on performance among maternal healthcare workers. The mean score on effect of stress was high among the Male Maternal health care workers (M=52.98 ± SD=18.7) compared to their female counterpart (M=48.71 ± SD=11.6). The study demonstrated the effect of high level of stress on the performance of male maternal healthcare workers relative to their female counterparts. It is therefore recommended that stress training be made compulsory for all maternal healthcare workers
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This article uses a relationality-sensitive perspective to analyse long-term breastfeeding. The data was gathered through open invitations to write, and the article is based on the written reflections of 39 long-term breastfeeding Finnish mothers. In Finland, the breastfeeding of babies is strongly supported, but long-term breastfeeding (over 12 months) is a more conflicted issue, and the cultural norm of one year of breastfeeding is strong. Through qualitative content analysis, the article shows how mothers reflect on long-term breastfeeding’s effects on their relations with their breastfed children, partners (if any), relatives and healthcare professionals. The findings show that long-term breastfeeding is often a rewarding experience, but that it takes place in a network of relations and has effects on those relations. With a relationality-sensitive approach to breastfeeding, we can better understand how mothering is done in and through relations with others, and how mothers express the need for a change in attitudes towards long-term breastfeeding. This article gives a voice to mothers who are often silent in our society, and therefore participates in the feminist empowerment of women and especially mothers.
Article
Objective We examine whom, among her social network members, a new mother ranks as her most important source of advice for infant care practices and how the ranking of a network member depends on their connectedness to a mother's other network members. Background Previous research points to the influence of personal networks members' advice on parental practices. However, to design effective interventions that facilitate safe and healthy infant and childcare practices, it is important to understand who, in parents' social circles, they turn to most for advice. Method We recruited 402 Black and White new mothers in Washington, DC. We analyze the importance rank they assign to their 1,791 network members using nested, dyad-level rank-ordered logit models. Results Connectivity to a mother's other network members and being the mother's mother (i.e., the baby's maternal grandmother) emerged as positive and significant predictors of being ranked as the most important sources of advice. Additionally, the effect of being a grandmother is stronger among grandmothers who are well connected to mothers' other network members. Conclusion Network members who are well embedded in mothers' own networks are usually viewed by mothers as key sources of advice. Embeddedness is an especially significant condition for new mothers when ranking babies' maternal grandmothers as main advisors. Implications We encourage future research on mothers' network members as potential targets for infant and childrearing-related interventions.
Article
Acknowledgements - The Great Breast-Feeding Question - A Tidal Wave of Good Advice - Infant Feeding in Women's Lives - Public Space and Private Bodies - Breast-feeding, Sex and Bodies - 'She said the baby belonged to the state': Health Professionals and Mothering - Control and Resistance in Infant Feeding Regimes - Feminism and Infant Feeding: Theory and Policy - Bibliography - Index
Article
OBJECTIVES: Rates of initiation and duration of breastfeeding for blacks are significantly lower than that of whites, and may be related to cultural and family characteristics. The purpose of this qualitative study was to learn about the experience of breastfeeding from black women who have breastfed a child. METHODS: Using a phenomenological approach, eight black women participated in a focus group using a structured interview format, discussing making the decision to breastfeed, challenges and difficulties, benefits and breastfeeding support. RESULTS: The experience of the participants could not be easily distinguished from other women similar in attitudes, education and lifestyle, suggesting that in this group, race was not a significant influence on the breastfeeding experience. CONCLUSIONS: Further study with black women of varied socioeconomic, ethnic and geographic categories than male alcoholics (Fried. et.al., 1998; Freeza, et. al., 1990). Women who abuse alcohol have death rates 50% to 100% higher than men who drink excessively. Some studies show that alcoholism actually decreases a woman's life expectancy by 15 years (Roman, 1998).
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Pork sausages are a popular meat as they are generally considered tasty, versatile and convenient and thus fit with the busy lifestyles of today's consumer, however, they can contain high levels of fat. Sales for this product have increased in recent years which suggests that the high fat levels are being traded—off against the positive characteristics associated with the product. In this study the perception of parents with regard to pork sausages is considered as this group face the added challenges of coping with children's food demands. An adaptation of the Theory of Planned Behaviour was used to guide this research. The influences of attitudes, subjective norms, perceived behavioural control, habit and pester power on intention to serve pork sausages were considered. The findings suggest that attitudes, pester power and habit are the most significant determinant of intention. This study also considers if this population group is homogenous with regard to their perceptions of sausages. Four segments were identified and their consumption behaviour differed. Furthermore, when asked if they would increase their consumption of sausages if a health benefit was added the responses differed considerably by segment. A number of marketing implications are suggested based on these findings.
Women once gave birth and began breastfeeding within the cultural context of a traditional system of care; now they begin breastfeeding in a hospital. Historically, hospital care was arranged to fit artificial feeding. Little was known about the science of breastfeeding until recently. Basing our breastfeeding care on the cultural norm of bottle feeding has led to the development of many unfavorable attitudes and practices. Given an opportunity to learn how breastfeeding works and to improve our breastfeeding care skills, hospital nurses can play an important part in current efforts to make breastfeeding the community norm.
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Our aim in this Gadamerian hermeneutic study was to understand maternal breastfeeding confidence and its meaning through listening to women's voices describing their experiences within the context of the United States. We asked 13 women, aged 23 to 42 years, who had breastfed a child within the last 2 years to tell us their breastfeeding stories. Women experienced maternal breastfeeding confidence as a dynamic interaction between their expectations, their infant(')s breastfeeding behavior, and sources of support. They described experiences that enhanced or diminished their confidence. Health professionals can use these findings to plan approaches that promote and support maternal breastfeeding confidence.
Article
Child survival strategies include prolonged and intensive breastfeeding, together with its early initiation, and breastmilk only for the first six months of life. This paper reports on local knowledge and attitudes of breastfeeding and the sociocultural factors that shape its practice in poor rural Yoruba communities of Southwestern Nigeria. The study has conducted 10 focus group discussions among homogeneous groups of grandmothers, pregnant women, lactating mothers, husbands, and community health workers, and a questionnaire survey of 256 third trimester pregnant women. All women in these communities breastfeed their infants on demand, and for up to two years, because breastmilk is universally accepted as the best food for babies, and breastfeeding spaces births. Prelacteal feedings of water herbal infusions and ritual fluids are the norm, and breastmilk is supplemented, from birth, with water and teas. Exclusive breastfeeding is considered dangerous to the infant: the baby has an obligatory requirement for supplementary water to quench its thirst and promote its normal development, and for herbal teas which serve as food and medicine. Colostrum is discarded because it is dirty, "like pus", and therefore potentially harmful to the infant, although 24% of the survey sample would give it to their babies. Expressed breastmilk is suspect as it can get contaminated, poisoned or bewitched. Complementary foods are introduced as early as two months because of perceived lactation insufficiency. The commonest supplement is a watery maize porridge of low nutrient density. Breastfeeding can also be dangerous, as toxins and contaminants can be passed to the infant through breastmilk. The most serious conflict with the WHO/UNICEF recommendations is the lack of local credibility of exclusive breastfeeding. According to local knowledge, the early introduction of water, herbal teas, and of complementary foods is designed to enhance child survival, while these are supposed to do the exact opposite by the WHO/UNICEF rationale, by exposing the infant to contaminants early, thereby increasing diarrheal morbidity and mortality. Child survival interventions need to address this conflict.