Relationship between Body Image and Decision to Breastfeed among Pregnant Women

Abstract

The study was a correlateral research design. The authors assessed the relationship between body image and decision to breastfeed among pregnant women. The subjects were 200 pregnant women ranging from 16 to 45 years selected for the study from Primary, Secondary and Tertiary levels of health care institutions in Anambra State of Nigeria. One research question and two null hypotheses were formulated to guide the study. The relationships between perceived breast role, age and occupation of pregnant women, and their body image with regard to decision to breastfeed were evaluated in the study. The instrument used for data collection was questionnaire on Body Image and Decision to Breastfeed (QBIDF). Mean score, standard deviation (SD) and Spearman Rank correlation coefficient (rho) were used to answer the research question while Mann – Whitney – U test and Wilcoxon Rank Sum test statistics were adopted in testing the null hypotheses at 0.01 level of significance. The result showed significant correlation between perceived breast role for beauty/attraction and decisions on the duration to breastfeed, significant relationship between age of pregnant women and their body image with regard to their decision to breastfeed, as well as significant relationship between occupation of pregnant women and their body image with regard to decision to breastfeed.

Full text

American Journal of Scientific Research
ISSN 2301-2005 Issue 78 October, 2012, pp.54-60
© EuroJournals Publishing, Inc. 2012
http://www.eurojournals.com/ajsr.htm
Relationship between Body Image and Decision to
Breastfeed among Pregnant Women
Chiejina EN
Nnamdi Azikiwe University Nnewi Campus
Odira CC
Nnamdi Azikiwe University Nnewi Campus
Abstract
The study was a correlateral research design. The authors assessed the relationship
between body image and decision to breastfeed among pregnant women. The subjects were
200 pregnant women ranging from 16 to 45 years selected for the study from Primary,
Secondary and Tertiary levels of health care institutions in Anambra State of Nigeria. One
research question and two null hypotheses were formulated to guide the study. The
relationships between perceived breast role, age and occupation of pregnant women, and
their body image with regard to decision to breastfeed were evaluated in the study. The
instrument used for data collection was questionnaire on Body Image and Decision to
Breastfeed (QBIDF). Mean score, standard deviation (SD) and Spearman Rank correlation
co-efficient (rho) were used to answer the research question while Mann – Whitney – U
test and Wilcoxon Rank Sum test statistics were adopted in testing the null hypotheses at
0.01 level of significance. The result showed significant correlation between perceived
breast role for beauty/attraction and decisions on the duration to breastfeed, significant
relationship between age of pregnant women and their body image with regard to their
decision to breastfeed, as well as significant relationship between occupation of pregnant
women and their body image with regard to decision to breastfeed.
Keywords: Body Image, Body attraction, Body satisfaction, Pregnant women, Perceived
breast role, Decision to breastfeed.
Introduction
Body image is how a person perceive the size, appearance and functioning of the body and its parts
(Kozier et al., 2004). Body Image also refers to a person’s perception of the aesthetic and sexual
attractiveness of his or her own body (Kozier et al., 2004). DeLaune and Ladner (2002) refer to body
image as an attitude about one’s physical attributes and characteristics, appearance and performance.
Body image is dynamic because any change in body structure or function, including the normal
changes of growth and development, can affect body image. Many teenagers will have harmless body
image distortions, and it is not uncommon for adolescents to feel self-conscious because “they think
their noses are too big, or their hips too wide, or their blemishes too prominent” (DeLaune and Ladner,
2002). Human society has at all times placed great value on beauty of the human body, but a person’s
perception of his/her own body may not correspond to society’s standard (Kozier et al., 2004). A

Relationship between Body Image and Decision to Breastfeed among Pregnant Women 55
person’s body image is thought to be, in part, a product of his or her personal experiences, personality
and various social and cultural forces. A person’s sense of his or her own physical appearance usually
in relation to others or in relation to some cultural “Ideal”, can shape his or her body, image (Kozier et
al., 2004).
Researchers (Thompson et al., 1999) classified body image into body esteem (positive or
negative feelings about one’s body), body satisfaction (satisfaction with an aspect of one’s body), and
body distortion (size estimation accuracy). Monteath and McCabe (1997) explained that although
societal ideals influence a woman’s body satisfaction, the degree of sway is balanced by a woman’s
self-esteem. Sydney (2010) noted that people who have low body image will try to alter the body
image in some way such as dieting or undergoing cosmetic surgery. Francoise (1984), in his theory of
unconscious body image stated that negative perceptions about a persons body (eg fatness), can in
some cases lead to mental disorders such as depression or eating disorders such as bulimia nervosa.
Studies have shown that females tend to link more about their body shape and endorse thinner figures
than men even into old age (Fermro et al., 2008; Sonia et al., 2008; Hawkins et al., 2004). Some girls
and young women compare themselves to models in terms of their physical attractiveness, and
according to Martin and Gendry (1997), many commentators regard the emphasis in the media and in
fashion industry on thinness and on ideal female body shape and size.
In relation to breastfeeding, body image disturbance traits may influence a woman’s initial
decision to breastfeed, as well as possibly promote discomfort within the breastfeeding relationship
causing early cessation. Littleton and Engebretson (2005) stated that the initial changes that occur in
the woman’s body validate her pregnancy, and she may demonstrate pride in her changing body; but as
pregnancy progresses, her increasing size, waddling gait, and positive changes may become
distressing. Fawett (1989) has it that during pregnancy, body image changes as the woman begins to
envision herself as a mother in addition to being daughter and/or wife. This change in body image is
part of the basis for the woman becoming narcissistic and introverted. According to Fawett (1989),
how the woman feels about her body as pregnancy progresses may influence decisions such as whether
to breastfeed. Huang et al (2004) reports that body image become increasingly negative as pregnancy
progresses, and reaches its peak during postpartum period. In addition, Littleton and Engebretson
(2005) opined that barriers or deterrents to breastfeed may be biologic, psychologic, social or cultural
in nature. Women who do breastfeed and encounter negative or sexual messages about their bodies
(whether real or imagined) may stop breastfeeding to shift the focus from themselves and to feel more
comfortable about their own bodies. Also Breast size has also been found to be an indicator of female
attractiveness in the context of Western culture (Furnham et al, 1998; Latteier, 1998; Jones, 2004).
Empirical works that focus on women’s social and emotional impacts of breastfeeding are less
common (Schmied and Barclay, 1999). The few studies conducted were focused on Western culture,
and some of the findings have not established clear relationship between body image and the choice of
infant feeding by pregnant women (Strang and Sullivan, 1985). Also, despite the global campaign on
promotion of breastfeeding, Foster et al (1996) reported attrition in breastfeeding rates. Roth (2006)
noted that while the educational programs launched to convey the benefits of breastfeeding often focus
on the health of the baby, the focus needs to shift to the decision making process that mothers go
through in making infant-feeding choice, including the effect body image has on breastfeeding
initiation and duration. These remarks constitute the problem of this study.
Research Question
 How does perceived breast role for beauty and attraction by pregnant women relate to their
decision on the duration to breastfeed?

56 Chiejina EN and Odira CC
Hypotheses
 Significant relationship does not exist between age of pregnant women and their body image
with regard to their decision to breastfeed.
 There is no significant relationship between the occupation of pregnant women and their body
image with regard to their decision to breastfeed.
Materials and Methods
The study was a correlational survey design which was carried out between April and June 2012. A
sample of 200 expectant mothers were selected from three health care institutions during their third
trimester. The selected health institutions were one University Teaching Hospital, one General
Hospital, One Voluntary Agency (Mission) hospital and one Primary Health Centre, all in Anambra
State of Nigeria. Ethical approval and the respondents’ consent were obtained prior to the study.
Inclusion factors in the study population were both primigravid and multigravid women. All the
200 respondents were included in the analysis as there were no missing data.
The instrument used for data collection was questionnaire titled “Body Image and Decision to
Breastfeed (QBIDBF) which had two sections. Section A of the instrument elicited information on
demographic data (eg age, educational level, religion, residential location (whether urban or rural),
marital status and parity). Section B of the instrument elicited information on self-concept of body
image (eg. whole body figure, body parts including the breasts), perceived breast role in beauty and
attraction, body satisfaction derived if breastfeeding is adopted, social and spouse influence on choice
of breastfeeding, and duration to breastfeed if chosen so as to preserve the attractive role of the breast.
The questionnaire items in section B adopted ordinal scales. A four points scale ranging from 1-4 was
used to measure the variables with strongly disagree having 1 point, disagree 2 points, agree 3 points
and strongly agree 4 points. Reliability co-efficient of the instrument was established through test-
retest procedure and Kinder Richards formular 21 method of estimating reliability was used giving a
result of 0.64.
The researchers adopted direct contact approach in data collection from the respondents. The
participants’ characteristics were calculated using frequency distribution. Mean scores, standard
deviation (SD) and Spearman Rank correlation co-efficient (rho) were used to answer the research
question while Mann-Whitney –U- Test and Wilcoxon Rank Sum test statistics were adopted in testing
the null hypotheses at 0.01 level of significance. The statistical analysis was performed using SPSS
package.
Result
Table 1: Demographic characteristics of the study population
Item Frequency Percentage
Health Institutions
Teaching Hospital 50 25
Voluntary Agency (Missionary) Hospital 100 50
General Hospital 21 10.5
Primary Health Centre 29 14.5
Education Level
Illiterate 7 3.5
Primary School 39 19.5
O’ Level 61 30.5
Tertiary 93 46.5

Relationship between Body Image and Decision to Breastfeed among Pregnant Women 57
Table 1: Demographic characteristics of the study population - continued
Ethnicity
Igbo 194 97.0
Yoruba 1 0.5
Edo 2 1.0
Efik 1 0.5
Tiv 2 1.0
Occupation
Civil Servant (CS) 55 27.5
Business 145 72.5
Religion
Christianity 196 98
Moslem 2 1.0
Traditional 2 1.0
Residence
Urban 152 76.0
Rural 48 24.0
Marital Status (MS)
Married 191 95.5
Single 9 4.5
Parity
Primigravid 73 36.5
Multigravid 127 63.5
Total population N=200
Demographic characteristics of the study population are shown in table 1. Majority (50%) of
the respondents were selected from Missionary (Voluntary Agency) hospital while the least number
(21%) was drawn from General Hospital. 14.5% of the respondents were drawn from Primary Health
Centre (grassroot), while 25% were selected from Teaching Hospital (tertiary Health Institution).
Table 1 also shows that majority of the respondents (46.5%) had tertiary education while 3.5%
were illiterates. 19.5% and 30.5% were Primary school and O’Level holders respectively. 72.5% were
business women while 27.5% were Civil Servants (White collar job). The Christians were 98%,
Moslems and traditionalists constituted 1.0% respectively. Majority (76%) resided in urban areas while
24% were living in the rural community. On marital status, 95.5% were married while 4.5% were
single. 63.5% were multigravid while 36.5% were primigravid women. The total population of the
respondents was 200.
Table 2: Descriptive Statistics of the measured variables
Variable N Minimum Maximum Mean ( x ) SD
Age 200 16.00 45.00 29.0350 5.09742
Body Image (BI) 200 1.00 4.00 1.6950 0.65363
Body size satisfaction (BS) 200 1.38 4.00 2.9737 0.53806
Social Influence 200 1.00 3.80 1.4740 0.54443
Self-perceived Breast Beauty 200 1.00 4.00 1.6263 0.56987
Spouse influence 200 0.50 3.00 1.2300 0.50894
Duration to Breastfeed 200 1.00 4.00 1.7270 0.56290
Valid N (Listwise)
Table 2 shows the descriptive statistics of the measured variables. Out of the 200 respondents,
the mean age was 29.0350 with a standard deviation of 5.09742, mean for body image (BI) was 1.6950
with SD of 0.65363, mean value for BS was 2.9737 with SD of 0.53806; for social influence, the mean
value was 1.4740 with SD of 0.54443, self-perceived breast beauty had mean value of 1.6263 with SD
of 0.56987, mean value for spouse influence 1.2300 with SD of 0.50894, while the mean value for

58 Chiejina EN and Odira CC
duration to breastfeed was 1.7270 and the SD 0.56290. The table also indicates minimum and
maximum values for each of the variables.
Table 3: Relationship between perceived breast role for beauty and attraction by pregnant women and their
decision on duration to breastfeed
Variables N
(X) SD rho Sig
Breast for Beauty/Attraction 200 1.6263 0.56987 0.549** 0.01
Duration to breastfeed 200 1.7270 0.56290
** Correlation is significant at 0.01 level (1-tailed)
In table 3, the rho correlation value of the relationship between pregnant women’s perceived
breast role for beauty/attraction and their decision to breastfeed was 0.549. This value was significant
at 0.01 level.
Table 4: Man-Whitney – U test Comparison of age of expectant mothers and their body image with regard to
decision to breastfeed
Variables N (X) Z –cal Critical value Probability
Age 200 29.0350
2.899 0.004 P<0.01
Body Image 200 1.6950
2) NB: Z-cal = standard Score
Table 4 shows that at 0.01 level of significance, the calculated Z – Score of 2.899 was more
than the critical value of 0.004. Therefore the null hypothesis is rejected, and there is significant
relationship between age of expectant mothers and their body image with regard to their decision to
breastfeed.
Table 5: Wilcoxon Rank sum test comparison of occupation of pregnant women and their body image with
regard to decision to breastfeed.
Variable Ranking order N Mean Rank Sum Of Ranks Z-Cal Z-Crit Probability
Occupation-
Body Image Civil Servant(CS) 55 89.02 4896.00 1.752 0.080 P<0.01
Business 145 104.86 15204.00
Total 200
NB: Z-cal = standard score
In table 5, the calculated Z-score of 1.752 was more than the critical value of 0.080 at 0.01 level
of significance. Therefore the null hypothesis which states that significant relationship does not exist
between the occupation of pregnant women and their body image with regard to their decision to
breastfeed is rejected.
Discussion
Findings from the study indicate significant and high correlation (rho = 0.549) between perceived
breast role for beauty/attraction and decision on the duration to breastfeed by pregnant women (table
3). Breast size has been found to be an indicator of female attraction in the context of Western culture
(Furnham et al. 1998; Latteier, 1998; Jones, 2004). Hughes (1984) observed that the changes
associated with lactation alter the way women perceive a part of themselves, and thus, their feeling of
attraction, and this subsequently influence the decision they take over infant feeding method. Huang et
al (2004) reports that body image becomes increasingly negative as pregnancy progresses and reaches

Relationship between Body Image and Decision to Breastfeed among Pregnant Women 59
its peak during postpartum period. Hence the negative feelings associated with perceived loss of
attraction could grossly reduce the duration pregnant women would chose to breastfeed.
The significant relationship observed between age of pregnant women and their body image
with regard to their decision to breastfeed (table 4) is noteworthy. The implication of this finding is that
age is a factor in decision-making on the method of infant feeding by pregnant mothers. The young
pregnant woman with uncomplicated pregnancy may decide not to breastfeed so as avoid body image
disturbance and retain her attractiveness. On the other hand, pregnant women that are in their middle
age and with many children, or women that conceived after many years of infertility would be less
concerned about body image and so would opt for breastfeeding. DeLaune and Ladner (2002) stated
that body image is dynamic because any change in body structure or function including the normal
changes of growth and development can affect body image.
Findings from the study also showed significant relationship between occupation of pregnant
women and their body image with regard to decision to breastfeed (table 5). Garner and Garfinkel
(1980) demonstrated that those in professions where there is a particular social pressure to be thin are
much more likely to develop anorexia during their carrier. The population for the current study was
generally civil servants and business women. These categories of workers are likely to choose
alternative (supplementary) methods of infant feeding so as to retain their jobs or businesses. If they
decide to breastfeed, it would likely be for a short period.
Conclusions
This study has established significant correlation between perceived breast role for beauty/attraction
and decision on the duration to breastfeed. The study also provides evidence that significant
relationship exists between age as well as occupation of pregnant women and their body image with
regard to their decision to breastfeed.
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