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'People try and police your behaviour': The impact of surveillance on mothers and grandmothers' perceptions and experiences of infant feeding



Pregnancy and motherhood are increasingly subjected to surveillance. Research has highlighted that public breastfeeding is difficult to navigate within existing constructs of acceptable femininity, but at the same time, mothers who formula feed are often located within discourses of the failed maternal subject. This article draws on intergenerational research with six mother/grandmother pairs from marginalised urban Welsh locales, which involved elicitation interviews around the everyday artefacts that participants presented to symbolise their experiences of motherhood and infant care. We examine the negotiation of acceptable motherhood in relation to the intrusive policing of lifestyle choices, consumption and infant feeding from family, friends and strangers. The article argues that the moral maze of surveyed motherhood renders infant feeding a challenging, and challenged, space for women. key words breastfeeding • infant formula • infant feeding • morality • motherhood • surveillance • stigma • visual methods • participatory research • qualitative research
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Accepted for publication 13 February 2017 • First published online 20 March 2017
‘People try and police your behaviour’: The impact
of surveillance on mothers and grandmothers’
perceptions and experiences of infant feeding
Aimee Grant,
Dawn Mannay,
Ruby Marzella,
Cardiff University, Wales, UK
Pregnancy and motherhood are increasingly subjected to surveillance. Research has highlighted
that public breastfeeding is difficult to navigate within existing constructs of acceptable femininity,
but at the same time, mothers who formula feed are often located within discourses of the failed
maternal subject. This article draws on intergenerational research with six mother/grandmother
pairs from marginalised urban Welsh locales, which involved elicitation interviews around the
everyday artefacts that participants presented to symbolise their experiences of motherhood and
infant care. We examine the negotiation of acceptable motherhood in relation to the intrusive
policing of lifestyle choices, consumption and infant feeding from family, friends and strangers. The
article argues that the moral maze of surveyed motherhood renders infant feeding a challenging,
and challenged, space for women.
key words breastfeeding • infant formula • infant feeding • morality • motherhood • surveillance
• stigma • visual methods • participatory research • qualitative research
Routine surveillance by health professionals has been a longstanding feature of
healthcare (Foucault, 1963), and increased visibility, both actual and the potential for,
results in self-regulation (Foucault, 1977). Despite a lack of evidence supporting the
eectiveness of individual programmes, many governments have invested heavily in
health promotion activities (Speller et al, 1997). Within the UK, these interventions –
such as Health Action Zones (1998–2003) and Healthy Towns (2008–present) and in
Wales, Communities First (2001–present) – have been targeted at areas of economic
deprivation. However, there has been insucient robust evaluation to determine if
these policies result in a reduction in health inequalities (Judge and Bauld, 2006).
Aimee Grant et al
Pregnancy is a key time when normal populations become subjected to increased
medical surveillance, and the UK government has prioritised reducing health
inequalities during this period (DH, 2010). Pregnancy-specific interventions
include increased surveillance by midwives and health visitors targeted at women
from deprived areas or young mothers, through Flying Start in Wales, Starting Well
in Scotland and the Family Nurse Partnership in England. Evidence for benecial
health impacts is mixed (Judge, 2005; Robling et al, 2016), and health promotion
interventions may actually disempower some participants (Grant et al, 2014). It is
not only professionals who hold the authority to judge, as in contemporary society
power is everywhere and held by everyone (Foucault, 1972). For Foucault (1977: 271),
‘power produces knowledge and power and knowledge directly impact one another’,
and thus health promotion has both altered society’s accepted ‘normal’ behaviours
and, through societal power and surveillance, stigmatised those who do not conform
to the public health ideal (Hacking, 1986; Wigginton and Lee, 2014). Accordingly,
individual self-regulation of health behaviour is fundamental in surveillance and care
of the self (Foucault, 1977, 1997), which occurs in response to perceived scrutiny by
others. This is particularly apparent in neoliberal Britain, as policy seeks to devolve
responsibility for health and wellness (and other fundamental areas of social policy)
from the government to the individual, and part of being a good citizen is accepting
this responsibility through displaying appropriate behaviours (Dean, 2015). Within
this article we use the term ‘surveillance’ in a broad sense, ranging from the potential
to be observed by others, for example, in public spaces, through to more active
interventions from others, including comments or questions to the individual, which
can be interpreted as value judgements.
Within contemporary society, attention has been directed towards pregnant women
who come to be seen as a vessel protecting the health of the foetus, where it is viewed
as having a higher importance than the woman herself (Lupton, 2012). Appropriate
health behaviours include being a healthy weight, not smoking or drinking alcohol
and avoiding foods associated with increased risks to the foetus (HSCIC, 2012).
Interventions may also attempt to deliver class-based values systems, including a
focus on the competence of mothers (Sorhaindo et al, 2016). Within this context,
surveillance is prima facie directed towards unborn babies and children (Armstrong,
1983). However, it is ultimately used to make moral judgements regarding a woman’s
suitability as the carrier of a foetus and/or the carer of babies and infants (Hacking,
1986). Intergenerational research with mother–grandmother dyads suggests that the
intensity of the gaze directed towards mothers has increased in recent decades (Fox
et al, 2009).
Mothers living in poverty are the most likely to undertake health behaviours that
are currently recognised as undesirable during pregnancy (HSCIC, 2012). These
behaviours often engender emotive responses – research examining the public’s views
about smoking during pregnancy has highlighted negative and judgemental discourses,
which Wigginton and Lee refer to as ‘good mothers don’t smoke’ (Wigginton and
Lee, 2014: 267). Moreover, the rejection of working-class value systems in notions of
acceptable pregnancies mean that working-class women are habitually represented
as lacking ‘moral value’ (Skeggs, 2005: 965). These representations often fail to
acknowledge the lived reality of life on a low income (Hanley, 2007), and, as Wenham
(2015) argues, pregnancy, particularly for young parents residing in marginalised areas,
can be characterised by vulnerability, uncertainty and a ‘fragile’ self-identity. This
‘People try and police your behaviour’
may be compounded by forms of external regulation from family and friends, who
reinforce discourses of inadequate mothering.
Heightened surveillance continues in the postnatal period, and current concerns
focus on infant feeding, with breast milk recommended as the exclusive food for the
rst six months. Within this context, how good a mother is has come to be measured
by whether she breastfeeds, and the use of infant formula has been reconciled as
‘somehow symptomatic of a woman’s failure as a mother’ (Lee, 2007: 1088). In the
UK, less than 1% of mothers feed their infants in line with ocial guidance (HSCIC,
2012), often leading mothers to experience a feeling of failure (Brown et al, 2011).
Alongside this, breastfeeding for longer than a few months (Stearns, 2011), or in public,
tends to be perceived negatively, including claims that women are ‘making a scene’
(Boyer, 2011) and undertaking a disgusting, even sexual act (Acker, 2009; Grant, 2016).
Reactions of disgust have long been associated with working-class motherhood, and
are typically shown in the terminology used in media discourses (Skeggs, 1997; Tyler,
2008), creating and stigmatising an undesirable ‘other’ (Katz, 1986).
Parenting increasingly occurs in the public arena in contemporary society (Boyer
and Spinney, 2016), and breastfeeding women manage their behaviour with reference
to views of what is acceptable feeding practice, while utilising shared public space in
which they will necessarily be visible (Battersby, 2007; Brown, 2016). Mothers who
nurse in public have been labelled ‘nasty’, ‘oensive’, ‘rude’ and ‘distasteful’, and have
been subject to the negative criticism that they are ‘exposing themselves’, leading
to breastfeeding women adopting a range of strategies to minimise their visibility
(Guttman and Zimmerman, 2000; Noble-Carr and Bell, 2012; Grant, 2015, 2016).
More than 40% of breastfeeding women have received negative reactions from
members of the public (HSCIC, 2012), and this negative view of public breastfeeding
has been linked with the increasing hypersexualisation of the breast in Western
societies (Acker, 2009). Combined with class-based othering practices, breastfeeding
in public may be particularly challenging for working-class women, which may lead
to the rejection of breastfeeding. Consequently, infant feeding idealism and infant
feeding realism become juxtaposed because infant feeding in the real world sits
within multiple values that compete with discourses of the optimum health ideal
(Hoddinott et al, 2012). The increased political prioritisation of breastfeeding alongside
the objectication and commodication of women and their breasts has rendered
infant feeding a site of moral and interactional ‘trouble’ (Lomax, 2013).
Our research, funded by the Children and Young Person’s Research Network
(CYPRN), engaged with intergenerational accounts of infant feeding in areas of
poverty within Wales, UK. Areas of poverty were principally chosen because of low
rates of breastfeeding (HSCIC, 2012) and high rates of public health intervention. We
aimed to understand inuences on infant feeding decisions, and experiences of infant
feeding, alongside how women navigated the dominant moral frameworks surrounding
infant feeding and how they engaged in discursive work to justify their status as
‘good mothers’. To explore continuities and changes over time, we undertook dyad
interviews, with mother–grandmother pairs. A participatory approach was adopted,
with participants asked to bring artefacts; these shaped the direction of the interviews.
Aimee Grant et al
Dyad interviewing
Intergenerational work is ‘central to the project of new motherhood’, which
conceptualises the development of maternal identities (Thomson et al, 2011: 119) and
provides opportunities to explore ‘partial identications’ and moments of connection
and disconnection (Mannay, 2013). Furthermore, the increasing focus on pregnancy
and infant feeding as a time to avoid risk makes comparisons between generations an
area of empirical interest (Fox et al, 2009). Therefore, the purposive sampling targeted
new mothers to be interviewed with their own mothers, the new grandmothers.
Intergenerational dyad interviews have been adopted in earlier research on
motherhood. Through the co-construction of events and the naturalness of
communication between the dyad pair, they can provide increased depth and valuable
insights into continuity and change, which might not be found by interviewing the
participants alone (Clendon, 2006). However, dyad interviews also allow pre-existing
power relations between mothers and grandmothers to be brought to the interview,
which can prove problematic where grandmothers supervise mothers’ behaviours
(Caldwell et al, 1998; Sciarra and Ponterotto, 1998). Accordingly, it is important to
acknowledge that pre-existing power relations between dyad participants were brought
to the interview, and that these inuenced the data produced. Five of the mother/
grandmother pairs chose to participate in a dyad interview, and one intergenerational
pair preferred to be interviewed separately.
Cardi University’s School of Medicine Ethics Committee provided ethical approval,
and participants were invited to contribute through the researchers’ contacts and
snowballing. Fourteen mothers of infants aged under 30 months who lived in urban
Communities First2 areas of South Wales, UK were invited to participate. Of these,
nine agreed and were requested by the researcher to invite their own mothers (the
grandmothers) to participate in the study. Seven mother/grandmother pairs agreed
to participate in an interview and six pairs, 12 participants, went on to undertake an
interview during July and August 2014. The mothers’ youngest children were aged
between six weeks and 25 months. Mothers themselves were aged between 22 and
43, and grandmothers between 42 and 74. There was intergenerational continuity in
employment type among four pairs. All participants were white, with ve mother–
grandmother pairs identifying as white Welsh. Five of the mothers and four of the
grandmothers had some experience of breastfeeding.
Data production
Visual methods can ‘allow for the explorations of greater complexities in everyday life
and give greater prominence to the ways in which people are active everyday theorists’
(Mannay and Morgan, 2015: 482), and have been applied successfully in a wide range
of studies (Rose, 2012; Lomax, 2015; Sorensen and Poland, 2015). More specically,
visual data production has been introduced and generated in studies with mothers to
engender more complex data than interviews alone, to facilitate more equal power
relations within interviews and to prompt participants to tell the stories that they
felt were most relevant (Clendon, 2006; Rose, 2012; Mannay, 2015). However, given
‘People try and police your behaviour’
the nature of the sample, it was important to avoid time-consuming pre-interview
tasks, so participants were invited to select everyday artefacts, prompting narratives
of associated experiences (Hurdley, 2006). Specically, mothers and grandmothers
were asked to select everyday objects that they associated with infant feeding and
their experiences of motherhood more generally.
Four mothers and three grandmothers brought a range of artefacts including
bottles, breast pumps, infant clothing, photographs and books. Participants were
asked to talk about the artefacts that they had brought along, with the interviewer
prompting for further details if it did not emerge through conversation between the
two participants. A brief topic guide was created and used in interviews, focusing on
views and experiences of infant feeding, including interaction with partners, family
and health professionals. Where topics did not arise naturally, they were introduced
as part of open-ended questions towards the end of the interview.
Where artefacts were not presented, participants were asked to recount their
experience of infant feeding in a free-form participant-led discussion, supported with
the same open-ended questions. However, the interviews that were based around
artefacts were longer and tended to be directed more easily by the participants, with
the interviewer taking the position of actively listening to the accounts of participants,
rather than raising a series of questions to be answered. All of the interviews were
conducted by the same member of the research team, Ruby, who did not have any
children, or direct experience of infant feeding.
Audio recordings of the interviews were transcribed verbatim, with interviewer notes
added to make it clear which artefact was being described and to record other points
of interest. Data production and analysis were conducted concurrently, with emergent
themes being explored in future interviews. In all, 24 artefacts were brought to the
interviews and there were six hours of recorded discussions that generated 83,236
transcribed words. The visual productions, which were photographed at the point
of data production with participant consent, acted as tools of elicitation, rather than
objects of analysis per se; however, they were considered in the analysis to clarify and
extend the associated interview transcripts (Mannay, 2016). Inductive thematic analysis
was facilitated by NVivo 10, allowing codes, categories and themes to be generated
from the empirical data produced with the participants (Braun and Clarke, 2006).
The theme of surveillance was further explored across the interviews as a whole to
appreciate its situatedness.
The participants’ accounts covered a range of themes including family relationships,
changes in identity, health and wellbeing, and childcare practices and routines.
However, the ndings presented here focus on participants’ subjective experiences
of surveillance by family, friends and strangers. Feelings of being watched, evaluated
and judged, with some direct experiences of being questioned by strangers, were
centralised in many of the participants’ reections, and the following sections explore
these in relation to pregnancy and infant feeding. Participants articulated two key
narratives around ‘good motherhood’, which sometimes conicted: rst, devoted
Aimee Grant et al
seless mothering, largely through following public health guidance; and second,
chaste or invisible mothering, through hiding the maternal breast. One participant
also highlighted a third discourse of freedom and maternal choice.
Pregnancy and surveillance
Within the interviews, participants were not asked directly about their experiences of
being pregnant, but pregnancy often featured in the discussions between mothers and
grandmothers, and this, in turn, provided the context for their experiences of being
subjects of surveillance when feeding their infants. For example, in the dyad interview
with Tanya3 (mother) and Diane (grandmother), Diane described several instances
when the pair had been out in public and strangers had suggested what Tanya should
have been doing, or sometimes controlled her behaviour through restricting access to
‘harmful’ goods, with the explicit rationale of protecting her unborn child. In this way,
participants become subject to the power of strangers, who legitimise their control
by evoking a discourse of the ‘good’ maternal subject who follows health guidance.
In one recollection, which was represented by a coee mug, Diane recalled how a
waiter acted “like the kinda food police” and refused to serve them the afternoon
tea they had been expecting, because of Tanya’s “big belly”. When Diane began this
account, Tanya’s rst contribution was to roll her eyes (“oh yeah [rolls eyes], yeah,
yeah, yeah”), suggesting a level of frustration at the way she was treated in the story
her mother is sharing. Tanya goes on to explain:
‘Yeah, he said: “You can’t have this”, “You can’t have that.” He didn’t ask us
what we wanted. He said: “The only things you can have are, um, cheese
and pickle.” He brought things [he decided] we could have, but he didn’t
ask if we liked ‘em, he didn’t, he didn’t ask if we wanted them … he even
went to the chef about what I can have instead of asking me: “What has
your health visitor said you can have?”…’
Diane explained that the waiter was “adamant” that he would not serve them other
types of food, as if he had a legitimate right to dictate what kinds of food both Tanya,
who was pregnant, and Diane, who was not pregnant, could eat, recalling “he didn’t,
like, give us any choice, did he? It was just, like: ‘We can’t serve you this’…. It was
like he was the pregnancy expert, wasn’t it?” Later in the interview Tanya reected
on this as something that made her feel “quite inferior” and how she felt like saying,
“yeah, you haven’t got the right to tell me what I can and can’t eat!” Diane also
commented, “and I weren’t impressed.” Mother and grandmother did not appear to
be reticent in the interview setting; however, they did not actively resist the waiter’s
restrictions, highlighting the power of societal expectations and actors over maternal
subjects. This lack of resistance could suggest a normalisation, and tacit acceptance,
of surveillance and intervention in the lives of pregnant women by non-professional
strangers. At this time, Tanya reported that she felt as though she, or at least her bump,
was “everyone’s property”, which was “a pain” for her to navigate, and unlike any
previous situation she had encountered.
Diane questioned the legitimacy of the increased public gaze and intervention in
the antenatal period: “I mean, it’s strange isn’t it, like, why do they care? I can’t see
why there’s like a xation: it’s like everybody … someone’s always got [to intervene].
‘People try and police your behaviour’
Tanya also reported that she felt a strong desire to reject any future interventions
directed towards her by strangers focused around maternal health risk behaviours:
“on my next one I’m gonna be, like, a right cow to everyone about everything and
I’ll say: ‘No! I do want prawns and will have prawns … [laughter]…. Let me speak to
the manager.’”This rejection of external control suggests a future where Tanya is able
to revise the role that she will play, refusing the scrutiny directed towards pregnant
women, and performing as she would in everyday (non-pregnant) life, where she has
freedom of choice. However, as representations of acceptable maternal subjects are
constructed by societal surveillance directed towards “big bellies”, Tanya is unlikely
be aorded such freedom in subsequent pregnancies. This is particularly relevant in
contemporary society where outside others take on the role of assuring compliance
to their understandings of appropriate behaviour in relation to the public health ideal.
Tanya’s account was in stark contrast to Diane’s own experiences of being pregnant,
when strangers undertook less surveillance of maternal health risks on behalf of the
unborn child, and she commented:
… it was really weird…. I couldn’t believe how interfering, like, from when
I was pregnant … when I was pregnant no one cared [laughter] you could
say: “Oh I’ll have a double vodka and coke with my fag” [laughter] and it
was like: “Yeah, no problem” [laughter]. So it’s just totally dierent … people
try and police your behaviour … when I was pregnant when no one cared
… you could have asked for any food or drink: I never got stopped having
Diane’s comments support previous research ndings of a signicant intergenerational
shift where pregnancy has become (experienced as) a public (as opposed to private)
phenomenon (Fox et al, 2009). In this instance, Tanya’s “big belly” marks her out as
someone to pay additional attention to, in her maternal embodiment.
For Erica (mother), surveillance in pregnancy was specically linked to infant
feeding, and the concept of whether to choose breast milk or infant formula, and
she explained:
‘People generally go “Oh [infant formula’s] gonna be really expensive.
Y’know they think that when you’re pregnant they can ask you anything,
and it would be: “Are you gunna breastfeed or are you gunna bottle feed?”
And “Oh well, y’know, breastfeeding now it’ll be cheaper. Think of all the
money you’ll spend on formula.”’
Diane, Tanya’s mother, also reported that she had mentioned to Tanya in the antenatal
period that: “[breastfeeding] was a good thing and I hope you try it”, but that her
friends also asked her about Tanya’s infant feeding intentions from early in the
‘Yeah my friends are really pro-breastfeeding, so as soon as Tanya said, like,
“I’m pregnant” [my friend’s] words were, like: “Are you breastfeeding?”’
Again, Erica’s comment, “they think that when you’re pregnant they can ask you
anything”, is symbolic of the increased community surveillance on the maternal
Aimee Grant et al
body. Erica reported that she planned to, and tried to, initiate breastfeeding, but
was physically unable to because she could not produce milk. The questions Erica
received in the antenatal period were value judgements around quality of mothering
behaviour (Lee, 2007), which contributed to producing her view of breastfeeding
as the ideal method of infant feeding. Erica performed considerable identity work
throughout the interview to highlight that some women could not breastfeed, the
positives of formula feeding, and that her baby had not been harmed because of not
receiving breast milk. Despite lengthy accounts of surveillance from family, friends
and strangers during pregnancy and early motherhood, participants rarely discussed
the input of health professionals, perhaps showing that this surveillance was expected
in the antenatal period, or, in Erica’s case, the intervention from health professionals
was minimal: “I thought the midwives in the hospital would push [breastfeeding]
but they didn’t.
Infant feeding and surveillance
Participants reported a range of pressures to feed their babies in particular ways,
including a general pressure to breastfeed, as opposed to using infant formula, that
came from societal knowledge and repetition of the mantra ‘breast is best’. They
also discussed an awareness of their visibility when feeding infants in public, which
related to breasts as sexual, or around other mothers, that could result in a sense of
competition to be the most seless maternal subject. Participants reported various
strategies to respond to these pressures, including politely responding to direct
questions about their feeding methods from strangers, disengaging in friendships with
those who forcefully promoted infant feeding, and quiet resistance to pressure from
family. Alongside this, some participants attempted to perform a “good mother” role
when feeding infants in public, where they were aware of having an audience, by
simultaneously demonstrating that they were breastfeeding while showing as little as
possible of their body, or by using expressed breast milk.
Among the mothers, an explicit rationale for feeding choice was absent for all but
one. Tanya reported that she made the decision to breastfeed autonomously, based
on convenience, rejecting the notion that discourses around appropriate feeding
inuenced her: “my decision wasn’t based on what anyone said I just.… I didn’t
care if anyone said breastfeed: if I wanted to bottle feed, I would have bottle fed.
However, this articulation of autonomy and freedom of choice in the maternal period
was contradicted twice later in the interview. Tanya reected on the pressures on
mothers to breastfeed: “I don’t think there should be so much pressure for mums
to breastfeed and then feel guilty about it”, suggesting that she had felt the force of
opinions from others and recognised that mothers are subject to societal pressure in
relation to infant feeding.Tanya suggested that partners, and possibly grandmothers,
should be the only people with legitimate power in the decision-making process.
However, Tanya’s mother was present, which may have inuenced this comment,
particularly as Diane mentioned that she wanted Tanya to breastfeed several times
during the interview. In contrast, Diane, who exclusively formula fed her children,
reported that she had experienced much less scrutiny regarding infant feeding. This
included contrasting the detailed guidance on how to prepare infant formula that
Tanya had received with the do ‘whatever’ approach that was commonplace when
her own children were infants.
‘People try and police your behaviour’
Similarly, Sharon (grandmother), reported that her daughter, Kayleigh, “has been
absolutely marvellous to be perfectly honest” in her infant feeding behaviour, which
included considerable “research” about best practice. Although Sharon had breastfed
herself, she felt that she had been “quite naïve … I probably hadn’t even thought about
it”, and stated that she felt that “nobody inuenced me or anything”, in contrast to
the plethora of information that Kayleigh had accessed. Arguably, Sharon’s decisions
would have been inuenced by some form of social power. However, her articulation
of decision-making highlighted a relative lack of societal concern regarding infant
feeding at that time (Hacking, 1990). The other four grandmothers did not explicitly
state their infant feeding preferences for their daughters during the interviews, perhaps
showing an acknowledgement of the potential for maternal guilt and the high levels
of scrutiny already focused on this area.
Grandmothers reported a range of infant feeding experiences, although none
recalled a strong pressure to breastfeed or instances in which they had encountered
surveillance of their infant feeding. For example, Debbie (Erica’s mother) reported a
strong desire to breastfeed, but stated that this was based on very limited information,
including minimal guidance from health professionals, and reported the normalisation
of formula feeding at the time: “I know people of my generation … some of them
wouldn’t [breastfeed] they’d go on bottle straight away. In contrast, Geraldine (Lauren’s
mother) reported that she had breastfed one of her children for seven months; however,
she expressed disgust toward a friend who had breastfed long term at the time: “my
friend breastfed until [her daughter] was ve [years old] … that’s disgusting … there’s
no need. This suggested that extended breastfeeding was found to breach discourses
of appropriate use of the (sexual) breast in contemporary society (Stearns, 2011).
Mothers reported that comments and behaviours from their family could inuence
their feelings towards infant feeding in the postnatal period. This ranged from
uncomfortable feeding experiences through to comments that the mothers perceived
to be judgements of their capability to look after their children. For example, Tanya
recounted feeling exposed: “it is still quite embarrassing when I’m sat on the sofa with
[my] dad doing these breastfeeds … and then I’m like really covering myself … and
even like under the covers it’s just embarrassing ‘cos dad’s quite old fashioned, isn’t
he?” Alongside this, Kayleigh experienced direct comments regarding the frequency
of her breastfeeding in the early weeks: “and you’d have some family members going,
ooh, is he feeding again … is he feeding, is he feeding that often?” Kayleigh reported
that these comments, which had also come from friends, made her question her ability
to feed her baby successfully: “and it just makes you doubt yourself.
Comments focused on adequacy or appropriateness of breastfeeding suggest a
tension between discourses focused on ‘good’ mothering through seless dedication
to the public health ideal, and the regulation of the maternal body, through a critique
of visible care work. These watchful commentaries serve to undermine breastfeeding
behaviour, which may lead to a decision to stop breastfeeding, increasing maternal
guilt for lack of adherence to the public health ideal.
Fearne also described how particular friends pushed her to breastfeed her baby,
and she disengaged in these relationships. This demonstrates that pressure around
infant feeding will not be tolerated by some mothers, where they are able to have a
high degree of control in the relationship, which is in contrast to relationships with
strangers, where mothers have less control over unplanned interactions and their
associated, possibly negative, reactions. A further issue that was explored in Tanya’s
Aimee Grant et al
interview was the tension between being a breastfeeding mother and engaging in
occasional nights out where alcohol would be consumed in line with guidance from
health professionals:
‘I went out and mum had [my baby] … my [relative], we said that we was
going out, and she was like: “Oh, she can’t go out; she’s breastfeeding. She can’t
drink alcohol” and I was obviously gonna pump it out and then breastfeed
the next day … and it’s just, it’s so intrusive and rude, and you get so angry
about it that you think, d’you know what [laughs], it’d be easier just to give
her [my baby] a bottle [of infant formula] from all these dierent inputs
here, and left right and left.
In addition to family members, Tanya commented that friends had remarked on her
plan to drink alcohol, saying that they would not judge her, but making her feel
judged by doing so:
‘People say things like “Oh, I won’t judge you!”, and it’s like “Oh, well thank
you!” Yeah, it’s like, why would you judge me? It’s nothing to do with you,
so why do you, why are you even saying? I didn’t even know I was in a jury,
like…. It’s just so rude and that’s, like, really close personal friends who were
saying “I won’t judge you”.
Tanya’s references to judgement reect the continual sense of evaluation from social
networks that has become attached to motherhood and mothering. Alongside
comments on feeding from family and friends, Tanya and some of the other participants
reported that strangers had questioned their feeding behaviour, as illustrated below:
‘Me and my partner went to a coee shop and we was heating up a bottle,
um, for [our daughter] and then the cleaner, this man, was, just cleaning
around the tables, who worked there, and he came up to me and said, “Are
you breastfeeding?” and, like, I said: “yes” I was, and I didn’t really take
oense to it but if I wasn’t, then I’d feel quite like … it’s intrusive … like I
wouldn’t walk up to him and say “What did you have for your lunch today?”
[laughter] like, why are you asking me what my child has for milk? But yeah,
like, random things like that….
Tanya struggled to understand the rationale for such questions (“it’s like, why do
you wanna know?”), and reported later in the interview that the cleaner, and other
strangers who questioned her infant feeding method, had “no right to tell someone
to breastfeed or not.” However, she noted that a negative response might occur if the
cleaner didn’t like her answer (“spitting in my tea”), perhaps explaining her decision
to answer his question. In contrast, when Tanya’s GP suggested that she may be
winding her baby incorrectly, Tanya told him that he was wrong. Diane also recalled
that Tanya had an “interfering” midwife for part of her antenatal care, to which Tanya
responds: “but that got nipped in the bud quite early.Tanya’s reasoning for being able
to respond to these demonstrations of power dierently is that she is condent that
she is a good mum: “you’re just getting teared down so much and ‘cos I know I’m
a good mum. I’ll just say, I’ll just answer them back.” It may be that the professional
‘People try and police your behaviour’
relationships between Tanya and her midwife meant that standards of behaviour were
clearly dened, ensuring that a ‘wrong’ answer could not have an unknown negative
impact, which could occur in interactions with strangers.
Tanya reported that she attempted to feed expressed breast milk from a bottle
whenever possible when she was in public, thus undertaking signicant additional
work in order to juggle competing good mother discourses around providing breast
milk while maintaining the invisibility of the maternal body. Her rationale for this was
her lack of condence, a feeling of increased visibility and the potential for (negative)
intervention from strangers when she was feeding directly from the breast. Although
Tanya had not received any comments explicitly related to feeding from the breast, she
felt that her breasts were viewed as sexual by observers, and breastfeeding was viewed
as a sexual display akin to pole dancing, which made her feel very uncomfortable. In
order to avoid showing her breasts when feeding in front of others, Tanya routinely
used a shawl to cover her body, which she brought to the interview. Tanya described
the importance of the shawl in her breastfeeding. As part of her account, Tanya
reported that even though she tried to cover her body, she would defend her right
to breastfeed in public if it was challenged, expressing a freedom of choice discourse
alongside a discourse of motherhood centred on the public health ideal, and later
mentioned that she would love to feel more condent with breastfeeding in public:
Tanya: ‘If I don’t have this [shawl] to cover myself it’s quite like, oh
God, who’s coming, who’s coming … okay, get o now, hide
the boob … and, um, yeah, you feel, like, really you’re, like.... I
was in the park, like, it only happened once, and I didn’t have
the cover and she was crying for the bottle and we hadn’t got
the bottle with us … so, um, yeah, you feel quite dirty … you
feel like … yeah it’s kinda like, I dunno, it’s kinda like you’re just
stood there pole dancing … that’s how you kinda get looked
at like … sorta like, ooh how dirty….
Interviewer: ‘Has anybody ever kind of made it obvious a bit or a bit like….
Tanya: ‘They wouldn’t dare [laughter] gimme attitude, I’d give it straight
In contrast, Kayleigh (mother), initially reported that she had never considered the need
to cover her body when breastfeeding in public. However, she implicitly responded to
an invisible maternal body discourse, in that she wore clothing that aimed to reduce
possible exposure when feeding, showing an awareness that exposing part of her
breast during feeding may be perceived negatively by those inadvertently observing
the feed. Moreover, through media coverage of women receiving negative attention
for breastfeeding in public and her participation in this research, she had begun to
understand that she was aware of others viewing her breastfeeding. Kayleigh had
not been conscious of receiving the negative looks that Tanya had been concerned
about, but was aware of a quiet surveillance that had always made breastfeeding in
public dierent to the relaxed experience she reported at home. Like Tanya, she
reected that when breastfeeding in public she also took a defensive stance to guard
against possible negativity, recalling, “I did have, like, a very deant look on my face
… that I don’t think anyone really would say anything!” Again, this suggests that
Aimee Grant et al
Kayleigh is subject to, and responsive to, the power of surveillance in relation to her
breastfeeding practices.
The point that participants felt the need to feed their infants in a particular way
outside of the home can have implications for feeding choices for later children (Fox
et al, 2009). Tanya reported three times during the interview that in the future, if she
had another child, she would consider not breastfeeding, including this example of
her conversation with her mother Diane:
Diane: ‘You’re glad you breastfed though, aren’t you, and gave her all
the nutrients and the whatever, the immunities and all that,
aren’t you?’
Tanya: ‘Yeah, I am happy about it, I just, I might, I might bottle feed
my next one, just to make a statement!’ [laughter]
Diane: ‘Yeah, it is better though. I liked that you breastfed. You’re happy
you breastfed, aren’t you?’
Tanya: ‘Yeah I’m happy I breastfed. I’d be more happy if it wasn’t such
an issue around it.
Diane: ‘And it’s a shame that because you breastfed and after
breastfeeding, in a way, you feel more anti-breastfeeding because
of your own experience … ‘cos you can breastfeed and it would
have worked out for you, but now, ‘cos of other people, it’s put
you o. It’s a shame.
Tanya: ‘Yeah, I haven’t looked at it like that.
Fearne also identied that feeding her baby in public was challenging. Like Tanya,
she routinely expressed her own milk to use in public, engendering the invisible
maternal body. However, she felt that when feeding her baby from a bottle she was
being judged by strangers as not embodying the public health ideal. These competing
dominant moral discourses, emphasising the superiority of breast milk over infant
formula, but the necessity of the hidden breast, impacted on Fearne’s perception of
her own parenting practice:
‘If you do bottle people are thinking: “why is she bottle feeding? Why is
she?” Even to the point I almost feel that I have to make comments that
it’s my own milk.
When her baby was undergoing a growth spurt, Fearne reported that she was unable
to express enough of her milk to meet his needs, and that she supplemented her own
milk with infant formula. In recognition of her visible failing to meet the public
health ideal, signied by formula milk, Fearne felt concerned that she would face
negative reactions from strangers. As such, she performed the act of mixing formula
as though it were a deviant act:
‘Yesterday was the rst time I felt comfortable to actually get the bottle out
in public and mix the bottle with people actually seeing and then to give it
to him ‘cos everyone’s watching ‘cos they think, y’know, cute baby, and that’s
what people do, but I felt kept thinking, oh, y’know, what are people gonna
think? What are people…? And at one point, we were in one restaurant once,
‘People try and police your behaviour’
I was actually conscious I was hiding the powder, like I was actually doing
it really secretively, mixing it.
However, Fearne was also aware that breastfeeding could be met with negative
reactions, including disgust at the visibility of the maternal body, demonstrating that
regardless of the method of feeding, mothers are aware of judgements that may lead
to negative comments or actions from strangers:
‘If I breastfeed in public [laughs] … this standard joke in my house, if I
breastfeed in Starbucks the whole café’s just gonna leave … and every
middle-class, y’know, over 60-year-old woman is just going to be horried.’
In this extract, Fearne rst refers to a general viewing public and her feelings about
their anticipated reaction to her breastfeeding in public. She positions this scenario as
a “standard joke”, which suggests that she is not expecting breastfeeding in Starbucks
to trigger a mass evacuation. However, her account resonates with accounts that
mothers may be viewed with disgust (Tyler, 2008), particularly when feeding their
infants (Boyer, 2011; Grant, 2015, 2016). Fearne’s more specic reference to middle-
class women over the age of 60 doesn’t reect the wider literature; however, the
cultural location of the participants, in marginalised and stigmatised Welsh locales,
may account for the reference to class as part of her experience of an undercurrent
of a society divided by class (Hanley, 2007). It is important to appreciate the classed
position and spatial marginalisation of the participants, and the ways in which this
inects their ideas about how they are judged and who makes these judgements.
Fearne’s experience stood in contrast to her mother Barbara’s recollections
of breastfeeding. Barbara reported that breastfeeding in Australia, where she had
previously lived, was subject to less public surveillance. She rationalised this as being
because the society was less conservative, so the display of the maternal breast was
less provocative, which was in part due to people generally showing more of their
bodies. However, she also commented that the acceptability might be down to the
way in which women were breastfeeding, with public breastfeeding in Australia being
described as almost invisible, thus displaying the good motherhood discourse of lack
of visibility that was common in the UK:
‘Y’know, the women out there [Australia] have got it down to a ne art, you
can walk past a woman and not know she’s breastfeeding.
Overall, the interviews with mothers and grandmothers produced a rich seam of
data, and we have only been able to discuss some of the points they raised within this
article. The use of dyad interviews and artefacts was particularly valuable in generating
conversations between participants, and allowing them to reect on their experiences
of motherhood and infant feeding in preparation for the interview. As in previous
research, the use of visual approaches (Hurdley, 2006; Rose, 2012; Mannay, 2016) and
dyad interviews (Clendon, 2006) generated multifaceted and emotional accounts from
participants. These techniques oered advantages, but it could be argued that some
experiences may not have been discussed in a dyad setting that would have been
Aimee Grant et al
raised in individual interviews. For example, the presence of grandmothers may have
reduced discussion regarding the challenges of the mother–grandmother relationship
in relation to infant feeding (Caldwell et al, 1998).
We found that mothers reported increased surveillance compared to grandmothers.
This surveillance, and the negotiation of acceptable motherhood behaviours in relation
to the intrusive policing of lifestyle choices and consumption from family, friends
and strangers, began in pregnancy and then continued to have an impact on mothers’
everyday lives, particularly through infant feeding. The most challenging form of
surveillance to manage was that from strangers in the public realm, where women
felt less in control of situations and dynamics between individuals. Participants often
performed public motherhood in ways that were highly orchestrated and self-aware,
as they had either experienced negative interactions with strangers regarding their
feeding choice, or felt anxious that these might occur (Lee, 2007). This indicates
that societal surveillance acts to shape individual mothers’ behaviours and identities
as maternal subjects (Foucault, 1977, 1997). This appeared to be a challenge that
grandmothers had not encountered, suggesting that changing societal interest in
avoiding risky health behaviours, in relation to pregnancy and maternity, had aected
the direction of the anonymous public gaze (Hacking, 1990). Some mothers did report
that they were able to reduce or control interactions with those who attempted to
regulate their feeding behaviour, but this agentic stance was usually related to friends
and health professionals rather than the general public.
Although this study was not comparative and only engaged with participants from
marginalised areas, previous research has explored the ways in which working-class
women and mothers are subjected to stigma, moral judgements and surveillance
(Skeggs, 1997; Tyler, 2008; Mannay, 2015). We were unable to fully explore the class-
related discourses within this article. However, the positioning in existing literature
(see, for example, Skeggs, 1997) may go some way towards explaining participants’
accounts of attempts to placate strangers who questioned their infant feeding practices,
but also the latent anger that this engendered for these marginalised women.
In their reections, mothers articulated two key discourses of ‘good motherhood’
that they attempted to display, but that sometimes conicted: rst, the need to
conform to the public health ideal through devoted and seless motherhood, which
usually materialised as providing breast milk; and second, the desirability of chaste,
invisible or disembodied motherhood, through attempts to hide the breastfeeding
body. Accordingly, participants amended their infant feeding behaviours from those
used at home, to attempt to perform respectable motherhood, including minimising
exposure of the breast while feeding (Guttman and Zimmerman, 2000; Acker, 2009;
Noble-Carr and Bell, 2012; Grant, 2016). For some mothers, this resulted in additional
work to express breast milk (Stearns, 2011). Participants described some instances of
undertaking both breast and formula feeding in public as though it were an illicit act
(Boyer, 2011), as they felt each option placed them at risk of judgement, negativity
and reprimand. These contradictory ‘good motherhoods’ render infant feeding a
site of moral and interactional ‘trouble’ (Lomax, 2013). Importantly, within this
moral framework, neither breast nor formula feeding could guarantee an acceptable
presentation of the maternal subject in public spaces.
1 Corresponding author.
‘People try and police your behaviour’
2 Communities First is the Welsh government’s agship area-based poverty reduction
programme, delivered in the most deprived areas of Wales at the time of the research.
3 All the participants are referred to using pseudonyms to maintain anonymity.
We would like to acknowledge the Children and Young People’s Research Network
(CYPRN) for their nancial support that enabled this project to be undertaken. We are
grateful to the mothers and grandmothers who took part in interviews, and shared their
experiences of this emotive topic area. We also extend our thanks to the reviewers for
their encouragement and invaluable comments on earlier drafts of this article, and the
editorial team at Families, Relationships and Societies for their support.
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... Interviews were the most utilised research method, although more than one research method was used in 15 of the studies. There was variation in approach between studies that employed interview methods, including online interviews and emails (Dowling & Pontin, 2017), visual methods (Grant et al., 2017) and ...
... We also noted a relative lack of discussion of the legal context by mothers (see Table 3), although in seven papers mothers' knowledge of legal protections for breastfeeding in public provided maternal confidence (Hauck et al., 2020;Isherwood et al., 2019;Marcon et al., 2019;Owens et al., 2018;Sheehan et al., 2019;Spurles & Babineau, 2011;Stevenson, 2019). Some mothers also noted that they were prepared to strongly assert their right to breastfeed in public if confronted by a stranger, although this was not explicitly linked to stating their legal right or knowledge of it (Boyer, 2011(Boyer, , 2012Charlick et al., 2017; | 35 of 47 Grant et al., 2017;Pallotti, 2016). However, other mothers expected their right to breastfeed in public to be ignored or actively challenged (Owens et al., 2018). ...
... All of the studies included in the analysis either explicitly reported on sexism and surveillance or contextualised their findings within an assumption of a sexist culture which used surveillance and stigma of women's bodies. Breasts were explicitly positioned as sexual, as opposed to maternal, particularly in studies reporting data from observers (Grant, 2015;Grant et al., 2017;Morris et al., 2016;Rhoden, 2016) and partners (Avery & Magnus, 2011;Bueno-Gutierrez & Chantry, 2015;Chantry et al., 2008;Furman et al., 2013;Helps & Barclay, 2015;Henderson et al., 2011;Rhoden, 2016). ...
Full-text available
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.
... Women's personal experiences with and perceptions about breastfeeding were certainly in uenced by the cultural pressure to breastfeed. The literature revealed that women were faced with judgement and disapproval when people around them discovered they opted out of breastfeeding (42). Women recalled the experiences of being questioned by others, including strangers, when they were bottle feeding their infants (18,42,43). ...
... The literature revealed that women were faced with judgement and disapproval when people around them discovered they opted out of breastfeeding (42). Women recalled the experiences of being questioned by others, including strangers, when they were bottle feeding their infants (18,42,43). ...
Full-text available
Background Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization. While the literature exploring breastfeeding beliefs and practices is growing, it offers various, and sometimes conflicting, explanations regarding women’s attitudes towards and experiences of breastfeeding. This research explores existing empirical literature suggestions regarding women’s perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices. Methods This paper uses a scoping review methodology developed by Arksey and O’Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of key words. After removing duplicates, papers published in 2010-2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data. Results In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it challenging to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women’s decision to breastfeed. Conclusion While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. Acknowledging that breastfeeding is associated with challenges and providing adequate institutional support can improve breastfeeding rates and have a positive impact on women’s breastfeeding experiences.
... However, despite the public health narrative around abstract breastfeeding having many benefits (NHS, 2020;UNICEF, 2019), society still perceives the embodied act of breastfeeding as disgusting and shameful. As such, F o r P e e r R e v i e w O n l y 3 women who breastfeed in public, who do so for an 'extended' time 1 , and who enjoy it are stigmatised (e.g., Boyer, 2018;Dowling & Brown, 2013;Grant, 2016;Grant, Mannay, & Marzella, 2017;Mathews, 2018;Newman & Williamson, 2018;Tăut, 2017;Tomori, Palmquist, & Dowling, 2016). Indeed, KLM's 2019 tweet presents breastfeeding as an activity that makes some people feel 'uncomfortable' and alludes to the possible 'offense' that might be caused: ...
... We see many similarities between Schipper's (2007) work on containment and Butler's (1988) early work on strict punishments, whereby those who deviate from socially mandated performances are stigmatised. We also note how Hoskin's (2019a) work on femmephobia helps to elucidate Stone and Gorga's (2014) containment practices whereby silence is used to exclude lesbian identities, and Tăut's (2017) notion of permission within (Hoskin, 2017a) and surveillance (Grant et al., 2017) is often used to prevent breastfeeding in public, as well as 'extended' ...
... Women's personal experiences with and perceptions about breastfeeding were also influenced by the cultural pressure to breastfeed. Welsh mothers interviewed in the UK, for instance, revealed that they were faced with judgement and disapproval when people around them discovered they opted out of breastfeeding [35]. Women recalled the experiences of being questioned by others, including strangers, when they were bottle feeding their infants [9,35,36]. ...
... Welsh mothers interviewed in the UK, for instance, revealed that they were faced with judgement and disapproval when people around them discovered they opted out of breastfeeding [35]. Women recalled the experiences of being questioned by others, including strangers, when they were bottle feeding their infants [9,35,36]. ...
Full-text available
Background Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization. While the literature exploring breastfeeding beliefs and practices is growing, it offers various and sometimes conflicting explanations regarding women’s attitudes towards and experiences of breastfeeding. This research explores existing empirical literature regarding women’s perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices. Methods This paper uses a scoping review methodology developed by Arksey and O’Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of keywords. After removing duplicates, papers published in 2010–2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data. Results In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it difficult to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women’s decision to breastfeed. Conclusion While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. It is important to acknowledge that breastfeeding is associated with challenges and provide adequate supports for mothers so that their experiences can be improved, and breastfeeding rates can reach those identified by the World Health Organization.
Mothering and motherhood can be a very challenging experience in the 21st century, where cultural pressures, on the one hand, and health experts’ regular parenting surveillance, on the other, continue to influence mothering decisions and practices. The socially constructed “good mother” discourses and associated pressures/influences can be amplified for vulnerable mothers who may feel marginalized from or judged by the broader society. This article presents findings from a study that involved interviews with ten young mothers and 12 staff working at a leading family welfare agency supporting young parents in Melbourne, Australia. The study examined how digital technology could promote a sense of agency for vulnerable mothers as well as barriers and enablers of accessing digital knowledge and online parenting support. In addition, the study explored how technology could assist community organizations’ staff in helping their clients better. This paper argues that, overall, digital technologies can positively influence the experience of mothering and can empower vulnerable mothers by increasing their access to various sources of support. Furthermore, our findings suggest that technology can enhance community and family service providers’ practice, opening possibilities for a more supportive relationship with clients by empowering them and increasing agency over their situation.
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Over the past two decades, scholars have investigated a multitude of different aspects of motherhood. This article provides a scoping review of research published from 2001 to 2021, covering 115 Social Science Citation Index-referenced papers from WEIRD countries, with the aim of reconstructing social norms around motherhood and mothers' responses to them. The analysis is theoretically based on normological and praxeological concepts. The findings reveal five contemporary norms of motherhood that reflect both stability and increasing differentiation, and are related to five types of mothers: the norms of being attentive to the child (present mother), of securing the chi-ld's successful development (future-oriented mother), of integrating employment into mothering (working mother), of being in control (public mother), and of being contented (happy mother). Relying on an intersectional lens, we analyze mothers' heterogeneous responses to these norms of motherhood, and examine how neoliberal demands build on and perpetuate inequalities.
Conference Paper
Behavior change and improving health literacy based on normative ideals of motherhood is a dominant paradigm to address maternal health challenges. However, these ideals often remove women’s control over their bodies overlooking how the bodily experiences of pregnancy are socially and culturally constructed. We report on 27 interviews with pregnant women and nursing mothers in rural and semi-urban areas of South India, and six focus groups with 23 frontline health workers as secondary data. We explore how the embodied pregnancy experiences are infuenced and negotiated by the socio-cultural context and existing care infrastructures. Our fndings highlight how the ways of seeing, knowing, and caring for a body of a pregnant woman through often conficting norms, beliefs and practices of medicine, nourishment and care actively shape the experiences of pregnancy. We open up a space for novel opportunities for digital health technologies to enhance women’s embodied experiences and pregnancy care infrastructures in the Global South.
Objective To explore the experiences of women during pregnancy with mild to moderate mental health problems and describe the barriers to receiving support in relation to their mental health. Research design and participants This paper reports part of a larger project which recruited women and midwives in one hospital in ‘X’. Participants completed questionnaires in early pregnancy in an antenatal clinic, and the characteristics of women with and without symptoms of anxiety and depression compared. All women were invited to express interest in a follow up interview in late pregnancy. Women identified to have depression and anxiety in early pregnancy, but not under the care of perinatal mental health services, were eligible for interview. Interviews were conducted with 20 women using a visual timeline to aid discussion and were thematically analysed. Findings In late pregnancy mental health disorders were reported by nine women, of which five were diagnosed during adulthood. EPDS scores found 15 women had symptoms of mild to moderate depression and GAD-7 scores indicating 15 women with mild to moderate anxiety. Three themes were identified: moods and emotions - past, present and future; expectations and control; knowledge and conversations. Key conclusions and implications for practice Due to limited access to specialist perinatal mental health services women relied on support networks and self-care to maintain their mental health. More time and better continuity at antenatal appointments along with improved mental health literacy may increase discussions regarding women's mental health during pregnancy. In addition investment is required to develop strategies and improve access to mental health services for women with mild to moderate mental health problems.
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Autism is often viewed as an impairment, preventing Autistic individuals from achieving success in the world. We argue that, Autism can be an enhancement, particularly in some professional contexts, including qualitative research. However, Autistic people experience higher rates of unemployment and underemployment (lower skills/part-time). The social model of neurodiversity highlights the role of inaccessible workplaces and practices. Alongside this, the concept of the ‘Autistic Advantage', a strengths-based model, emphasises the ways in which Autistic people are assets to the social structures in which they exist. Two late diagnosed Autistic women, acknowledged as qualitative research experts, review the literature on Disability, neurodiversity and research; outline their own professional strengths; discuss their professional strengths in the light of the literature; and make recommendations for Autistic researchers and their neurotypical colleagues. Autistic qualities and preferences can be strengths in qualitative research teams. This includes long periods of concentration (hyperfocus), leading to ‘flow’ and creative thinking, attention to detail, and detailed knowledge of topic areas that are of interest to the individual. We conclude that qualitative research teams can benefit from working inclusively with Autistic researchers. We present guidance to facilitate inclusive working, without which Autistic researchers may be Disabled by their work environment
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Purpose – Evaluation of the Teens & Toddlers (T & T) positive youth development (PYD) and teenage pregnancy prevention programme suggested that the intervention had minimal effectiveness partly due to its unclear theory of change. The purpose of this paper is to examine the lived experiences of young women participating in the programme to contribute to a clearer understanding of intervention process and potential mechanisms. Design/methodology/approach – The authors conducted four focus groups (n=20), eight paired or triad interviews (n=12) and 15 interviews with young women participating in an randomized controlled trial of the T & T programme in England, analysing these data using a phenomenological approach. Findings – T & T provided some opportunities to experience the “five Cs” that underpin PYD programme theory: competence, confidence, connection, character and caring. However, the young women did not experience the programme in a way that would consistently develop these characteristics. The lack of opportunities for skill-building and challenge in the activities constrained their ability to build competence and confidence. Some programme facilitators and counsellors were able to achieve connections and caring relationships with the young women, though other adults involved in the programme were sometimes perceived by the participants as overly critical. The character development activities undertaken in the programme addressed attitudes towards sexual risk-taking. Originality/value – Few studies of the PYD approach examine young people’s perspectives. This research suggests that the young women were not consistently provided with opportunities to achieve youth development within the T & T programmes. In refining the programme, more thought is needed regarding how delivery of particular components may facilitate or impede a PYD experience.
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Stigma and concern about public breastfeeding have been identified as contributing towards low breastfeeding rates in high-income countries. Despite this, very little research has examined public perceptions of breastfeeding. Among existing studies, lack of familiarity with breastfeeding, sexist views and hyper-sexualisation of the breast were identified alongside discomfort at viewing breastfeeding by strangers. During 2014, in the United Kingdom (UK), several cases of women being criticised for breastfeeding in public appeared in national newspapers. A Critical Discourse Analysis approach was used to theoretically frame analysis of 884 naturally occurring comments relating to a protest supporting women's right to breastfeed in public from the UK's most popular online news site, Mail Online. Findings are discussed in relation to mothers' roles as citizens and sexual beings, with a particular focus on the visibility of breasts in public space. Women who breastfeed in public were viewed as unattractive, lazy, bad parents and lacking in self-respect. More specifically, women who breastfed in public were viewed as exhibitionist. This was contrasted with the desirability of breastfeeding within the home, which was seen as an appropriate way to feed an infant. The undesirability of public breastfeeding was inherently linked to sexuality, with breastfeeding women viewed as sexual aggressors ("flashers") or inviting sexual contact from men. It is argued that these views originate in unequal gender relationships in society and the framing of breasts as sexual rather than nurturing. These discourses are played out in public space in which mothers are marginalised in a patriarchal society.
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Background: Many countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. Methods: We did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation (<16 weeks vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866. Findings: Between June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64-1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI -47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99-1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77-1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother-child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention. Interpretation: Adding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge. Funding: Department of Health Policy Research Programme.
This article draws on qualitative longitudinal data obtained over a five-year period with young mothers. What makes the approach described in this article unique is how it views teenage pregnancy and motherhood as fluid and dynamic, moving away from the static snapshots that often depict young mothers as struggling (or failing) at one moment in time, to a more nuanced account that reflects their journeys into motherhood and the changes that occur through time. Three main themes are explored. First, emphasis is placed on the acute awareness of stigmatisation and how the women in the study consequently felt pressure to prove that they were different or set apart from the stereotypical teenage mother. Second, factors that either neutralise or exacerbate the experience of stigma are explored. Finally, it is argued that greater attention should be paid to the process of stigmatisation through the notion of a maternal career. This framework allows for an appreciation of both the complexity of how lives unfold and of the many factors that can influence its direction.
This paper is about the entanglements or mutually affecting engagements with the material world that occur in the course of trying to becoming mobile with a small baby. Drawing on a rigorous empirical base of 37 interviews with 20 families in East London, we analyse the relationships between discourses of parenting and the material practices of journey-making. Bringing together conceptual work on the new materialism and mobility studies, we advance the concept of mother–baby assemblages as a way to understand mobile motherhood, and consider the emotional and affective dimensions of parenting in public that emerge through journey-making. We argue that the transition to motherhood occurs in part through entanglements with the more than human in the course of becoming mobile (including matter, affects, policies and built form). We further argue that approaching motherhood from the perspective of material entanglements advances geographical scholarship by deepening our understanding of mobility as a relational practice. Finally, we extend conceptual work in Geography as a whole by showing the utility of new materialist philosophy as a means for theorising identity.
In this article, we show how using a visual method enabled an exploration of the nuances o everyday encounters of older men living alone. It made visible more fleeting encounters, alertin us to the significance of such encounters. The article argues the need to pay more attention t social encounters, situated somewhere in the space between acquaintanceship and strangerhood While not always easy to articulate verbally, characteristics of such encounters are nonetheles meaningful and supportive of masculine identities delineated by older men living alone.
The distinctiveness of Wales, in terms of its political life and culture, has grown considerably over the last decade (Mackay, 2010). Nevertheless, beneath the imagery of the definitive nation, Wales remains a complex and divided land in which a marginalised and demonised working-class has come to characterise areas of Wales dominated by poverty and social exclusion. Such polarisation has a spatial dimension that is illustrated in the creation of new ghettos of prosperity and poverty, which now dominate the Welsh socio-economic terrain, and this ‘stigma of place’ permeates the identities of residents. The chapter begins by considering how moral panics about particular places create ‘spatial folk devils’. The creation of moral panics through political discourses and mediated forms is then explored in terms of contemporary representations. Drawing on research with mothers and their daughters in a marginalised Welsh locale, the chapter examines the ideology of unity alongside the divisions of everyday life, and the ways in which respectable and acceptable working-class femininities are negotiated against a pervasive discourse of lack, stigma and classed moral panics.
Stigma is a significant barrier to breastfeeding. Internationally, mothers have reported stigma surrounding public breastfeeding. In the United Kingdom, the Equality Act 2010 gives women the right to breastfeed in public, including within private businesses. In April 2014, a woman who was breastfeeding in a UK sports shop was asked to leave, resulting in a localized protest by breastfeeding mothers. This resulted in the issue of public breastfeeding being highlighted in local, national, and social media. To examine online opinion regarding breastfeeding in public and protesting about the right to breastfeed in public within the context of a single case. Online user-generated content relating to the case of Wioletta Komar was downloaded from Twitter and the comments section of a UK online news source, Mail Online. Data comprised 884 comments and 1210 tweets, collected within 24 hours of the incident. Semiotic and thematic analysis was facilitated by NVivo 10. Comments from Twitter were supportive (76%) or neutral (22%) regarding the protesting women and public breastfeeding. Conversely, Mail Online comments were mostly negative (85%). Mail Online posters questioned the legality of public breastfeeding, while Twitter comments acknowledged and supported women's legal right to breastfeed publicly. Many Mail Online commenters stated that they found it uncomfortable to watch breastfeeding or thought it was unnecessary to breastfeed in public. If the UK government is serious about increasing breastfeeding, interventions to promote public support for public breastfeeding are urgently required. © The Author(s) 2015.
The influences of supportive and conflictual mother-daughter relationships on depressive symptoms expressed by African American and White teenage mothers and grandmothers were examined. Interviews were conducted with 83 grandmother-teenage mother dyads to assess their individual perspectives of the quality of their relationship and their psychological well-being. Findings indicated that grandmothers assessed the mother-daughter relationship as more favorable than young mothers. African American teenage mothers were more likely than White mothers to report childrearing conflicts with grandmothers. Grandmothers, regardless of race, were more likely than teenage mothers to report less conflict around raising the young mothers' babies. Although racial differences were found in the number of depressive symptoms expressed among grandmothers, this finding did not hold when controlling for socioeconomic status. Similarly, the inverse relationship found between supportive maternal relations and depressive symptoms at the bivariate level of analysis was no longer important for predicting depressive symptoms among teenage mothers in the presence of conflictual mother-daughter relationships. Implications of these and other findings for future social network research and family interventions are discussed.