than Feeding: Lived Experiences of Low-Income Women Receiving Lactation Support

173 Pages·2015·0.95 MB·English

University of South Florida
Scholar Commons
Graduate Teses and Dissertations Graduate School
1-1-2013
More than Feeding: Lived Experiences of Low-
Income Women Receiving Lactation Support
Emily Anne Dunn
University of South Florida,
More than Feeding:

Lived Experiences of Low-Income Women Receiving Lactation Support

by

Emily A. Dunn

A thesis submitted in partial fulfillment
of the requirements for the degree of
Master of Arts
Department of Anthropology
College of Arts and Sciences

and

Master of Public Health
Department of Community and Family Health
College of Public Health
University of South Florida

Co-Major Professor: Nancy Romero-Daza, Ph.D.
Co-Major Professor: Ellen Daley, Ph.D.
Daniel Lende, Ph.D.

Date of Approval:
March 26, 2013

Keywords: brestfeeding, evaluation,
maternal and child health, feminism, applied anthropology

Copyright © 2013, Emily A. Dunn
ACKNOWLEDGMENTS

This work would not have been possible without the assistance and encouragement of my
mentor, Alex Boyer. I sincerely appreciate the support and guidance of my committee,
Nancy Romero-Daza, Ellen Daley, and Daniel Lende. I want to thank Amy Hammant for
her time and counsel. Most importantly, I am grateful to the mothers who allowed me
into their homes. Thank you for sharing the details of your lives.
TABLE OF CONTENTS

LIST OF TABLES ............................................................................................................. iv

ABSTRACT ........................................................................................................................ v

CHAPTER ONE: INTRODUCTION ................................................................................. 1
Research Setting ....................................................................................................... 3
Study Overview ........................................................................................................ 5
Research Aims ............................................................................................ 6
Defining “Breastfeeding” ......................................................................................... 7
Thesis Outline ........................................................................................................... 9

CHAPTER TWO: BACKGROUND AND SIGNIFICANCE ......................................... 11
Breastfeeding and Public Health ............................................................................ 11
Benefits of Breastfeeding .......................................................................... 11
Breastfeeding Rates .................................................................................. 15
Breastfeeding Interventions ...................................................................... 16
Theoretical Framework .......................................................................................... 21
A Biocultural Perspective ......................................................................... 21
Feminism and Breastfeeding ..................................................................... 23
The Biology of Lactation ....................................................................................... 25
History, Policy, and Economy ................................................................................ 29
Medicalization ........................................................................................... 32
History ....................................................................................................... 34
Current Policies ......................................................................................... 37
The Socio-Cultural Context .................................................................................... 39
Embodiment ........................................................................................................... 44
Human Rights and Advocacy ................................................................................. 50

CHAPTER THREE: METHODS ..................................................................................... 53
Participant Observation .......................................................................................... 54
Data Collection ......................................................................................... 54
Semi-Structured Interviews .................................................................................... 55
Recruitment ............................................................................................... 55
Data Collection ......................................................................................... 57
Data Analysis ......................................................................................................... 58
Ethical Considerations ............................................................................................ 58
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Positionality ............................................................................................................ 59

CHAPTER FOUR: RESULTS ......................................................................................... 62
Participant Demographics ...................................................................................... 62
Antepartum Knowledge and Intentions .................................................................. 65
General Feelings Prior to Birth ................................................................. 66
Education .................................................................................................. 70
Reasons for Breastfeeding Duration ......................................................... 72
Plans for Breastfeeding Next Baby ........................................................... 74
Baby Café Program ................................................................................................ 75
Other Support ......................................................................................................... 80
Perceptions of Hospital Support ............................................................... 81
WIC and Healthy Start .............................................................................. 83
The Most Helpful Support ........................................................................ 85
Personal Support System .......................................................................... 86
Room for Improvement ............................................................................. 88
Economics .............................................................................................................. 89
Breastfeeding as Less Expensive than Formula ........................................ 89
Breast Pumps ............................................................................................ 90
Worksites .................................................................................................. 92
Work and Maternity Leave ....................................................................... 93
Other Economic Barriers .......................................................................... 95
Perceptions and Embodiment ................................................................................. 96
Personal Privacy ........................................................................................ 96
Production and Pumping ........................................................................... 98
Breastfeeding vs. Bottle feeding ............................................................. 100
Pain ......................................................................................................... 101
Exhaustion ............................................................................................... 105
Other Sensations ..................................................................................... 106
Perception of Self and Baby ................................................................... 109
Nursing in Public .................................................................................................. 111
Outward Attitudes ................................................................................... 112
Inward Attitudes ...................................................................................... 114

CHAPTER FIVE: DISCUSSION AND RECOMMENDATIONS ............................... 120
Discussion of Results ........................................................................................... 120
Knowledge and Intentions ...................................................................... 120
Economics ............................................................................................... 122
Perceptions and Embodiment ................................................................. 124
Nursing in Public .................................................................................... 128
ii
Social Support ......................................................................................... 130
The Baby Café ........................................................................................ 132
Pumping ................................................................................................................ 134
Recommendations to the Baby Café .................................................................... 138
Limitations ............................................................................................................ 141
Contributions to Anthropology and Public Health ............................................... 142
Future Research .................................................................................................... 143
Directions for Advocacy ...................................................................................... 146

REFERENCES ............................................................................................................... 149

APPENDIX A ................................................................................................................. 163

APPENDIX B ................................................................................................................. 164

iii
LIST OF TABLES

Table 1: Participants’ Intended Breastfeeding Duration ……………………………… 64

iv
ABSTRACT

Increasing breastfeeding duration, especially among low-income women, has
become a national public health priority. These mothers and their babies have less
equitable access to support, resources, and the health benefits of breastfeeding. This
thesis examines breastfeeding from a biocultural perspective with a focus on political
economy, embodiment, and human rights. This research explores the lived experiences of
new mothers who receive services from a community non-profit lactation support
program which is aimed at providing in-home postpartum breastfeeding support to low-
income/at-risk mothers. Evaluation of program services and analysis of women’s
narratives will provide insight into improvement of lactation services for all women.
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CHAPTER ONE: INTRODUCTION

The public health significance of breastfeeding is well known, with breast milk
providing a multitude of protective health benefits for both mother and child (American
Academy of Pediatrics 2012). Research has found that longer durations of breastfeeding
are associated with greater protective effects and health outcomes for mothers and babies
(U.S. Department of Health and Human Services 2011). It is known that women who
intend to breastfeeding understand the health benefits for the baby, but knowledge alone
is not enough to overcome significant breastfeeding barriers (Mitra et al 2004). Three-
fourths of women in the U.S. initiate breastfeeding, but fewer than half are still
breastfeeding at six months (Centers for Disease Control and Prevention 2010). Large
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health disparities exist by government-defined racial/ethnic categories and income
levels, with black infants and low-income income infants breastfeeding at the lowest rates
(CDC 2010, Ryan, Wenjun and Acosta 2002).
Factors that have been found to have a large influence on breastfeeding success
include interpersonal support levels, education, employment, and wealth or income level,
issues which are related to the socioeconomic context (Rudzik 2012:108). Other factors
that influence the breastfeeding experience include structural barriers such as limited

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“Race” in anthropology is conceptualized as a social construction without biological basis in
which humans are classified into groups based on heritable characteristics, common geography
and shared customs. In this thesis, the culturally and government defined racial and ethnic
classifications will be used.
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maternity leave, lack of work support for breastfeeding, and cultural mores that promote
formula feeding and discourage nursing in public. This study explores these and other
factors in order to better understand the lived experiences of low-income women from an
anthropological perspective.
Anthropologists are well positioned to examine the broad context in which
breastfeeding is situated. The consideration of biological, historical, political, economic,
and socio-cultural dimensions is a unique contribution of anthropology to the topic of
breastfeeding. As Rudzik (2012) writes, “Breast-feeding is a quintessential
anthropological subject, being rooted in our evolved biology and profoundly influenced
by our cultural beliefs and practices. While the ability to breast-feed is virtually universal
among women, the experience of breast-feeding is particular to each woman” (108).
Anthropologists have played an integral role in illuminating the evolutionary and
biological significance of lactation in human history, as well as the cultural and societal
forces that affect the practice of breastfeeding worldwide (Trevathan 2003; Dettwyler
1995; Van Esterik 1995; Avishai 2011; Tomori 2011).
Breastfeeding cannot be understood without considering all levels from the
individual to community to world capitalism. Penny Van Esterik writes “As much a part
of the self and identity as political economy… breastfeeding research requires synthesis
of multiple methods and theoretical approaches,” thus making it an ideal topic of inquiry
for anthropology (1995:163). As “anthropology is at the nexus of the biological and
social,” a biocultural approach is a useful theoretical framework for the examination of
lactation (Levins and Lewontin 1998:xi). Furthermore, feminist inquiry into lactation
encompasses an examination of power, class, race, and economics as well as advocacy
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