A Qualitative Description of African American Women's Breastfeeding Experiences

Abstract

The low rates of breastfeeding among African American women in the U.S. is a poorly understood, persistent disparity that contributes to higher incidences of morbidity and mortality for African Americans across the lifespan. Understanding how African American women experience breastfeeding in the context of their day-to-day lives lead to suggestions for new strategies that could promote and protect breastfeeding within the African American population. This aim of this study was to explore the breastfeeding experiences of African American women from a wider demographic who had successful breastfeeding experiences. Black feminist thought, a critical social theory, provided the theoretical framework and the lens for of discovering not simply what, but how and why certain cultural and environmental factors affect the breastfeeding decisions made by African American women. The Sequential-Consensual Qualitative Design (SCQD), a three stage qualitative methodology, was used to explore the cultural, personal, and political context of African American women's breastfeeding experiences. Stage one included 4 individual interviews with key informants who were African American women who assisted women with breastfeeding. Stage 2 included individual interviews with 17 African American women who breastfed at least one healthy baby. Stage 3 was accomplished through a focus group of 7 African American women who breastfed. Qualitative content analysis from a feminist perspective was used to analyze and code the transcripts of the interviews and focus group. Codes extracted from the key informant interview data from stage 1 of the study supported and mirrored the 5 key dimensions of Black feminist thought, and provided cultural guidance in the development of the interview questionnaire for stage 2 of the study, accessing the personal voice. Themes that emerged from stage 2 of the study included (a) self determination and intrinsic motivation for breastfeeding, (b) breastfeeding as a spiritual tradition, and (c) empowerment through breastfeeding. The focus group participants in stage 3 of the study confirmed the three themes from stage 2 and discussed ideas for breastfeeding promotion. Themes that emerged from the focus group included: (a) supportive spheres of influence surrounding African American women, (b) corporeal images of the sexual breast versus nurturing breast, and (c) breastfeeding as activism and an act of resistance. Focus group participants recognized that strengthening support systems is necessary to increase breastfeeding rates in the African American population. Specific targeted areas of support identified by the focus group participants included health care providers, employers, faith communities, and family members. Negative stereotypes of Black women's bodies lead to feelings of vulnerability when breastfeeding in public for some of the participants. Increasing the visibility of breastfeeding in the African American community as an empowering and nurturing experience may be the key to increasing breastfeeding rates and embracing cultural change.