Engaging the Community to Identify Factors Impacting Breastfeeding for Low-Income African American Women

Background:

The benefits of breastfeeding for mothers and infants have been well established in the literature. Breastfeeding is a health behavior that can work toward the achievement of health equity, which is identified as a social work grand challenge by the American Academy of Social Work & Social Welfare. Unfortunately low-income African American women have disproportionately low rates of breastfeeding.

A number of interventions have been designed to address this issue; unfortunately most have been unsuccessful because they fail to address the culturally-specific mechanisms that impact breastfeeding among African American women. Culturally-grounded research is needed to develop more effective breastfeeding interventions. Thus this study sought to determine: How do low-income, pregnant and postpartum African American women describe breastfeeding within their unique socio-cultural context?

Methods:

A grounded theory framework suggested the need for a community based participatory action research approach, to understand the unique cultural context of breastfeeding beliefs and behaviors among low-income African American women. Group model building, a systems dynamics methodology, was used to elicit factors that help and hinder breastfeeding in five individual model building sessions. Models were constructed in each session, capturing the relationships between these factors. The investigator and a community representative then consolidated the factors and models, and validated them with a subset of participants.

Theoretical sampling was used to identify WIC peer helpers with direct experience working with African American women (n = 3), and pregnant and postpartum African-American women who qualified for WIC (n = 21). Nearly 80% of the participants lived on a monthly household income less than $1,100, and 76% of the women had a high school diploma or less.

Results:

Participants identified 82 unique supportive factors for breastfeeding across groups. These factors were then consolidated into 10 overarching themes. Regarding breastfeeding barriers, participants named 83 unique factors which were categorized into 14 themes. In each model building session, factors and themes were also connected in models. These individual models were then consolidated into a final model with three distinct domains: Returning to Work or School, Social Acceptance of Breastfeeding, and Knowledge, Support, and Persistence.

In the spirit of CBPAR, these findings were presented to nurses working in an obstetric clinic, social worker trainees placed in an integrated health care setting, employees of a community pregnancy program, and WIC peer helpers. The factors were also circulated to a national sample of lactation scholars and practitioners.

Conclusions and Implications:

This research provides a substantial contribution as it uncovers a number of ways that low-income, African American women are situated within a unique cultural milieu as it relates to breastfeeding. Results from this study were contextualized using the social ecological model, and the findings have clear implications for micro, meso, and macro-level interventions to increase breastfeeding rates among this population. Given the short and long term benefits of breastfeeding related to both infant and maternal health, this research has important implications for health equity across the life course.