Title: Breastfeeding and ethnicity: findings from literature, qualitative research and practice in Lothian
1Breastfeeding and ethnicityfindings from
literature, qualitative research and practice in
Lothian
- Carolyn Worlock, Judith Sim and Dorothy-Ann
Timoney
2Methods
- Focus groups moderated in the respective minority
languages using a semi-structured schedule. - Including English-speaking and white groups.
3Breastfeeding and ethnicity survey findings
- Infant Feeding Survey 2005 (Bolling et al, 2007)
- Across the UK, mothers from all minority ethnic
groups were more likely to breastfeed than white
mothers. - More than 9 out of 10 mothers who classified
themselves as Asian, Black, Chinese or other
ethnic origin initially breastfed compared with
three quarters of white mothers.
4Breastfeeding and ethnicity survey findings
- At six months, 37 of Asian mothers and 57 of
Black mothers were breastfeeding compared with
23 white mothers. Rates were also higher among
mothers of mixed ethnic origin (40 and Chinese
and other ethnic origin (40)
5Findings from the Millennium Cohort study
Griffiths et al (2005)
- White women are least likely to start and
continue to breastfeed. - They are more likely to do so if their partner is
of a different ethnic group to their own - Lone mothers are more likely to breastfeed if
they live in communities of high minority ethnic
prevalence, among women who are more likely to
breastfeed.
6Findings from the Millennium Cohort
study(Hawkins et al, 2008)
- The influence of moving to the UK on maternal
health behaviours. - First and second generation mothers from minority
ethnic groups were less likely to breastfeed for
at least four months than migrant women, after
adjustment for sociodemographic characteristics.
7Breastfeeding in Asian Families (Thomas and
Avery, 1997)
- Considerable variation between groups.
- White women more likely to hold and breastfeed
immediately and be feeding on leaving hospital - Significantly higher proportion of white mothers
who breastfed were breastfeeding at 4 months.
8Qualitative work
- Bowes and Domokos (1998) found that in Glasgow
- Women of Pakistani origin found it difficult to
muster support they needed in establishing
breastfeeding - More likely to face stereotyped views of their
wants, needs and experiences - This was more pronounced in hospital than at home
9Qualitative work ..
- Differences between groups. South Asian women
introduced solids earlier than they would have
liked because they didnt feel they could
breastfeed publicly. Somali women were more
comfortable (Ingram et al 2008) - Bangladeshi and Pakistani women found it
difficult to breastfeed outside the home but this
was less of an issue for African-Caribbean women
(Condon et al, 2003)
10Qualitative work ..
- Somali and African-Caribbean women held positive
attitudes to breastfeeding, but younger women
were less committed than older women.
11Lothian research
- Pilot and on-going research with staff on working
cross-culturally - Focus groups with women 8 groups, 52
participants. - Cantonese, Arabic, Bengali, Polish and
Urdu-speaking groups, 1 second-generation South
Asian group, 1 European group.
12Work with staff
- Confusion about practices in relation to
colostrum amongst South Asian women, particularly
amongst hospital-based staff. - Staff recognised taboos on breastfeeding amongst
Gypsy/Traveller women
13Focus group research selected findings
14Commitment to breastfeeding
- Women in all groups expressed a desire in
principal to breastfeed - I think we have all breast fed our babies.
- (woman in the Cantonese-speaking group)
- Cultural understandings about colostrum did not
form a barrier to breastfeeding
15A thing of the past
- Back home now they dont throw it away. Before
they used to throw that shal dudh away. They
call it shal dudh, harmful milk, back home. Now
doctors explain about it, now theres books
available everywhere. In earlier days it was
said if it is fed itll cause illness to the baby
.. the baby will have a tummy upset.
(Syhleti-speaking woman)
16A thing of the past ..
- Facilitator Does a woman breastfeed her child
in Pakistan? - Woman No, but now they have started to. We had
become very Westernised, now we are returning to
doing what we did before. - (Exchange in the Urdu-speaking group)
17Breastfeeding workshops
- The only women who had attended these were women
in the European group, and women in the 2nd
generation South Asian group. - All women in the first had attended, and only 2
women in the second. - Women in other groups were largely unaware of the
sessions.
18Gender-related barriers to attendance
- I went to the workshops and the woman was
excellent I was attending this workshop for
breastfeeding because I wanted to breastfeed
him. I waited till the end because there was men
there as well and I found that really awkward.
That is the only thing that I would recommend
that they just do it for women only or something.
Maybe have two separate workshops. I just
would not do anything at all until they had all
left basically. The woman was excellent, she
was brilliant. - Woman in 2nd generation South Asian group
19Gender-related barriers to attendance
- ... it's done while men are present. Many men
are present. I only went one day. I just went in
and rushed out immediately. They go with their
partners, with their husbands. .. go holding
hands. I see them all sitting there- they don't
feel shy ( overlapping). They were showing
childbirth, how could I watch that sitting in
front of men? Oh no!(laughter) - Woman in Syhleti-speaking group
20Solutions for South Asian woman and others
- there should only be mums because they feel shy
in the presence of husbands (Urdu-speaking
woman) - I am very happy to participate in this group, it
would have been wonderful to have had such a
group at that time. Then I could have been asked
any of the questions I had. - (Cantonese-speaking woman)
21Lack of continuity compounded by lack of fluency
in English
- When I had my last daughter. She wasn't feeding
very well, she wasn't you know, my breast was
full of milk and so sore and she wasn't taking
this much. I asked the midwife, she said "go to
the toilet and spray some of the milk in the
sink to get rid of the (soreness). The
second day, I told the other midwife I did this
and she said, "no, don't do this again. The body
will produce more milk and you will have the same
problem everyday so leave it for one day, and it
will get rid of it." .. Just absolutely
different! (Cantonese-speaking woman)
22Privacy for breastfeeding
- Regarding the period you spend in hospital after
giving birth, for us the staff should understand
that we have a culture. we remain covered from
strange men. It is just like a game all the time.
I close all the curtains around me because of
other people in the room, and they just come ...
Oh my God ... I explained to every single lady,
(they) come and open it. Sometimes the staff, the
workers, sometimes one of the midwives, I don't
know, those with the yellow uniform. I don't know
who ... whatever. They say Oh why is this
curtain closed?
23Balance between the needs of mother and baby
- its not just about the baby, it is about the
parent, the woman giving birth as well and they
dont focus on that at all. It is like all this
palaver about bonding with your baby, skin to
skin contact, getting this done and getting that
done you know to bond with your baby. You think
well if you actually looked after me a bit better
then I will be able to bond with my baby. - (woman in the 2nd generation South Asian group)
- Contradictory views in the European group
24Conclusions from focus group research
- High levels of commitment, but specific barriers
faced by minority ethnic women distinct from
those related to socio-economic status. - Some commonalities and some differences between
groups of minority ethnic women not homogenous
25Conclusions ..
- Cultural understandings of breastfeeding are
not the barrier that hospital-based staff earlier
thought it to be. - Barriers to information and support lie in
language and culturally-specific ideas about
gender. - Wider recommendations in relation to mixed gender
sessions Bestfed and NHS HS - will reinforce
barriers of access to some groups of minority
ethnic women.