Breastfeeding and ethnicity: findings from literature, qualitative research and practice in Lothian

1
Breastfeeding and ethnicityfindings from
literature, qualitative research and practice in
Lothian

• Carolyn Worlock, Judith Sim and Dorothy-Ann
  Timoney

2
Methods

• Focus groups moderated in the respective minority
  languages using a semi-structured schedule.
• Including English-speaking and white groups.

3
Breastfeeding 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.

4
Breastfeeding 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)

5
Findings 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.

6
Findings 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.

7
Breastfeeding 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.

8
Qualitative 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

9
Qualitative 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)

10
Qualitative work ..

• Somali and African-Caribbean women held positive
  attitudes to breastfeeding, but younger women
  were less committed than older women.

11
Lothian 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.

12
Work 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

13
Focus group research selected findings
14
Commitment 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

15
A 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)

16
A 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)

17
Breastfeeding 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.

18
Gender-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

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Gender-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

20
Solutions 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)

21
Lack 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)

22
Privacy 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?

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Balance 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

24
Conclusions 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

25
Conclusions ..

• 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.