Exploring Normative Influences and Nativity Differences in Breastfeeding Among Middle-Class Black Women
2016-06-21T00:00:00Z (GMT) by
Previous research suggests that racial disparities and intra-racial differences by nativity status in breastfeeding behaviors might be explained by differences in a combination of attitudes, subjective norms, and perceptions of behavioral control. However, little is known about the extent to which behavioral differences in breastfeeding by nativity status among Black women are explained by differences in attitudes, subjective norms, and perceived behavioral control, particularly at the population level. Utilizing the Theory of Planned Behavior, this dissertation research explored the role of race/ethnicity and nativity status in breastfeeding initiation and duration using quantitative and qualitative methods. The quantitative investigation examined the role of one subjective norm, breastfeeding discouragement and its sources, to understand underlying racial and intra-racial differences by nativity status in breastfeeding disparities using a sample of women from the Pregnancy Assessment and Monitoring System (PRAMS). Using semi-structured individual interviews, the qualitative study explored the attitudes, norms, and behavioral control perceptions with respect to breastfeeding of 20 middle-class, immigrant and US-born Black mothers in Ohio. Quantitative findings showed that breastfeeding discouragement was not associated with never breastfeeding or breastfeeding discontinuation by four weeks and 10 weeks among all mothers in Ohio. Additionally, the relationship between breastfeeding discouragement and breastfeeding behaviors was not moderated by race or nativity, nor did breastfeeding discouragement account for racial differences or nativity differences between Black mothers in breastfeeding behaviors. Breastfeeding discouragement from health providers was associated with a higher prevalence of never breastfeeding among mothers who reported breastfeeding discouragement. Qualitative findings also revealed that most mothers encountered unsupportive breastfeeding comments, ranging from very subtle to quite obvious suggestions against breastfeeding, yet all participants had initiated or expressed breast milk to their infants. These unsupportive comments led many participants to begin formula supplementation. Public health practice and policy implications, along with directions for future research, are presented. This study demonstrates that more research is needed to understand the sources of breastfeeding disparities in the United States, particularly the lower rates of breastfeeding among Black women. Study findings also demonstrate a need for intervention in health care settings and workplaces to increase breastfeeding rates.