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Engaging Field-Based Professionals in a Qualitative Assessment of Barriers and Positive Contributors to Breastfeeding Using the Social Ecological Model

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Abstract

Despite broad recognition of benefits associated with breastfeeding, rates in the United States continue to be below targets established by Healthy People 2020, especially for economically disadvantaged women. This study engaged field-based professionals through a focus group process to collect perceptions on factors that determine a woman’s decision to breastfeed. Field-based professionals participated in one of six focus groups. Following the social ecological model (SEM), focus group questions addressed barriers and contributors to breastfeeding at the individual, interpersonal, community, organizational, and public policy levels. Thematic content analysis was used in identifying, analyzing, and reporting on themes within the focus group data. Commonly reported themes were identified that negatively influence a mother’s decision to breastfeed such as modesty/general discomfort to breastfeed in front of others, negative breastfeeding perceptions of family members, friends, boyfriends and co-workers, breastfeeding not being viewed as the societal “norm”, and the availability of free formula samples. Despite identified barriers, commonly reported themes that positively influence a mother’s decision to breastfeed included general knowledge on the benefits, positive breastfeeding perceptions of family members, friends, boyfriends, and co-workers, the availability of “mom and baby” groups, and Baby Friendly hospital practices. The findings provide field-based perspectives that identify opportunities to support breastfeeding through the lens of the SEM. Opportunities to better support breastfeeding include educating mothers and their social support systems on the specific benefits of breastfeeding, challenging existing breastfeeding norms, and working with hospitals on establishing policy to not provide free formula samples.

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Acknowledgments

We thank Liza Drew, Kara Squillante, Keene State Dietetic Interns and Nutrition Option students, members of the Coalition, Southwestern Community Services and Southern New Hampshire WIC, Monadnock Birthing Center, Cheshire Medical Center/Dartmouth-Hitchcock Keene, Home Healthcare Hospice and Community Services, Monadnock Regional Hospital, the New Hampshire Breastfeeding Task Force, Karen Schifferdecker, and Maryanne Keating for their assistance. Support for the research was funded through the following: Keene State College Faculty Development Grant and Cheshire County HEAL.

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Authors and Affiliations

  1. Department of Health Science, Keene State College, 229 Main Street, Keene, NH, 03435-2903, USA

    Rebecca L. Dunn, Karrie A. Kalich & Margaret J. Henning

  2. Community Health Clinical Integration, Cheshire Medical Center/Dartmouth-Hitchcock Keene, Keene, NH, 03431, USA

    Rudolph Fedrizzi

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  1. Rebecca L. Dunn
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  2. Karrie A. Kalich
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  3. Margaret J. Henning
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  4. Rudolph Fedrizzi
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Correspondence to Rebecca L. Dunn.

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Dunn, R.L., Kalich, K.A., Henning, M.J. et al. Engaging Field-Based Professionals in a Qualitative Assessment of Barriers and Positive Contributors to Breastfeeding Using the Social Ecological Model. Matern Child Health J 19, 6–16 (2015). https://doi.org/10.1007/s10995-014-1488-x

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