Maternal and Child Health Journal

, Volume 20, Issue 7, pp 1549–1557 | Cite as

Cultural Norms in Conflict: Breastfeeding Among Hispanic Immigrants in Rural Washington State

  • Sarah Hohl
  • Beti Thompson
  • Monica Escareño
  • Catherine Duggan


Objectives To examine perceptions, experiences, and attitudes towards breastfeeding among Hispanic women living in rural Washington State. Methods Twenty parous Hispanic women of low acculturation, aged 25–48 years and residents in rural Washington State participated in an exploratory, face-to-face interview. Interviews were audio-recorded, translated and transcribed, and analyzed using a thematic content analysis approach. Results Nine emergent themes were grouped into three overarching categories: (1) Breast is best; (2) Hispanic cultural and familial expectations to breastfeed; and (3) Adapting to life in the United States: cultural norms in conflict. Women said they were motivated to breastfeed because of their knowledge and observations of its health benefits for mother and child. They said breastfeeding is ingrained in their Hispanic cultural heritage, and infant feeding choices of female family members were particularly influential in women’s own decision to breastfeed. Women said they experienced embarrassment about breastfeeding in the United States and as a result, often chose to initiate formula feeding as a complement so as to avoid feelings of shame. Additionally, they faced economic pressure to work, key barriers for continued breastfeeding among Hispanics in the United States. Conclusions for Practice Knowledge of the benefits of breastfeeding for mother and child and longstanding cultural practices of breastfeeding are not enough to encourage exclusive breastfeeding to 6 months among this rural Hispanic population. Continued support through family-level interventions as well as work place policies that encourage breastfeeding are needed for rural Hispanics to reach optimal breastfeeding rates.


Breastfeeding Hispanic/Latino Health disparities Rural populations Immigrant health 



The authors would like to thank the staff at the Fred Hutchinson Cancer Research Center site office, Centro para Promover la Salud Comunitaira (Center for Community Health Promotion), and the community members of the Lower Yakima Valley who made this work possible. This project was supported by the National Cancer Institute (Grant # U54CA153502).

Compliance with Ethical Standards

Conflict of interest

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.


  1. 1.
    Arenz, S., Rückerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity—A systematic review. International Journal of Obesity, 28(10), 1247–1256.CrossRefPubMedGoogle Scholar
  2. 2.
    Ball, T. M., & Wright, A. L. (1999). Health care costs of formula-feeding in the first year of life. Pediatrics, 103(Supplement 1), 870–876.PubMedGoogle Scholar
  3. 3.
    Bernard, H. (2011). Research methods in anthropology: Qualitative and quantitative approaches. Lanham: Altamira Press.Google Scholar
  4. 4.
    Bernard, H. H. R., & Ryan, G. W. (2009). Analyzing qualitative data: Systematic approaches. Thousand Oaks: SAGE.Google Scholar
  5. 5.
    Bunik, M., Clark, L., Zimmer, L. M., Jimenez, L. M., O’Connor, M. E., Crane, L. A., & Kempe, A. (2006). Early infant feeding decisions in low-income Latinas. Breastfeeding Medicine, 1(4), 225–235.CrossRefPubMedGoogle Scholar
  6. 6.
    Centers for Disease Control and Prevention Health Disparities and Inequalities: Morbidity and Mortality Weekly Report. (2011). Centers for Disease Control and Prevention, 60.Google Scholar
  7. 7.
    Chatterji, P., & Brooks-Gunn, J. (2004). WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers. American Journal of Public Health, 94(8), 1324–1327.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    DeNavas-Walt, C., & Proctor, B. D. (2014). Income and poverty in the United States: 2013. U.S. Census Bureau, Current Population Reports, pp. 60–249.Google Scholar
  9. 9.
    Dietz, W. H. (2001). Breastfeeding may help prevent childhood overweight. JAMA, 285(19), 2506–2507.CrossRefPubMedGoogle Scholar
  10. 10.
    Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., & Eidelman, A. I. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506.CrossRefPubMedGoogle Scholar
  11. 11.
    Gibson-Davis, C. M., & Brooks-Gunn, J. (2006). Couples’ immigration status and ethnicity as determinants of breastfeeding. American Journal of Public Health, 96(4), 641.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Glazier, R. H., Bajcar, J., Kennie, N. R., & Willson, K. (2006). A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care, 29(7), 1675–1688.CrossRefPubMedGoogle Scholar
  13. 13.
    Harley, K., Stamm, N. L., & Eskenazi, B. (2007). The effect of time in the US on the duration of breastfeeding in women of Mexican descent. Maternal and Child Health Journal, 11(2), 119–125.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Horta, B. L. (2007). Evidence on the long-term effects of breastfeeding. Geneva: WHO.Google Scholar
  15. 15.
    Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.CrossRefPubMedGoogle Scholar
  16. 16.
    Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment, 153, 1–186.PubMedGoogle Scholar
  17. 17.
    Kimbro, R. T., Lynch, S. M., & McLanahan, S. (2008). The influence of acculturation on breastfeeding initiation and duration for Mexican-Americans. Population Research and Policy Review, 27(2), 183–199.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kramer, M., & Kakuma, R. (2007). Optimal duration of exclusive breastfeeding. Cochrane database of systematic reviews. doi: 10.1002/14651858.CD003517.pub2.Google Scholar
  19. 19.
    Mack, N., Woodsong, C., MacQueen, K. M., Guest, G., & Namey, E. (2005). Qualitative research methods: A data collectors field guide. Research Triangle Park, North Carolina: Family Health International.Google Scholar
  20. 20.
    National Center for Chronic Disease Prevention and Health Promotion. (2014). Breastfeeding among US children born 20012011. CDC National Immunization Survey. Retrieved 4/10/2045.
  21. 21.
    Passel, J. S., Cohn, D., & Lopez, M. H. (2011). Hispanics account for more than half of nation’s growth in past decade. Washington, DC: Pew Hispanic Center.Google Scholar
  22. 22.
    Rimer, B. K., & Glanz, K. (2005). Theory at a glance: A guide for health promotion practice. Washington, DC: National Institutes of Health.Google Scholar
  23. 23.
    Saldana, J. (2009). The coding manual for qualitative researchers. Thousand Oaks: Calif Sage.Google Scholar
  24. 24.
    Schmied, V., Olley, H., Burns, E., Duff, M., Dennis, C.-L., & Dahlen, H. G. (2012). Contradictions and conflict: A meta-ethnographic study of migrant women’s experiences of breastfeeding in a new country. BMC Pregnancy and Childbirth, 12(1), 163.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Shepherd-Banigan, M., Hohl, S. D., Vaughan, C., Ibarra, G., Carosso, E., & Thompson, B. (2014). “The Promotora Explained Everything”: Participant Experiences During a Household-Level Diabetes Education Program. Diabetes Educator, 40(4), 507–515. doi: 10.1177/0145721714531338.CrossRefPubMedGoogle Scholar
  26. 26.
    Smith-Morris, C., Morales-Campos, D., Alvarez, E. A. C., & Turner, M. (2013). An anthropology of familismo: On narratives and description of Mexican/Immigrants. Hispanic Journal of Behavioral Sciences, 35(1), 35–60.CrossRefGoogle Scholar
  27. 27.
    Tarrant, M., Dodgson, J. E., & Wu, K. M. (2014). Factors contributing to early breast-feeding cessation among Chinese mothers: An exploratory study. Midwifery, 30(10), 1088–1095.CrossRefPubMedGoogle Scholar
  28. 28.
    Taveras, E. M., Capra, A. M., Braveman, P. A., Jensvold, N. G., Escobar, G. J., & Lieu, T. A. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112(1), 108–115.CrossRefPubMedGoogle Scholar
  29. 29.
    Thompson, B., Coronado, G. D., Solomon, C. C., McClerran, D. F., Neuhouser, M. L., & Feng, Z. (2002). Cancer prevention behaviors and socioeconomic status among Hispanics and non-Hispanic whites in a rural population in the United States. Cancer Causes and Control, 13(8), 719–728.CrossRefPubMedGoogle Scholar
  30. 30.
    US Bureau of the Census. (2002). US Census Bureau, detailed tables: Yakima County, Washington. Retrieved May 3, 2003, from
  31. 31.
    US Department of Health and Human Services. (2011). Healthy people 2020. Washington, DC: US Department of Health and Human Services.Google Scholar
  32. 32.
    Victora, C. G., Wagstaff, A., Schellenberg, J. A., Gwatkin, D., Claeson, M., & Habicht, J.-P. (2003). Applying an equity lens to child health and mortality: More of the same is not enough. The Lancet, 362(9379), 233–241.CrossRefGoogle Scholar
  33. 33.
    Waldrop, J. (2013). Exploration of reasons for feeding choices in Hispanic mothers. MCN: The American Journal of Maternal/Child Nursing, 38(5), 282–288.Google Scholar
  34. 34.
    World Health Organization. (2013). Health topics: Breastfeeding. Retrieved February 18, 2015, from

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sarah Hohl
    • 1
  • Beti Thompson
    • 1
    • 2
  • Monica Escareño
    • 3
  • Catherine Duggan
    • 1
  1. 1.Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of Health Services, School of Public HealthUniversity of WashingtonSeattleUSA
  3. 3.Centro Para Promover la Salud ComunitairaFred Hutchinson Cancer Research CenterSunnysideUSA

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