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Ecological Factors Influencing Breastfeeding Decisions among Korean Immigrant Mothers in America

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Abstract

There are complex relationships among individual, family, community, and social factors related to breastfeeding. Immigrant mothers, specifically, face several unique challenges to practicing breastfeeding while negotiating these factors within two cultural worlds. Grounded in the theory of planned behavior and the ecological perspective, our qualitative study findings unveil a part of the complex and dynamic process of breastfeeding decision-making among Korean immigrant mothers in the United States. To elicit mothers’ underlying beliefs of attitude and intention toward breastfeeding as immigrants, we conducted in-person interviews with 13 pregnant and postpartum Korean immigrant mothers, ages ranging from 30 to 39. The findings revealed that Korean mothers held positive attitudes toward breastfeeding. However, translation of these positive attitudes toward breastfeeding into actual practice depended on the feasibility of actual breastfeeding by mothers. To overcome several barriers to breastfeeding, such as inadequate milk supply, health concerns, employment status, and the relationship with a firstborn child, many Korean mothers combined breastfeeding with formula feeding. The factors that shaped the development of beliefs and behavioral intentions toward breastfeeding among Korean immigrant mothers included the dynamic family interactions with their children, husbands, mothers, mothers-in-law, and sisters; support from friends and infant care experts; information available through various technology and media; and Korean-specific cultural traditions. Our findings suggest possible directions for future cross-cultural research on breastfeeding within diverse family contexts, and may inform the design of population specific intervention programs.

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References

  • Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211. https://doi.org/10.1016/0749-5978(91)90020-t.

    Article  Google Scholar 

  • Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Upper Saddle Rivers, NJ: Prentice-Hall Inc.

    Google Scholar 

  • Aksu, H., Küçük, M., & Düzgün, G. (2011). The effect of postnatal breastfeeding education/support offered at home 3 days after delivery on breastfeeding duration and knowledge: A randomized trial. Journal of Maternal-Fetal and Neonatal Medicine, 24, 354–361. https://doi.org/10.3109/14767058.2010.497569. Epub2010 Jul 7.

    Article  PubMed  Google Scholar 

  • American Dietetic Association. (2009). Position of the American Dietetic Association: Promoting and supporting breastfeeding. Journal of American Dietetic Association, 109, 1926–1942.

    Article  Google Scholar 

  • Andrews, T., & Knaak, S. (2013). Medicalized mothering: Experiences with breastfeeding in Canada and Norway. The Sociological Review, 61, 88–110. https://doi.org/10.1111/1467-954X.12006.

    Article  Google Scholar 

  • Bai, Y., Middlestadt, S. E., Peng, C. Y. J., & Fly, A. D. (2009). Psychosocial factors underlying the mother’s decision to continue exclusive breastfeeding for six months: An elicitation study. Journal of Human Nutrition and Dietetics, 22, 134–140. https://doi.org/10.1111/j.1365-277X.2009.00950.x.

    Article  PubMed  Google Scholar 

  • Bai, Y., Middlestadt, S. E., Peng, C. Y. J., & Fly, A. D. (2010). Predictors of continuation of exclusive breastfeeding for the first six months of life. Journal of Human Lactation, 26, 26–34. https://doi.org/10.1177/0890334409350168.

    Article  PubMed  Google Scholar 

  • Bai, Y., Wunderlich, S. M., & Fly, A. D. (2011). Predicting intentions to continue exclusive breastfeeding for six months: A comparison among racial/ethnic groups. Maternal and Child Health Journal, 15, 1257–1264. https://doi.org/10.1007/s10995-010-0703-7.

    Article  PubMed  Google Scholar 

  • Behling, O., & Law, K. S. (2000). Translating questionnaires and other research instruments: Problems and solutions. Thousand Oaks, CA: Sage.

    Book  Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design.. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Callister, L. C. (2001). Culturally competence care of women and newborns: Knowledge, attitudes, and skills. Journal of Obstetric, Gynecologic and Neonatal Nursing, 30, 209–215. https://doi.org/10.1111/j.1552-6909.2001.tb01537.x.

    Article  Google Scholar 

  • Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage.

    Google Scholar 

  • Chen, W.-L. (2010). Understanding the cultural context of Chinese mothers’ perceptions of breastfeeding and infant health in Canada. Journal of Clinical Nursing, 19, 1021–1029. https://doi.org/10.1111/j.1365-2702.2009.02956.x.

    Article  PubMed  Google Scholar 

  • Chibucos, T. R., Leite, R. W., & Weis, D. L. (2005). Readings in family theory. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Choices in Child Birth. (2016). Overdue: Medicaid and private insurance coverage of doula care to strengthen maternal and infant health. 2016 Issue Brief. http://transform.childbirthconnection.org/wp-content/uploads/2016/01/Insurance-Coverage-of-Doula-Care-Brief.pdf.

  • Chung, H., Korean Family Studies Association. (2011). The early years of marriage. Korean families: Continuity and change (pp. 331–353). Seoul, Korea: Seoul National University Press.

    Google Scholar 

  • Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five traditions. 2nd edn. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Cross-Barnet, C., Augustyn, M., Gross, S., Resnik, A., & Paige, D. (2012). Long-term breastfeeding support: Failing mothers in need. Maternal and Child Health Journal, 16, 1926–1932. https://doi.org/10.1007/s10995-011-0939-x.

    Article  PubMed  Google Scholar 

  • Grassley, J., & Eschiti, V. (2008). Grandmother breastfeeding support: What do mothers need and want? BIRTH, 35, 329–335. https://doi.org/10.1111/j.1523-536X.2008.00260.x.

    Article  PubMed  Google Scholar 

  • Guyer, J., Millward, L. J., & Berger, I. (2012). Mothers’ breastfeeding experiences and implications for professionals. British Journal of Midwifery, 20, 724–733. https://doi.org/10.12968/bjom.2012.20.10.724.

    Article  Google Scholar 

  • Hoeffel, E. M., Rastogi, S., Kim, M. O., & Shahid, H. (2012, March). The Asian population: 2010. 2010 Census Briefs (C2010BR-11). http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf.

  • Humes, B. R., Jones, N. A., & Ramirez, R. R. (2011, March). Overview of race and Hispanic origin. 2010 Census Briefs (C2010BR-02). http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf.

  • Jang, J., Lee, S., Sung, M., & Lee, J. (2016). Family relationships and communication in South Korea. In G. Jian & G. Ray (Eds.), Relationships& communication in East Asian Cultures: China, Japan and South Korea (pp. 165–196). Dubuque, IA: Kendall Hunt Publishing Company.

    Google Scholar 

  • Jeong, I. S., Lee, S. J., Jeong, J. S., Yoon, S. W., Jeong, S. Y., Ha, J., & Song, J. Y., et al. (2013). Development of infection control guideline for postpartum care centers. Korean Journal of Nosocomial Infect Control, 18, 57–88.

    Article  Google Scholar 

  • Kim, S., Cho, A., Kim, Y., Do, S., & Lee, K. (2006). The 2006 national survey on fertility, family health and welfare in Korea (Research Report # 2006-24). https://www.kihasa.re.kr/html/jsp/publication/research/view.jsp?bid=12&ano=202.

  • Kim, S., & Yoon, J. W. (2012). The use of an online forum for health information by married Korean women in the United States. Information Research, 17. http://www.informationr.net/ir/17-2/paper514.html.

  • 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, 183–199.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kozhimannil, K. B., & Hardeman, R. R. (2016). Coverage for doula services: How state Medicaid programs can address concerns about maternity care costs and quality. BRITH, 43, 97–99. https://doi.org/10.1111/birt.12213.

    Google Scholar 

  • Lee, J., & Bauer, J. W. (2013). Motivations for providing and utilizing child care by grandmothers in South Korea. Journal of Marriage and Family, 75, 381–402. https://doi.org/10.1111/jomf.12014.

    Article  Google Scholar 

  • Lee, S., & Keith, P. M. (1999). The transition to motherhood of Korean women. Journal of Comparative Family Studies, 30, 453–470.

    Google Scholar 

  • Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage Publications.

    Google Scholar 

  • McInnes, R. J., Hoddinott, P., Britten, J., Darwent, K., & Craig, L. C. A. (2013). Significant others, situations and infant feeding behavior change processes: A serial qualitative interview study. BMC Pregnancy and Child Birth, 13, 114–126. http://www.biomedcentral.com/1471-2393/13/114.

    Article  Google Scholar 

  • Mendlinger, S., & Cwikel, J. (2006). Health behaviors over the life cycle among mothers and daughters from Ethiopia. Nashim: A Journal of Jewish Women’s Studies & Gender Issues, 12, 57–94.

    Google Scholar 

  • Ministry of Health & Welfare. (2014). The Mother and Child Health Law. http://www.law.go.kr/DRF/lawService.do?OC=lrzh&target=law&MST=142601&type=HTML&mobileYn=&efYd=20140807.

  • Nommsen-Rivers, L. A., Mastergeorge, A. M., Hansen, R. L., Cullum, A. S., & Dewey, K. G. (2009). Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae. Journal of Obstetrics, Gynecological, Neonatal, and Nursing, 38, 157–173.

    Article  Google Scholar 

  • Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Perkins, D. F., Ferrari, T. M., Covey, M. A., & Keith, J. G.(1996). Getting dinosaurs to dance: Community collaborations as applications of ecological theory. In C. B. Simerly, H. Light & D. I. Mitstifer (Eds.), A book of readings: The context for professionals in human, family, and consumer sciences (pp. 31–39). Alexandria, VA: American Association of Family and Consumer Sciences.

    Google Scholar 

  • Rivis, A., & Sheeran, P. (2003). Descriptive norms as an additional predictor in the theory of planned behavior: A meta-analysis. Current Psychology: Developmental, Learning, Personality, Social, 22, 218–233.

    Article  Google Scholar 

  • Scanlon, K. S., Grummer-Strawn, L., Li, R., Chen, J., Molinari, N., & Perrine, C. G. (2010). Racial and ethnic differences in breastfeeding initiation and duration, by state: National immunization survey, United States, 2004-2008. Morbidity and Mortality Weekly Report, 59, 327–334.

    Google Scholar 

  • Song, J.-E., & Park, B.-L. (2010). The changing pattern of physical and psychological health, and maternal adjustment between primiparas who used and those who did not use Sanhujofi facilities. Journal of Korean Academy of Nursing, 40, 503–514. https://doi.org/10.4040/kjan.2010.40.4.503.

    Article  PubMed  Google Scholar 

  • Statistics Korea. (2013). Postpartum care places. http://kosis.kr/statHtml/statHtml.do?orgId=117&tblId=TX_117_2009_H8211&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1&path=.

  • Statistics Korea, & Ministry of Gender Equality and Family. (2015). Statistical report on women’s lives. http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=346959.

  • Stearns, C. A. (2011). Cautionary tales about extended breastfeeding and weaning. Health Care for Women International, 32, 538–554. https://doi.org/10.1080/07399332.2010.540051.

    Article  PubMed  Google Scholar 

  • Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Taylor, E. N., & Wallace, L. E. (2012). For shame: Feminism, breastfeeding advocacy, and maternal guild. Hypatia, 27, 76–98. https://doi.org/10.1111/j.1527-2001.2011.01238.x.

    Article  Google Scholar 

  • Textor, L., Tiedje, K., & Yawn, B. (2013). Mexican and Somali immigrant breastfeeding initiation and counseling: A qualitative study of practices. Minnesota Medicine, 96, 46–50.

    PubMed  Google Scholar 

  • Topa, G., & Moriano, J. A. (2010). Theory of planned behavior and smoking: Meta-analysis and SEM model. Substance Abuse and Rehabilitation, 1, 23–33. https://doi.org/10.2147/SAR.S1516.

    Article  PubMed  PubMed Central  Google Scholar 

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Author Contributions

S.Y.L.: designed and executed the study, analyzed the data, and wrote the paper. Y.K.B.: designed and executed the study, analyzed the data, wrote a part of the theory section and collaborated in the writing and editing of the paper. S.B.Y.: assisted with the data analyses, and collaborated in the writing and editing of the paper.

Funding

This study was partially funded by a Separately Budgeted Research Award and Summer Grant Proposal Development Award from Montclair State University.

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Authors and Affiliations

  1. Department of Family Science and Human Development, Montclair State University, 4038 University Hall, Montclair, NJ, 07043, USA

    Soyoung Lee

  2. Department of Nutrition and Food Studies, Montclair State University, 2153 University Hall, Montclair, NJ, 07043, USA

    Yeon K. Bai

  3. Department of Family Science and Human Development, Montclair State University, 4144 University Hall, Montclair, NJ, 07043, USA

    Soo-Bin You

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  1. Soyoung Lee
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Correspondence to Soyoung Lee.

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The authors declare that they have no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at Montclair State University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lee, S., Bai, Y.K. & You, SB. Ecological Factors Influencing Breastfeeding Decisions among Korean Immigrant Mothers in America. J Child Fam Stud 27, 928–943 (2018). https://doi.org/10.1007/s10826-017-0927-x

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