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GENERAL PRACTICE: Pat Hoddinott and Roisin Pill Qualitative study of decisions about infant feeding among women in east end of London BMJ 1999; 318: 30-34 [Abstract] [Full text]

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Embarrassment with breast feeding: Whose problem is it?

Jane A Scott   (6 January 1999)

Breastfeeding

Brian O Suilleabhain   (30 January 1999)

Embarrassment with breast feeding: Whose problem is it? 6 January 1999
Jane A Scott, Project Manager PFK Edinburgh Ltd. Institute of Medical Research Send response to journal: Re: Embarrassment with breast feeding: Whose problem is it?	Breast feeding rates in Australia are considerably higher than those in the UK, with over 80% of women initiating breast feeding and up to 50% continuing to at least partially breast feed at 6 months (1). Nevertheless the rates are still lower than recommended national targets. A qualitative study conducted in Perth, Australia, of attitudes to breast feeding, in particular breast feeding in public (2), reinforces some of the findings of Hoddinott and Pill. In the Perth study a series of focus groups involving separate groups of mothers, fathers, adolescent girls and male university students were conducted. A number of distinct themes emerged from the analysis. Firstly, breast feeding in public was seen by parents of young children as being routine, necessary and often unavoidable. As in the UK study, with the exception of adolescent girls, there was a general acceptance of breast feeding in public as long as it was performed discreetly, that is, with a minimum of breast showing. Overt public displays of breast feeding were not considered acceptable by any of the groups. Male students and adolescent girls expressed embarrassment when they witnessed women breast feeding. However, male students indicated that they were less embarrassed if the woman first asked their permission to breast feed in front of them, or at least acknowledged that she was going to breast feed in front of them. We dubbed this theme ‘breast feeding etiquette’. As in the UK study, the theme of the sexual versus the functional role of the breast was explored and most male students and adolescent girls agreed that their embarrassment at witnessing breast feeding stemmed from the sexual role of the breast. The findings of the Perth study suggest that if breast feeding is to become both socially desirable and acceptable, that initiatives to promote breast feeding should be targeted at teenage students. It is this group, in Australia, that experience embarrassment and awkwardness when witnessing a woman breast feed. They are inclined to think that a woman should isolate themselves rather than breast feed in public. This attitude, if carried into adult years, may result in the early discontinuation of breast feeding. 1. Scott JA, Binns CW, Aroni RA. The influence of reported paternal attitudes on the decision to breast-feed. J Paediatr. Child Health. 1997;33:305-7. 2. Scott JA, Binns CW, Arnold RV. Attitudes toward breastfeeding in Perth, Australia: Qualitative analysis. J Nutr Educ. 1997;29: 244-9.
Breastfeeding 30 January 1999
Brian O Suilleabhain Send response to journal: Re: Breastfeeding	Editor - The study findings of Hoddinott et al (1) demonstrate some of the barriers to the more widespread practice of breastfeeding particularly among women in lower socioeconomic groups. An antenatal apprenticeship to a breastfeeding mother is suggested as a way of instilling confidence and passing some practical knowledge on to women with little direct or indirect experience of breastfeeding in their own lives. I would like to draw attention to a measure that could be more easily implemented and that has been previously validated. This measue involves the establishment of antenatal group classes for women at which discussion is led by a supervisor (usually a midwife) on topics such as benefits and difficulties with breastfeeding, common myths, physiology of lactation and expression of breastmilk. It is essential that the supervisor encourages women to come forward and discuss their own fears and anxieties rather than indulge in didactic lecturing. This technique has been evaluated in a randomised controlled prospective study carried out at Cook County Hospital in Chicago. Initiation rates and rates of sustained breastfeeding were considerably higher in women who had attended the classes compared with those who had received routine antenatal care.In addition the peer support provided in the group classes led to considerably greater duration of breastfeeding in this group compared with another group who received individual counselling sessions antenatally. All of the women entered into the study were black and in a lower socioeconomic group. These classes were not difficult to set up, were well attended in the main and most women were satisfied with how they were run. I appreciate that there is no one simple solution to this complex issue but could the piloting of this suggestion be what one might call a good start? Brian O Suilleabhain Specialist Registrar in Public Health Northumberland Health Authority Morpeth NE 61 2PD