Identifying Barriers and Facilitators to Breastfeeding Initiation in the African American Community

While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are choosing to not exclusively breastfeed their newborn infants. With the highest rates of infant mortality, premature birth, low birth weight and very low birth weight; African American infants can benefit greatly from an increase in breastfeeding initiation and continuation. The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. The specific aims were: 1) to describe and analyze the process African American women undergo when deciding on an infant feeding method; 2) to describe the barriers and facilitators encountered during this decision making process as it unfolds over time from antepartum through birth and the early postpartum period; 3) to understand the role social support persons, specifically grandmothers and parenting partners of the babies play in the decision making process. Participants were recruited from public health programs and community based organizations in the Bay Area. Twenty two participants were enrolled; 14 pregnant women and eight support persons. Data were collected through field observations and multiple in-person interviews. A total of 43 audio-recorded interviews were completed from March 2013 to June 2014. Participants were able to describe the benefits of breastfeeding. Most participants noted an intention to exclusively breastfeed during the antepartum period and expressed guilt for not being able to exclusively breastfeed during the postpartum period. Combination feeding (the use of both breast milk and formula feeding) was a common occurrence and the use of social media for social and educational support was frequently noted. Life experiences (e.g. challenging family dynamics and difficulty with latch), public health programs (home visitors), and changes to the family dynamic (lack of support) played a significant role in the infant feeding decision making process. These data suggest that while exclusivity goals are not being met; African American women are breastfeeding. Future interventions geared towards this population should include social media, messaging around combination feeding and increased education for identified social support persons