Breastfeeding is Natural but Not the Cultural Norm: A Mixed-Methods Study of First-Time Breastfeeding, African American Mothers Participating in WIC

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Objective Identify facilitators, barriers, and needs to increase breastfeeding (BF) support. Design Semistructured interviews based on the Theory of Planned Behavior, Iowa Infant Feeding Attitude Scale, and Breastfeeding Self-Efficacy Scale–Short Form to measure attitudes and self-efficacy, respectively. Setting One WIC clinic in central Illinois. Participants First-time BF African American mothers enrolled in WIC (n = 15). Phenomenon of Interest BF facilitators and barriers in the African American community. Analysis Descriptive coding and inductive thematic analysis. Results Six themes emerged: normative infant feeding behavior within the sociocultural context; cultural beliefs about maternal nutrition and BF; time and costs associated with BF; managing and integrating BF while maintaining a social life; necessity of social support from significant others and female role models; and suboptimal support from institutions (hospitals, schools, workplace, and community). A novel finding was that participants believed that BF was expensive, because they believed that mothers must eat healthy to breastfeed. In addition, BF was considered natural but not the cultural norm. Mean Iowa Infant Feeding Attitude Scale score (n = 15) was 70 (SD = 7), indicating a positive attitude toward BF. Breastfeeding Self-Efficacy Scale–Short Form mean score of 62 indicated a relatively high level of self-efficacy. Conclusions and Implications Interventions should focus on providing social support (emotional, tangible, informational, and encouragement) to African American mothers and their social networks to promote a BF-friendly environment.

Original languageEnglish (US)
Pages (from-to)S151-S161.e1
JournalJournal of Nutrition Education and Behavior
Issue number7
StatePublished - Jul 2017


  • African American
  • WIC
  • breastfeeding
  • mixed methods

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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