Indiana University-Purdue University Indianapolis (IUPUI) / Despite clinical recommendations, only 25.8% of infants in the United States are exclusively breastfed at 6 months of age. Breastfeeding policies and communication campaigns exist to support exclusive breastfeeding, and women who use formula report facing stigma and feeling like a failure. Narratives can be used to discern how individuals make sense of experiences related to health, and narrative theorizing in health communication provides a framework of problematics used to explain how individuals construct stories that reveal the tensions between continuity and disruption and creativity and constraint. Individual experiences are often influenced by master narratives such as “Breast is best,” which are phrases that shape our understanding of the world. Because of the negative impact of using formula on maternal well-being, the purpose of this research was to use a narrative framework to analyze the stories of women who used formula in relation to the master narrative of breast is best. Building off of pilot interviews with 22 mothers, semi-structured interviews were conducted with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women perceived formula as shameful and costly. Conversely, they viewed breastfeeding as biologically superior, better for bonding, and a way to enact good motherhood. Current messaging about breastfeeding, particularly for women who intend to breastfeed, may have unintended negative effects when women face a disruption to their breastfeeding journey. In addition, women viewed breastfeeding and formula feeding as in relation to and in opposition to one another, reducing the perceived acceptability of behaviors such as combination feeding. Despite constraints in the master narrative regarding acceptable infant feeding practices, women demonstrated creativity in their individual stories and found formula feeding enabled more equitable parenting and preserved mental health. Practical implications include that organizations promoting exclusive breastfeeding in the United States should move away from framing breastfeeding as an all-or-nothing choice and develop tailored and value-neutral messaging recognizing breastfeeding as a complex psychosocial and biological process.

Today breastfeeding is a common conversation with the ever-growing holistic movement and the effort to 'go green' as demonstrated by the proliferation of the organic food industry in recent years within the United States. Breastfeeding may reduce poor health outcomes including infant morbidity and mortality. Infant mortality is a priority in Tarrant County within southeast Fort Worth as defined by this project’s client Healthy Moms – Healthy Babies – Healthy Community. The purpose of this research was to identify the contextual factors that influence breastfeeding decisions among the zip codes in southeast Fort Worth in which infant mortality is greatest. In analysis of the data among breastfeeding mothers and stakeholders, support was the greatest contribution to successful breastfeeding.

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published_or_final_version / Nursing Studies / Master / Master of Nursing

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The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern. / Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.

<p>Syftet med denna studie var att beskriva kvinnors upplevelser av amning och metoden som användes i litteraturstudien var deskriptiv. Upplevelserna i 17 studier kategoriserades i fem grupper; förutsättningar, motstridiga råd, svårigheter, positiva erfarenheter och samhällssyn. Att få motstridiga råd från sjukvården var den upplevelse som beskrevs oftast och de olika känslomässiga svårigheter kvinnorna upplevde i samband med amningen var en annan tydlig upplevelse. Kvinnorna upplevde också att de hade bristfällig kunskap om amning och dess fördelar. Amning sågs som något naturligt men förväntningarna stämde inte överens med upplevelsen. Kvinnorna använde sig av olika strategier för att lyckas med amningen och många ansåg att amning är viktigt för barnet och de trivdes med att amma. I Sverige och i Västvärlden vill man främja amning pga. dess hälsomässiga och känslomässiga betydelse för mamma och barn. Amning är dock ett sammansatt fenomen som kräver en helhetssyn och framtida forskning bör sträva efter att öka förståelsen för ammande kvinnors situation för att rätt bemöta dessa kvinnor i vården. Kvinnor behöver få ökad kunskap för att upplevelserna ska överensstämma med förväntningarna. Sjukvården bör ge enhetliga råd och adekvat stöd, och även skapa medvetenhet om hur attityder påverkar amningspraktiken.</p>

Syftet med denna studie var att beskriva kvinnors upplevelser av amning och metoden som användes i litteraturstudien var deskriptiv. Upplevelserna i 17 studier kategoriserades i fem grupper; förutsättningar, motstridiga råd, svårigheter, positiva erfarenheter och samhällssyn. Att få motstridiga råd från sjukvården var den upplevelse som beskrevs oftast och de olika känslomässiga svårigheter kvinnorna upplevde i samband med amningen var en annan tydlig upplevelse. Kvinnorna upplevde också att de hade bristfällig kunskap om amning och dess fördelar. Amning sågs som något naturligt men förväntningarna stämde inte överens med upplevelsen. Kvinnorna använde sig av olika strategier för att lyckas med amningen och många ansåg att amning är viktigt för barnet och de trivdes med att amma. I Sverige och i Västvärlden vill man främja amning pga. dess hälsomässiga och känslomässiga betydelse för mamma och barn. Amning är dock ett sammansatt fenomen som kräver en helhetssyn och framtida forskning bör sträva efter att öka förståelsen för ammande kvinnors situation för att rätt bemöta dessa kvinnor i vården. Kvinnor behöver få ökad kunskap för att upplevelserna ska överensstämma med förväntningarna. Sjukvården bör ge enhetliga råd och adekvat stöd, och även skapa medvetenhet om hur attityder påverkar amningspraktiken.