The United States has established breastfeeding as an important health indicator within the Healthy People agenda. Healthy People target goals for breastfeeding initiation, duration, and exclusivity remain unmet. The US Surgeon General's Office reports that lack of knowledge and widespread misinformation about breastfeeding are barriers to meeting Healthy People goals. Breastfeeding mothers are vulnerable to messages that cast doubt on their ability to breastfeed. Very little research has examined specific approaches to help people resist negative messages about health beliefs and behaviors. The objective of this quasi-experimental study was to test an intervention designed to help mothers defend their breastfeeding decisions and resist influences that attempted to persuade them to give formula to their babies. Women attending prenatal breastfeeding classes were recruited and assigned to comparison and intervention groups. The intervention was a board game based on McGuire's inoculation theory of resistance to influence. Controlling for intention to breastfed, intervention and comparison groups were examined for differences in maternal self-efficacy to resist persuasion to give formula and breastfeeding rates for initiation, duration, and exclusivity. Data analyses consisted of analysis of covariance and logistic regression. There was no significant difference between comparison and intervention groups, both groups had high self-efficacy to resist giving formula to their babies; nor were there significant differences regarding breastfeeding initiation, duration and exclusivity. The lack of significant differences may have been influenced by ceiling effects in all of the breastfeeding variables, possibly due to the high socioeconomic level of the sample. The intervention may have worked better in women who were more prone to dissuasive influence, such as those with lower education.

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No / The objective of this study was to design, implement and evaluate an intervention based on the theory of planned behaviour (TPB) to enhance young peoples' motivations to breastfeed/support a partner to breastfeed. Six semi-structured focus groups were first conducted with 48 13–14-year-olds from two schools in Northern Ireland. The salient beliefs elicited were subsequently used to design a TPB-based questionnaire that was then administered to 2021 13–14-year-old pupils (852 males; 1169 females) from 36 post-primary schools to identify the most important determinants of breastfeeding. The results were used to inform the design and implementation of an intervention package that was subsequently evaluated using a cluster randomised controlled trial involving 44 randomly selected schools across Northern Ireland. Questionnaires were administered to 18 intervention and 26 control schools at baseline and again at 1 and 6 months post-intervention to evaluate its effectiveness. Multi-level modelling was employed to analyse the data. The results revealed significant effects on women's intention to breastfeed, β = 0.208, t(1275) = 2.715, P = 0.007; attitudes, β = 0.223, t(1275) = 4.655, P < 0.001; moral attitudes, β = 0.231, t(1275) = 4.211, P < 0.001; subjective norm, β = 0.118, t(1275) = 2.521, P = 0.012; and knowledge, β = 0.109, d.f. (1275) = 7.843, P < 0.001. However, for men, the results revealed significant effects on only the construct of knowledge, β = 0.104, t(541) = 4.345, P < 0.001.The research has provided evidence to support the need for breastfeeding education in schools and has shown how a theoretical framework may be used to inform the design and evaluation of a health behaviour intervention. / Research and Development Office of Northern Ireland: Northern Ireland Research and Development Office. Grant Number: RSG/2584/03RRG3.33

Research has long shown that breastfeeding provides many concrete health benefits for both mothers and infants that other forms of infant feeding do not. As such, unsurprisingly, breastfeeding has been deemed the preferred infant feeding method by the national and global medical communities and widespread initiatives promoting breastfeeding have followed. However, despite being well-intentioned, messaging around breastfeeding has left some people who cannot or choose to not breastfeed feeling othered and inadequate. While the health benefits of breastfeeding should not be understated, there are other experiences and perspectives that deserve to be in the conversation when thinking about breastfeeding and breastfeeding promotion. This thesis seeks to analyze breastfeeding and breastfeeding promotion from a bioethical perspective, providing an alternative lens through which to think critically about the way breastfeeding recommendations and initiatives are impacting real people. In this thesis, I will discuss the history of breastfeeding in the United States, why breastfeeding has come to be the gold standard of infant feeding, and real-life experiences of breastfeeding. I will also analyze breastfeeding, breastfeeding messaging, and current breastfeeding initiatives through the four principles of bioethics: beneficence, maleficence, autonomy, and justice. Lastly, I will offer my view and recommendations on how to incorporate bioethical perspectives into breastfeeding promotional strategies to create a more effective, inclusive, and supportive breastfeeding culture at the individual, community, and national level. / Urban Bioethics

Effective educational efforts require knowledgeable health professionals to promote breastfeeding and instigate changes in individual behavior. This research was conducted to assess breastfeeding knowledge, and attitudes, beliefs, and intentions among students and professionals in health-related fields. A 5-year prospective study was conducted to investigate breastfeeding knowledge, and attitudes, beliefs, and intentions regarding breastfeeding in the workplace among nutrition students (n=69) while in school and later while in the workplace. A 47-item questionnaire was mailed to participants to survey knowledge, and attitudes, beliefs, and intentions related to breastfeeding in the workplace along with demographic information. From baseline to follow-up, nutrition students had a significant increase in breastfeeding knowledge (P<0.001), and change in attitudes (P<0.01) and change in intentions (P<0.02) regarding breastfeeding in the workplace. Sources of breastfeeding information were predictors of attitudes and intentions regarding breastfeeding in the workplace. In a separate study, a cross-sectional comparison of nutrition students (n=270) and non-nutrition students (n=271) at Virginia Tech demonstrated that nutrition students had significantly higher scores on breastfeeding knowledge, and attitudes, beliefs, and intentions regarding breastfeeding in the workplace scales (all P<0.001) compared to non-nutrition students. The 47-item questionnaire was also used in this investigation with junior, senior, and graduate students enrolled at Virginia Tech in spring of 20004. In both nutrition and non-nutrition students, attitudes and beliefs were significant predictors (both P<0.001) of intentions regarding breastfeeding in the workplace. In a final study, a cross-sectional evaluation of the Caribbean Association of Home Economics (CAHE) (n=71) revealed that respondents had mean (&#177;SD) scores of 5.76 + 1.34 for breastfeeding knowledge, 3.67 + 0.50 for attitudes, and 4.23 + 0.68 for beliefs related to breastfeeding in the workplace. Based on the 35-item survey, attitudes regarding breastfeeding in the workplace were positive predictors of beliefs (P<0.001). Overall, nutrition students, nutrition graduates, and CAHE members are knowledgeable about breastfeeding and possess positive attitudes and intentions regarding breastfeeding in the workplace. Attitudes regarding breastfeeding in the workplace are critical to intended behaviors. Nutrition program graduates may be effective educators of and advocates for breastfeeding and for breaking barriers to breastfeeding in the workplace. / Ph. D.

The Lactation Support Program at Virginia Tech, renamed the Nursing Mom's Support Program, was established  in 1999 when a group of women through the Women's Center and Work/Life Resources publicized a private concern about expressing milk.  While the basic goal was to create a universal opportunity for women seeking to express milk during the workday, university administrators also saw the program as a way to advance the progressive goals of the university and increase the recruitment of competitive faculty and students.  Lack of awareness about the program and struggles of women today reflect the original abandonment of an education component that would have maintained a collective conversation about the needs of working women, mothers, and caregivers in general.   Even though many of the women in this study did not use the spaces, or were unaware of their existence, most participants felt that the program represented a significant success for the university and stated that they felt supported because of the mere existence of these spaces. Viewed in this manner, it is possible to see how the production of space and its symbolic value masks over any residual injustices and replaces concerns about milk expression on the individual.  Yet, the permeable nature of lactation (scheduling, cleaning pump parts, storing milk, etc.) means that the women expressing milk will always be visible.  This visibility creates an opportunity to continue to address milk expression as a public concern and shift social expectations of what it means to be a worker. / Master of Science

Submitted in full compliance with the requirements for a Master’s Degree in Technology: Nursing, Department of Community Health Studies at the Durban University of Technology, 2009. / Purpose: Breastfeeding is a key child survival strategy important for the long-term health of both the mother and child. The number of women in paid employment has increased exponentially, yet very few of these women continue breastfeeding as recommended by the World Health Organisation. The purpose of this qualitative study was to identify the factors affecting breastfeeding practices in the workplace. Objectives of the study are to: 1: Describe managers’ attitudes to and knowledge about providing breastfeeding support. 2: Identify mothers’ attitudes towards breastfeeding and the workplace environment. 3: Describe the practices of the breastfeeding mothers in the workplace. 4: Identify factors that influence breastfeeding practices within the workplace environment Method The theoretical frameworks adopted were the Situation- Specific Theory of Breastfeeding and the BASNEF model. The frameworks together with the literature review provided the background which informed this study. The research was a case study of two multi -national companies in Durban, KwaZulu Natal; participants were mothers and managers in the companies. Purposive sampling was used for selecting eight women who participated in the focus groups, two follow up interviews were conducted and five managers were interviewed. Data collection techniques also included a reflexive journal and field observation. After a thorough review of the data, the main themes which emerged were used to guide the discussion and answer the objectives of the study. Results The two companies reflected a scenario of pressures in the workplace environment affecting women’s choices regarding combining work and breastfeeding; societal pressures were dictating acceptable behaviour. Breastfeeding was not a priority for employers, no breastfeeding policy existed. Breastfeeding mothers were isolated and employers and employees were not engaging on the issue. Conclusions and Recommendations Simple enabling factors within the workplace would allow mothers, their infants and employers to enjoy the benefits of supporting breastfeeding in the workplace; this would be a win-win situation. Government, non-governmental organisations and society have a responsibility to overtly protect, support and promote breastfeeding in society and in the workplace.

The benefits of breastfeeding for mother and baby are well established; however, only 37.5% of Scottish women are currently breastfeeding at six to eight weeks with less than 1% breastfeeding exclusively for six months, as recommended by UK and international health policy. Family influence is amongst the socio-demographic factors which affect breastfeeding initiation and duration and women who were not breastfed themselves are 25% less likely to initiate breastfeeding. While there is a growing body of literature which seeks to understand breastfeeding by exploring the perspectives of breastfeeding mothers, no studies can be found describing the experience of making a different feeding choice from that of one’s family-of-origin, nor of the potential impact of this decision on relationships with them. As such, this study exploring the experience of being the first in your family to breastfeed is novel. The aim of the study was to investigate the experience and meaning of being the first person to breastfeed in a family. Consequently, areas explored included women’s experience of initiating and sustaining breastfeeding when they have no immediate family history of breastfeeding, how women make sense of their decision to breastfeed and their understanding of how their decision has affected their relationships. A methodological development in the form of an Infant Feeding Genogram was used to record relevant demographic and family information and semi-structured interviews with fourteen women obtained in-depth narratives. Interpretative phenomenological analysis (IPA) was used as an approach and to analyse the data. Following the completion of idiographic analysis, cross participant analysis was undertaken and four superordinate themes emerged: Breaching Family and Social Norms; Volitions and Imperatives; Unprepared for the Challenge; and A Sacrifice but Worth It. Within these superordinate themes, 13 themes were identified and articulated. Findings from this research were synthesised to provide an account of how women experience being the first to breastfeed in a family, make sense of their decisions and the impact this has on their relationships with their family. This provides an understanding of women’s experience in an original context, and the contextualising within the existing literature generates commonalities and highlights differences between the experience of this group of breastfeeding women and the wider cohort. The findings of this research inform recommendations for practice at both an individual and public health levels, and have implications for policy makers, health professionals and breastfeeding support organisations. It is asserted that policy makers and the health service need to acknowledge the unanticipated consequences of some current breastfeeding discourses associated with health promotion practices, and take a mother and family focussed approach to breastfeeding that acknowledges women’s embodied experience, which often includes breastfeeding difficulties. A mother and family centred approach can identify and adapt to women’s support needs in their own particular context, which may include very limited community and family support for their decision.

Bröstmjölk är en komplett näringskälla för det nyfödda barnet. Förutom att tillföra barnet alla näringsämnen hen behöver så ger bröstmjölken energi, bygger upp kroppen samt skyddar det nyfödda barnet mot sjukdomar. Amning är ett samspel mellan mamma och barn som påverkas av många faktorer. För en tvillingmamma är initiering av amning en större utmaning än för en mamma som fött ett barn, då omvårdnaden kring barnen blir dubbel. Syftet med studien var att beskriva tvillingmammors erfarenhet av amningsstöd, dels från vårdpersonal, dels från sociala medier, för att initiera och upprätthålla en fungerande amning. Studien är en intervjustudie med kvalitativ metod. Datamaterial samlades in genom intervjuer av sex utvalda tvillingmammor. Mammorna söktes och valdes ut via en Facebookgrupp. I resultatet framkom två kategorier: Mammans initiativ och Vårdpersonalens engagemang. Resultatet tyder på att de intervjuade mammornas erfarenhet är att vårdpersonal idag saknar den specifika kunskapen om/och förståelse för hur mycket arbete det innebär för en tvillingmamma att få amningen att fungera. Många mammor söker idag den information de inte erhållit via vårdpersonal på annat sätt, oftast via sociala medier. Utifrån den här studien kan vårdpersonal få en ökad förståelse för tvillingmammors behov av extra amningsstöd och information. / Breast milk is a complete food source for the newborn. In addition to supplying the baby all the nutrients it needs breast milk also provides energy, builds up the body and protects the newborn against disease. Breastfeeding is an interaction between mother and child that is affected by many factors. For a twin mother is initiation of breastfeeding more of a challenge than for a mother who gave birth to a child, then care about the children becomes twice.The purpose of this study was to describe the mother of twin´s experience of breastfeeding support, both from health professionals as well as from social media, to initiate and maintain a functional breastfeeding. The study is an interview study of qualitative method. Data material was collected through interviews with six selected twin mothers. The informants were sought and selected through a Facebook group. The results revealed two categories: The mother's initiative and The involvement of health professionals. The result indicates that the interviewed mothers experience is that health professionals today lack the specific knowledge and understanding of how much work it means for a twin mother to get a functional breastfeeding. Many mothers today are using other sources in seeking the information they did not receive by health professionals, mostly through social media. Based on this study, health professionals might gain a greater understanding of the need twin mothers have for more support and information regarding breast feeding twins.