published_or_final_version / Public Health / Master / Master of Public Health

The aim of this study was to examine four women’s experiences of and attitudes towards breastfeeding. In order to achieve this end, the four women were interviewed individually. Breastfeeding is a controversial subject, which is also mirrored by the women and the different advice and recommendation that they meet. Consequently, each woman has to take a stand for what she thinks is suitable regarding her individual situation. Moreover, breastfeeding is embedded in complex historical, political and cultural systems. This becomes obvious in the contemporary principle of breastfeeding on demand, according to which breastfeeding is adapted to the child’s needs. Thus, a majority of the interviewees have difficulties with combining breastfeeding on demand with ideas of gender equality. Due to breastfeeding on demand, the women must also breastfeed in public. In those situations, the women are keen on breastfeeding as discretely as possible. / Syftet med den här uppsatsen är att undersöka fyra kvinnors erfarenheter av och attityder till amning. Av den anledningen blev de fyra kvinnorna individuellt intervjuade. Amning är ett kontroversiellt ämne, som också speglades av kvinnorna och de råd och rekommendationer de möter. Konsekvensen av detta är att varje kvinna måste ta ställning till vad som passar deras individuella situation. Dessutom, amning är inbäddat i ett komplext historiskt, politiskt och kulturellt system. Detta blir tydligt genom den rådande fria amningsprincipen, som innebär att amningen är anpassad efter barnets behov. Majoriteten av kvinnorna har därför svårigheter med att kombinera fri amning med idéer om jämlikhet. På grund av fri amning, måste kvinnorna ibland amma offentligt. I de situationerna är kvinnorna måna om att amma så diskret som möjligt.

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.

African-American women are associated with having the lowest incidence of breast-feeding among ethnic groups. The purpose of this study was to examine attitudes toward infant feeding, feeding intentions, and previous breast-feeding exposure among African-American women. Leininger's Culture Care theory provided the framework. A convenience sample of 98 gravid, adult African-American women receiving care at community health centers was administered a 42-item questionnaire on infant feeding attitudes, intentions, and exposure. Findings indicated that mothers choosing breast-feeding agreed more with the benefits of breast-feeding, and were likely to have previous breastfeeding exposure. Formula feeding mothers agreed more with inconveniences of breast-feeding and advantages of formula feeding, and were more likely not to have had previous exposure. These findings suggest that providing culturally congruent education on the benefits of breast-feeding, information on skills to overcome barriers, and positive breast-feeding exposures could positively effect the incidence of breast-feeding in the African-American population. / School of Nursing

Amning, amningskomplikationer, stöd och råd vid amning är en del av den sexuella och reproduktiva hälsan och ingår i barnmorskans kompetensområde.Det finns mycket forskning som beskriver nyblivna föräldrars upplevelse av amningsstöd men inte lika mycket forskning på hur vårdpersonalen upplever amningsstödet som ges till gravida och nyblivna föräldrar. Syftet med denna studie var att undersöka vårdpersonals upplevelser av amningsstöd till gravida och nyblivna föräldrar.Studien utfördes genom en kvalitativ metod utifrån en induktiv ansats. Data hämtades från intervjuer med semistrukturerade frågor i 11 fokusgrupper. All data bearbetades genom kvalitativ, induktiv innehållsanalys.Resultatet i studien visade att vårdpersonal upplever amningsstödet de ger som en viktig del i deras arbete. Amningsstödet hade brister och en betydande brist uppgavs vara kontinuiteten av amningsstöd genom hela vårdkedjan.Informanterna ansåg att amningsstödet borde förbättras och många förslag nämndes för att främja amningen hos nyblivna föräldrar och barn.Denna studie kan öka medvetenheten av den egna och kollegornas upplevelse av amningsstöd vilket kan leda till ett bättre samarbete mellan enheterna och en bättre kommunikation samt förändringar i organisationen som gynnar och främjar amningen. / Providing support and advice during lactation and breastfeeding complications are parts of the sexual and reproductive health.There are much research that describes new parents' experience of breastfeeding support, but not as much research that describes health professionals´ experiences of breastfeeding support that is given to pregnant and new parents. The purpose of this study was to investigate the health professionals´ experiences of breastfeeding support to pregnant and new parents.The study was conducted through a qualitative method based on an inductive approach.Data was collected from interviews with semi- structured questions in 11 focus groups. All data were processed by qualitative and inductive content analysis.The results of the study showed that healthcare professionals are experiencing breastfeeding support as an important part of their work.Breastfeeding support had flaws and a significant deficiency was reported to be continuity of breastfeeding support throughout the continuum of care.The informants felt that breastfeeding support should be improved and many suggestions were mentioned to promote breastfeeding among new parents and children.This study may highlight work professionals knowledge about their own and co-worker’s experiences of breastfeeding support which could lead to better cooperation and communication between units to promote and support breastfeeding.

Thesis (M.S.)--University of Wyoming, 2009. / Title from PDF title page (viewed on Apr. 16, 2010). Includes bibliographical references (p. 71-75).

Bakgrund: Det naturligaste sättet att ge näring åt ett nyfött barn är genom att amma, vilket inte alltid är enkelt och problemfritt. I Sverige föds ungefär 7000 barn per år som behöver vård på neonatalavdelningar. När ett barn är fött för tidigt kan amning dessutom vara förenat med ytterligare svårigheter. Problematiken som kan uppstå kan bero på att det för tidigt födda barnet är omoget och därför inte har samma förutsättningar som fullgångna barn har för att amma. Mödrar på neonatalavdelningar kan samtidigt uppleva en stress och oro över den nya situationen med att ha fått ett för tidigt fött barn. Vårdpersonal har en viktig roll i att ge det amningsstöd som krävs för att främja amning bland för tidigt födda barn. Syfte: Syftet med studien var att belysa mödrars upplevelser av amningsstöd på neonatalavdelningar. Metod: En intervjustudie med kvalitativ ansats utfördes. Elva intervjuer genomfördes och materialet analyserades med inspiration av Burnards analysmetod för kvalitativa intervjuer.Resultat: Mödrarnas upplevelser av amningsstöd resulterade i fyra kategorier: bemötande, vägledning, kompetens och tillgänglighet, med två tillhörande underkategorier vardera.Slutsats: Mödrarna upplevde att endast ett fåtal av personalgruppen kunde ge amningsstöd. Amningsstöd handlade om både kunskap och erfarenhet, men även om upplevelsen kring samspelet mellan personalen och modern. Samspelet handlade till stor del om personalens bemötande och tillgänglighet. Helheten var betydelsefull för upplevelsen av amningsstöd. / Background: The most natural way to nourish a newborn baby is by breastfeeding, which is not always easy and trouble-free. Each year about 7000 children who need care in neonatal departments are born in Sweden. When a baby is born prematurely breastfeeding may be associated with additional difficulties. The difficulty that may arise may be the premature baby’s immaturity and therefore the conditions are not the same as a full-term baby’s capacity to breastfeed. At the same time, mothers in neonatal departments experience stress and anxiety about the new situation of having a premature baby. Nursing staff have an important role in providing the breastfeeding support needed, to promote breastfeeding among premature babies.Aim: The aim of the study was to highlight mothers’ experiences of breastfeeding support in neonatal departments.Method: An interview study with a qualitative approach has been performed. Eleven interviews where completed and then analyzed with inspiration of Burnards method of analyzing qualitative interviews.Results: The mothers' experiences of breastfeeding support resulted in four categories: encounter, guidance, competence and availability, with two matching subcategories each.Conclusion: The mothers felt that only a few of the nursing staff could provide breastfeeding support. Breastfeeding support was about knowledge and experience, but also about the experience of the interaction between the staff and the mother. The interaction was largely about the staff's encounter and availability. The entirety was important for the experience of breastfeeding support.

Bakgrund: Under en längre tid har man sett sjunkande amningsfrekvens trots flera nationella satsningar för att skydda amningen. Idag vet vi mer om amningens påverkan på kvinnan och barn och därför är det av största vikt att utforska eventuella hinder samt befintliga styrkor som kan påverka amningen i positiv eller negativ riktning. BVCsjuksköterskan står för den senare del av vårdkedjan, där ett stort antal kvinnor väljer att avbryta initierad amning av en eller annan anledning, och har därmed en chans att påverka utfallet. Motiv: Trots allt sjunkande amningsfrekvens i Sverige återfanns få artiklar som berörde BVC sjuksköterskans erfarenheter av amningsstöd. Genom att undersöka BVCsjuksköterskans upplevelser av att ge amningsstöd på barnavårdscentralen görs det möjligt att lyfta fram hinder och styrkor i att ge amningsstöd till nyblivna föräldrar. Syfte: Studiens syfte är att belysa BVC sjuksköterskors erfarenheter kring amningsstöd på barnavårdscentralen. Metod: Individuella, semistrukturerade intervjuer genomfördes. Resultaten analyseradesmed kvalitativ innehållsanalys. Sex distriktssköterskor yrkesverksamma på barnavårdscentraler i en mellanstor svensk stad ingick i studien.  Resultat: Studiens resultat visade att BVC sköterskornas erfarenheter kring amningsstödpå barnavårdscentralen varierar. Efter analys av intervjuer kunde tre olika kategorier identifieras: ”BVC sjuksköterskans utmaningar”, ” Det kan vara svårt att nå föräldrar med rätt information” samt ”Att stötta amning på föräldrarnas villkor”. Dessa kategorier kunde sammanföras i ett gemensamt tema ”Det är utmanande för BVC sjuksköterskan att ge amningsstöd”.  Konklusion: Att ge amningsstöd på BVC är utmanande. Det framkom vara betydelsefullt med riktlinjer för likvärdig amningsrådgivning samt behov av bättre amningsutbildning och kompetensutveckling. Tidspress framhävdes i samtliga intervjuer vilket påverkade möjlighet till att upptäcka och förebygga amningskomplikationer. Det framkom som viktigt att nå kvinnorna med rätt information för att kunna stötta realistiska förväntningar kring amning, kvinnornas självkänsla samt mående. Det belystes hur viktigt det är för BVC sjuksköterskan att arbeta med föräldrar mot samma mål och stötta deras val kring amning. Att synliggöra utmaningar BVC sjuksköterskor står inför, kan ge en riktlinje om vilka somförändringar behövs för att BVC sjuksköterskor ska få det stöd de behöver för att vända amningsfrekvensen uppåt. Studien kan även hjälpa den enskilda BVC sjuksköterskan att reflektera över sitt arbete med amning. Mer omfattande forskning krävs för att få en djupare förståelse kring BVC sjuksköterskors erfarenheter kring amningsrådgivning på barnavårdscentralen. / Background: For a long time, declining breastfeeding frequency has been contribute to several national initiatives to protect breastfeeding. Today we know more about the impact of breastfeeding on women and children. Therefore, it is of most importance to explore obstacles and strengths that can possibly affect breastfeeding in a positive or negative direction. The BVC-nurse is responsible for the later part of the care chain, where a large number of women interrupt initiated breastfeeding for one or another reason, and thus have a chance to influence the outcome. Motive: Despite the declining frequency of breastfeeding in Sweden, few publications were found concerning the BVC-nurse's experience of breastfeeding support. By examining the BVC-nurse's experiences of providing breastfeeding support at the childcare center, it is possible to highlight obstacles and strengths in providing breastfeeding support for new parents. Aim: The aim of the study is to high light the BVC-nurse's experiences regarding breastfeeding support at the childcare center. Methods: Individual, semi-structured interviews were conducted. The results wereanalyzed using qualitative content analysis. Six district nurses working at a childcare centers in a medium-sized Swedish city were included in the study. Result: The results of the study showed that the BVC nurses' experiences of breastfeeding at the childcare center varied. After analysis of interviews, three different categories were identified: "BVC nurse's challenges ", “It can be difficult to reach parents with the right information" and "Supporting breastfeeding on parental terms". These categories could be brought together in a common theme "It is challenging for the BVC nurse to provide breastfeeding support.” Conclusion: Providing breastfeeding support at BVC is challenging. It turned out to be important with guidelines for equivalent breastfeeding counseling and the need for better breastfeeding training and competence development. Time pressure was emphasized in all interviews, which affected the ability to detect and prevent breastfeeding complications. It emerged as important to reach the women with the right information to be able to support realistic expectations about breastfeeding, women's self efficacy and well-being. It was highlighted how important it is for the BVC nurse to work with parents towards the same goal and support their choices about breastfeeding. By highlighting the challenges BVC nurses face, can provide a guideline on what changes are needed for BVC nurses in order to receive the support they need to turn the frequency of breastfeeding upwards. The study can also help the individual BVC nurse to reflect on her work with breastfeeding. More extensive research is needed to gain a deeper understanding of BVC nurses' experiences of breastfeeding counseling at the childcare center.

The purpose of this study was to address the aggressive marketing of commercial formula and breastfeeding cessation in Indonesia using an evaluation of a counter-marketing continuing education module. Using a convenience sample (N = 99) of breastfeeding educators and/or counselors, paired t-tests showed a significant increase in participants’ knowledge about counter-marketing after they participated in the training. Findings also showed significant increases post-training for stage of changes, self-efficacy, knowledge, and motivation to perform four key talking behaviors: i.e., involving talking to new and pregnant mothers about corporations’ inappropriate and aggressive marketing of formula, and the risks of becoming dependent on expensive formula and losing the ability to produce their own breast milk. These findings suggested that exposure to the counter-marketing continuing education training served as a brief intervention associated with significant improvements in level of knowledge about counter-marketing among participants and in stage of change self-efficacy, knowledge, and motivation for performing key behaviors of interest. Backward-stepwise regression revealed that higher level of motivation for taking an active role in the proposed campaign (i.e., A Campaign to Expose the Truth about Becoming Dependent on Commercial Formula and Breastfeeding Cessation) was significantly predicted by: (1) higher pre-training self-efficacy for talking to expectant and new mothers about the reasons to breastfeed their infant (β = .327, SEB = .118, p = .007); (2) lower pre-training knowledge for talking to expectant and new mothers about corporations’ inappropriate and aggressive marketing of commercial infant formula (β = -.270, SEB = .092, p = .004); and, (3) higher level of knowledge for taking an active role in the proposed campaign (β = .392, SEB = .083, p = .000). Participants rated the training as very good (74.7%, n = 74). Qualitative data showed that the training provided new knowledge and a new approach in addressing aggressive formula marketing by corporations. Further, participants found that the training has made them more confident and motivated to work with mothers and the community to advocate and educate about negative impacts from commercial formula.

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