Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

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

Addressing the sub-optimal breastfeeding initiation and duration rates has become a national priority. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration between providers such as lactation professionals, nurses, pediatricians, and the family. The purpose of this exploratory study was to understand International Board Certified Lactation Consultants' (IBCLCs) perceived barriers to managing early breastfeeding problems. This qualitative study was guided by the symbolic interactionist framework through a grounded theory methodological approach. In-depth interviews were conducted with 30 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers were identified and grouped into the following categories: indirect barriers such as social norms, knowledge, attitudes; direct occupational barriers such as institutional constraints, lack of coordination, and poor service delivery; and direct individual barriers including social support and mother's self-efficacy. A model was developed to illustrate the factors that influence the role enactment of IBCLCs in terms of managing breastfeeding problems. IBCLCs overwhelmingly wish to be perceived as valued members of a health care team, but often find interprofessional collaboration is a struggle. However, IBCLCs find creative strategies to navigate challenges and describe their role as pivotal in empowering mothers and their families to meet their breastfeeding goals. Though rarely actualized, IBCLCs place strong value on coordinated, team approaches to breastfeeding management that employ transparent communication between providers and focus on empowering and educating mothers. Strategies for better collaboration and communication between IBCLCs and other providers are needed. Findings provide insight into the management issues of early breastfeeding problems and may lead to future interventions to reduce early weaning, thus increasing the lifelong health benefits of breastfeeding to the infant and mother.