Pressure and judgement within a dichotomous landscape of infant feeding: A grounded theory study to explore why breastfeeding women do not access peer support provision

Abstract

Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) interventions are a recommended tool to increase breastfeeding rates, intervention studies identify that engagement with BPS is problematic. Due to a paucity of research in this area, this study explores why breastfeeding women do not access BPS in South-West England. Utilising Charmaz’s (2006) constructionist grounded theory approach, twenty-four semi-structured interviews were undertaken with 33 participants (13 women, six health professionals and 14 peer supporters). Analysis involved open coding, constant comparisons and focussed coding.

One core category and three main themes explicating non-access were identified. The core category concerns women’s experiences of pressure and judgment around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, ‘place and space of support’, describes the contrast between a perceived pressure to breastfeed, and a lack of adequate and appropriate support. Theme two, ‘one way or no way’, outlines the rules based approach to breastfeeding adopted by some health professionals, and how women avoided BPS due to anticipating a similar approach. Theme three, ‘it must be me’ concerns how a lack of embodied insights could lead to ‘breastfeeding failure’ identities. A background of dichotomised language, pressure, and moral judgement, combined with the organisation of postnatal care and the model of breastfeeding adopted by health professionals, may prevent women’s access to BPS. A socio-cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted.