Philosophical, Cultural, and Ethical Perspectives Influencing Breastfeeding

Culture may be defined as practices, values, and norms which can be shared or learned, and may correlate with race, nationality, or ethnicity.⁴²

What a woman learns about breastfeeding is often learned from her mother and reflects her culture’s attitudes and beliefs toward breastfeeding.

It is important to evaluate a mother’s cultural influence on breastfeeding:

• If necessary, or if it may make her more comfortable, invite interpreter services to facilitate the conversation.
• Ask the mother open-ended questions about her family history of breastfeeding, such as her mother, sisters or aunt, and whether or not she knows anyone nearby who is currently breastfeeding.
• The role of the father and other family members in the care of the newborn and the new mother may vary across cultures from a prominent role, to a passive or even a non-existent role. It is important to understand how much a mother may have to handle on her own and to understand her support system.

Strengthen the support the mother receives by using effective and culturally aware communication.

• Uphold the mother’s right to be treated with respect by taking her views into account.
• Awareness of cultural factors in a woman’s life will improve the quality of care given and how it is delivered.

Culture is not limited to ethnicity, but may also involve a number of other factors, such as:

• Age
• Parity
• Health concerns for both mother and child
• Socioeconomic status
• Presence of physical or mental disabilities
• Sexual orientation

Potential barriers may hinder breastfeeding in immigrant families, including:

• Language barriers, both verbally and in literacy
• Prescription drug compliance and sharing
• Cultural roles in the family dynamic
• Immigrant concerns: fears of deportation, lack of insurance, unaware of rights to health information, informed consent, confidentiality, and emergency medical care may prevent mothers from seeking help and support for their breastfeeding needs.
• Social stigmas, such as taboos involving discussing sex and other women’s health concerns
• Differences in Eastern and Western medicine and child care, such as:
  • Proper clothing and housing needs for the baby
  • Car seats
  • Vaccinations and immunizations for mother and baby
  • Follow-up postpartum visits and regular visits to pediatricians

When counseling mothers of culturally diverse backgrounds, it is important to remember:

• Show respect and understanding for their views and where they come from, and the mother’s feelings
• Do not ridicule, laugh at, or undermine the mother’s beliefs
• Present evidence based research on breastfeeding
• Help her feel good about breastfeeding her new baby!

The AAP Residency Curriculum provides additional information on cultural competency and breastfeeding.³⁸ These cultural case studies can be found here.

A Variety of Lactation Support Providers

Professional Lactation Consultant:

An IBCLC is an International Board Certified Lactation Consultant—a professional certification with prerequisite coursework and clinical experience. IBCLCs perform professional comprehensive clinical lactation consultations, in a hospital, outpatient or home setting.

Certified Breastfeeding Educators and Counselors:

These individuals have taken a multi-day course, such as the Certified Lactation Counselor (CLC) course or the Certified Lactation Educator (CLE) course, and are prepared to counsel, coach and instruct breastfeeding families in uncomplicated situations. Many certified breastfeeding educators and counselors must participate in continuing lactation education to maintain their certifications. Health care professionals, such as RNs, MDs or RDs may complete such a certification course to augment their training or to prepare to sit for the IBCLC exam and become an IBCLC.

Peer Counselor:

A peer counselor is a mother with personal breastfeeding experience. WIC and La Leche League peer counselors undergo training to support new mothers to breastfeed successfully.

A Variety of Community-Based Programs and Organizations:

Woman, Infant, and Children (WIC) program:

The WIC Program offers free nutrition education, referrals and healthy foods to qualifying pregnant and postpartum women, infants and children under the age of five. Approximately half of all babies born in the United States are eligible for WIC.

WIC Breastfeeding Services:

• Individual breastfeeding education and assessment
• Prenatal breastfeeding classes
• Breastfeeding peer counselors
• Help accessing breast pumps
• Educational materials in a variety of languages
• Extra food for nursing mothers

Visit http://www.mass.gov/wic for more information about program eligibility in Massachusetts. 

La Leche League:

La Leche League provides education, information and encouragement for women who want to breastfeed. La Leche League hosts monthly group meetings and offers mother-to-mother support at no charge. More information available at http://lllmarivt.org/

Baby Cafe:

Baby Café offers free breastfeeding support from specially trained staff for pregnant and breastfeeding mothers.  More information available at Baby Cafe USA

Nursing Mothers Council:

Provides free breastfeeding support, trainings to become breastfeeding counselors, and offers continuing education to health care providers. Nursing Mothers Council hosts monthly group meetings and offers mother-to-mother support at no charge. More information available at http://www.bace-nmc.org/

Access Zipmilk www.zipmilk.org to find listings for each of these resources near where your patients live or work.

ZipMilk.org is not available in every state yet. It is currently in Ma, CT, GA, MT, NJ, NC, NJ, and WI. If you want to know what is available in your state, please contact your state breastfeeding coalition.