Breastfeeding Among High-Risk Inner-City African-American Mothers: A Risky Choice?

Objective: This study identified barriers to breastfeeding among high-risk inner-city African-American mothers. Subjects and Methods: We used audiotaped focus groups moderated by an experienced International Board Certified Lactation Consultant, with recruitment supported by the community partner MomsFirst (TM) (Cleveland Department of Public Health, Cleveland, OH). Institutional Review Board approval and written informed consent were obtained. Notes-based analysis was conducted with use of a prior analytic structure called Factors Influencing Beliefs (FIBs), redefined with inclusion/exclusion criteria to address breastfeeding issues. Results: Three focus groups included 20 high-risk inner-city expectant and delivered mothers. Relevant FIBs domains were as follows: Risk Appraisal, Self Perception, Relationship Issues/Social Support, and Structural/Environmental Factors. Risk Appraisal themes included awareness of benefits, fear of pain, misconceptions, and lack of information. Self Perception themes included low self-efficacy with fear of social isolation and limited expression of positive self-esteem. Relationship Issues/Social Support themes included formula as a cultural norm, worries about breastfeeding in public, and challenging family relationships. Structural/Environmental Factors themes included negative postpartum hospital experiences and lack of support after going home. Conclusions: Several findings have been previously reported, such as fear of pain with breastfeeding, but we identified new themes, including self-esteem and self-efficacy, and new concerns, for example, that large breasts would suffocate a breastfeeding infant. The FIBs analytic framework, as modified for breastfeeding issues, creates a context for future analysis and comparison of related studies and may be a useful tool to improve understanding of barriers to breastfeeding among high-risk inner-city women.