Exploring the Experiences of Women Who Breastfeed Long-Term
Total Page:16
File Type:pdf, Size:1020Kb
EXPLORING THE EXPERIENCES OF WOMEN WHO BREASTFEED LONG-TERM Sally Jane Dowling A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the degree of Doctor of Philosophy Faculty of Health and Applied Sciences University of the West of England, Bristol September 2013 This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement Acknowledgements My life has been changed in many ways by my experiences of breastfeeding all three of my daughters. The journey that culminates with this PhD began with those three very different experiences and it is dedicated to them, my lovely girls. Breastfeeding the younger two and then undertaking the PhD that grew from that experience would not have been possible without the constant and loving support and patience of Mick. I cannot thank him enough for both of those things. In more recent times the support he has given me to reach the end of this process, both practical and emotional, has been invaluable. My excellent supervision team – Jane Powell, David Pontin and Jennie Naidoo – have been constant in their belief in my abilities and always generous in their support and encouragement. In particular I would like to thank Jane for her interest in me at the beginning, and persistence and faith during the last few months of the work; David for believing in me and making it all possible at the very beginning and Jennie for her support and eye for detail. Thank you David and Jennie for excellent editorial assistance, and all three of you for your friendship. I am grateful for the financial and other support that I have received from the Faculty of Health and Life Sciences, University of the West of England. Others whose support has been invaluable include my parents, Valerie and Brian Dowling, who have always believed in and supported me. In particular my father Brian’s practical help with scanning documents and formatting pages was very helpful in the last months and weeks of preparation. My friends have also been an important part of the process. Mary Stewart was there at the very beginning of my youngest daughter’s life and breastfeeding journey and, from the moment we first met, has been very important to me. Kate Boyer and Christine Andrew I particularly thank for their support, intelligent and helpful conversation and academic stimulation. Martin McCrea and Judy Wilson have continued to support all of us as a family through their wonderful friendship. Thank you also to Lashings Coffee Shop, who have provided not only a good place to work, but a comfortable and supportive environment in which many women breastfeed every day. Finally I would like to thank the people without whose dedication and experience I would not have breastfed at all – Jo Taylor and April Whincop – as well as all the women I met in the course of this work who gave me their time, and shared with me their experiences of breastfeeding. Abstract This thesis reports the results of qualitative research using ethnographic methods to explore the experiences of women who have breastfed long-term. Data collection methods included participant observation in three breastfeeding support groups, face-to-face interviews and online asynchronous interviews using email. A clear contribution to new knowledge has been demonstrated in a number of areas. Knowledge has been furthered by presenting in-depth, rich findings about the experience of an under-researched group in a sensitive area. Placing these within the context of a cross-disciplinary perspective and by using insider research methods has strengthened their authenticity and credibility. The Social-Ecological Model is used both to structure a review of relevant literature and to underpin the thesis as a whole, demonstrating the complex social and cultural contexts within which women breastfeed long- term. Findings, from a group of strong-willed and determined women show that breastfeeding long-term is a rewarding but challenging commitment, often undertaken in the absence of societal support. Theoretical concepts of liminality, stigma and taboo are explored within the thesis and used as a lens through which to view the findings from the study. Previous work using these concepts to think about breastfeeding is drawn on and developed to further understanding of the experiences of long-term breastfeeding. Table of Contents Acknowledgements ............................................................................................................. 3 Abstract .............................................................................................................................. 5 Table of Contents ................................................................................................................ 6 Chapter 1: Introduction and background ............................................................................ 14 1.1 Background - orientation ......................................................................................... 14 1.2 Context of contemporaneous media and academic debate ....................................... 17 1.3 Personal stance, motivation and professional experiences ........................................ 21 1.4 Justification for long term breastfeeding research .................................................... 26 1.5 The research questions ............................................................................................ 28 1.6 Terminology ............................................................................................................ 30 1.7 Outline and structure of the thesis ........................................................................... 33 Chapter 2: Background to the research and discussion of contextual literature. ................. 36 2.1 Introduction ............................................................................................................ 36 2.2 The Social-Ecological Model (SEM) ........................................................................... 41 2.2.1 The development of the SEM ............................................................................ 41 2.2.2 The use of the SEM in breastfeeding health promotion ................................... 42 2.2.3 The use of the SEM to think about breastfeeding long-term ........................... 43 Figure 1: Influences on breastfeeding behaviour and experiences ............................... 44 2.3 Breastfeeding and feminism ..................................................................................... 45 2.4 Societal level influences ........................................................................................... 50 2.4.1 Breastfeeding policy worldwide ........................................................................ 50 2.4.2 Issues in undertaking breastfeeding research .................................................. 53 2.4.3 The health benefits of breastfeeding ................................................................ 57 2.4.4 The benefits of long-term breastfeeding .......................................................... 68 2.4.5 Criticisms of the evidence for the health benefits of breastfeeding ................ 70 2.5 Community and interpersonal level influences ......................................................... 74 2.5.1 UK policy, breastfeeding promotion and advice ............................................... 74 2.5.2 How are women supported to breastfeed in the UK? ...................................... 74 2.5.3 How many women breastfeed in the UK and for how long? ............................ 75 2.6 Individual level influences: women’s experiences .................................................... 79 6 2.6.1 The range of women’s experiences .................................................................. 79 2.6.2 Understanding women’s experiences of breastfeeding ................................... 82 2.6.3 Breastfeeding babies: early experiences........................................................... 83 2.6.4 Experiences of long-term breastfeeding ........................................................... 85 2.6.5 Attachment parenting ....................................................................................... 93 2.6.6 Summary/Gaps in the literature ....................................................................... 97 2.7 Conclusion ............................................................................................................... 99 Chapter 3: Conceptual models (liminality, stigma and taboo)............................................ 100 3.1 Introduction ......................................................................................................... 100 3.2 Liminality ............................................................................................................. 103 3.2.1 Introduction..................................................................................................... 103 3.2.2 The concept ..................................................................................................... 103 3.2.3 The use of liminality in understanding health issues, including breastfeeding ..................................................................................................................................... 108 3.2.4 Mahon-Daly and Andrews: liminality and breastfeeding ............................... 113 3.3 Stigma ..................................................................................................................