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Breastfeeding and the Individual: the Impact of Everyday Stressful Experience and Hormonal Change on Breastfeeding Duration Among Women in São Paulo, Brazil

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Breastfeeding and the Individual: the Impact of Everyday Stressful Experience and Hormonal Change on Breastfeeding Duration Among Women in São Paulo, Brazil University of Massachusetts Amherst ScholarWorks@UMass Amherst Open Access Dissertations 2-2010 Breastfeeding and the Individual: The Impact of Everyday Stressful Experience and Hormonal Change on Breastfeeding Duration Among Women in São Paulo, Brazil Alanna Emilia Frances Rudzik University of Massachusetts Amherst, [email protected] Follow this and additional works at: https://scholarworks.umass.edu/open_access_dissertations Part of the Anthropology Commons Recommended Citation Rudzik, Alanna Emilia Frances, "Breastfeeding and the Individual: The Impact of Everyday Stressful Experience and Hormonal Change on Breastfeeding Duration Among Women in São Paulo, Brazil" (2010). Open Access Dissertations. 172. https://scholarworks.umass.edu/open_access_dissertations/172 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Open Access Dissertations by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. BREASTFEEDING AND THE INDIVIDUAL: THE IMPACT OF EVERYDAY STRESSFUL EXPERIENCE AND HORMONAL CHANGE ON BREASTFEEDING DURATION AMONG WOMEN IN SÃO PAULO, BRAZIL A Dissertation Submitted by Alanna Rudzik, M.Sc. Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY February 2010 Department of Anthropology © Copyright by Alanna E.F. Rudzik 2010 All Rights Reserved BREASTFEEDING AND THE INDIVIDUAL: THE IMPACT OF EVERYDAY STRESSFUL EXPERIENCE AND HORMONAL CHANGE ON BREASTFEEDING DURATION AMONG WOMEN IN SÃO PAULO, BRAZIL A Dissertation Presented by ALANNA E. F. RUDZIK Approved as to style and content by: ______________________________________________________ Lynnette Leidy Sievert, Chair ______________________________________________________ Lynn Morgan, Member ______________________________________________________ Paula Stamps, Member _________________________________ Elizabeth Chilton, Department Chair Anthropology ACKNOWLEDGEMENTS My heartfelt thanks go out to all the women from the Eastern Zone who took part in this research project. I am indebted to them for their patience, generosity and good humour. Their willingness to share their time, their struggles and their stories with me made my fieldwork an unforgettable learning experience. I would also like to thank Irmã Monique Bourget, M.D., director of the Santa Marcelina Foundation of São Paulo, as well as the administrative staff of the Programa Saúde de Familia for the infrastructural and logistical support without which I would not have been able to complete this research. During my time at UMass I have learned a great deal from the many faculty members that I have interacted with. In particular, I want to thank the members of my dissertation committee. As my advisor, Lynnette Sievert supported and encouraged me throughout the design, execution and analysis that produced this dissertation, giving me in equal measure direction and the freedom to do my own thing. And, in addition, she gave me what all doctoral candidates need: deadlines! During the writing of my dissertation, her generosity with her time and support was unfailing; she always ready to read and critique drafts of chapters and to offer fresh perspectives. Her encouragement, patience and kindness set her apart as the model of a great graduate advisor. Thank you for everything, Lynnette! Lynn Morgan of Mount Holyoke College and Paula Stamps of the Department of Public Health have each contributed to my intellectual development and to the development of my dissertation. Lynn has consistently motivated me, with a balance of iv rigour and encouragement, to think about human biology in general, and my research in particular, in new ways. Paula’s feedback on my writing has encouraged me to think and write more clearly and to look to the “big picture,” while her ethics class has shaped my thinking about research design and the IRB process. To both of them, my sincerest thanks. It was in Brooke Thomas’ class that I first encountered the philosophy of Merleau-Ponty and it was Brooke who first encouraged me to think about a bio- experiential approach. For that, and for sharing his unique perspective on anthropology and life with me and all his students, I thank him. Since arriving at UMass, I’ve learned a huge amount from my fellow graduate students. Thank you to Zachary Dubois whose support and friendship has often come at the moments when the way forward seemed the least clear. I look forward to many more evenings spent drinking wine and hashing out abstracts. Thank you to Broughton Anderson who has been a sounding board and a good friend through all the ups and downs of graduate life. Our afternoons and evenings spent at the ABC have convinced me that social theory is best taken with a large glass of beer. Thank you to Alexis Dolphin who has been a source of great advice and inspiration even after she returned to our home and native land. Thank you to Chris Sweetapple, Heidi Bauer-Clapp and the writing group for helping me hash out the theory, and to Valerie Joseph who advised me to start with the “ouch.” My parents, Eileen and Oleh, and my brother, Nick, have been there throughout my academic journey and their love and support (emotional, financial…editorial) has v never failed. They have always believed in me and encouraged me to let “genius burn.” Thank you, Dr. O.E.R., Dr. E.P.R. and Dr. N.R.! Finally, I want to thank my fiancé Quentin Lewis for his love, friendship and support. Throughout these doctoral years he has been my rock, always there to cheer me on during the good parts and to help me through the hard parts. I look forward to our many adventures to come, in Toronto and beyond. This research was funded by SSHRC Doctoral Fellowship # 752-2005-0519 and a Whiting Foundation Teaching Grant. Additional logistical and material support was provided by the Center for Human and Primate Reproductive Ecology at Yale University, the Laboratory for Human Biology Research at Northwestern University and the Santa Marcelina Philanthropic Foundation. vi ABSTRACT BREASTFEEDING AND THE INDIVIDUAL: THE IMPACT OF EVERYDAY STRESSFUL EXPERIENCE AND HORMONAL CHANGE ON BREASTFEEDING DURATION AMONG WOMEN IN SÃO PAULO, BRAZIL FEBRUARY 2010 ALANNA E. F. RUDZIK, B.A., UNIVERSITY OF TORONTO M.Sc., UNIVERSITY OF TORONTO Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Lynnette Sievert Breastfeeding offers significant benefits to the breastfed infant as well as the breastfeeding woman. The World Health Organization now recommends exclusive breastfeeding until six months, followed by supplementation and continued breastfeeding to two years or more. Around the world, public health programs endeavour to promote breastfeeding through educational programs. In Brazil, such programming is widespread, and yet less than 30% of women in São Paulo breastfeeding exclusively even to four months post-partum. This study uses a qualitative-quantitative bio-experiential approach to explore the way that stressful experiences and circumstances in the lives of low-income women from the Eastern Zone of São Paulo, Brazil, influence their decision to wean or supplement their infant before 12 weeks post-partum. Sixty-five first-time mothers participated in a 12-week longitudinal study of life stressors and breastfeeding practice. Participants were asked to complete one pre-partum and six post-partum interviews. Narrative and biological data were collected from each participant at each interview. Statistical analysis revealed that among these participants the breastfeeding hormone oxytocin did not mediate breastfeeding duration. Oxytocin vii appeared to act as a biomarker of stressful experience, while Epstein-Barr Virus antibody titre, a commonly used biological measure of psychosocial stress, did not. Unplanned pregnancy, older age and higher mean oxytocin level were statistically associated with weaned outcome at 12 weeks. Unplanned pregnancy, older age, higher mean oxytocin level, higher mean satisfaction score regarding financial situation and lower mean satisfaction score regarding interpersonal factors were associated with decreased duration of any breastfeeding. Unplanned pregnancy, older age and lower mean satisfaction score regarding interpersonal factors were associated with decreased duration of exclusive breastfeeding. Ethnographic analysis revealed that the effect of unplanned pregnancy may be connected to the discourse of the self-sacrificial, child-centric “good mother.” Exclusive breastfeeding was seen as a hallmark of this idealised maternal type. Single women with unplanned pregnancies expressed a great deal of ambivalence towards their own maternity and toward the somewhat unobtainable good mother ideal, especially with relation to the physical and psychological challenges breastfeeding. Women’s ambivalence appeared to influence their decisions to supplement or wean their infants by or before 12 weeks post-partum. viii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS .................................................................................................v ABSTRACT ...................................................................................................................... vii LIST OF TABLES ........................................................................................................... xiv LIST OF FIGURES ........................................................................................................
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