The Pennsylvania State University The Graduate School College of Education “I SAW A WRONG AND I WANTED TO STAND UP FOR WHAT I THOUGHT WAS RIGHT:” A NARRATIVE STUDY ON BECOMING A BREASTFEEDING ACTIVIST A Dissertation in Adult Education by Jennifer L. Pemberton © 2016 Jennifer L. Pemberton Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education May 2016 ii The dissertation of Jennifer L. Pemberton was reviewed and approved* by the following: Elizabeth J. Tisdell Professor of Adult Education Dissertation Adviser Chair of Committee Doctoral Program Coordinator Robin Redmon Wright Assistant Professor of Adult Education Ann Swartz Senior Lecturer, RN-BS Program Janet Fogg Assistant Professor of Nursing Hershey Coordinator *Signatures are on file in the Graduate School. iii ABSTRACT The purpose of this narrative study was two-fold: (a) to examine how breastfeeding mothers learn they are members of a marginalized group; and (b) to investigate how some of these mothers move from marginalization to activism. This study was grounded in two interconnected theoretical frameworks: critical feminism (also with attention to embodied learning) and women’s emancipatory learning in relation to breastfeeding and activism. There were 11 participants in the study, chosen according to purposeful criteria related to the study’s purpose; they represent diversity in age, race/ethnicity, sexual orientation, religion, and educational background. Data collection included narrative semi-structured interviews, which were co-constructed between the researcher and the participants, and researcher-generated artifacts. Both narrative and constant-comparative analysis were used to analyze the data. There were three sets of findings that emerged from the data. First, those related to the marginalization of breastfeeding mothers indicate that their marginalization is manifested in: negative views of breastfeeding in public; lack of breastfeeding support of some health professionals; the commercial formula industry; and returning to employment. Second, the findings regarding how they learned to be activists indicate they did so: by becoming conscious of marginalization; through mentoring, networking, and collaboration; through sometimes leveraging men’s power and support; and through social media and technology. Third, the findings regarding what they learned from being activists center on: seeing activism as a continuum; perspective-taking; learning leadership skills; and claiming their own empowerment. The findings from this study have implications for both theory and practice. Related to adult learning theory, this study offers new insight into the role of embodied learning as part of women’s activist learning. The public health field can glean from this study how to better educate women not only on breastfeeding, but also on public health issues in general by fostering iv collaboration and connection, and adopting insights from feminist pedagogy. Further, integrating activism and emancipatory learning into the curriculum for health care professionals can help them not only in their efforts at patient education, but in their own activist efforts for healthcare. The study ends with discussion of suggestions for further research. v TABLE OF CONTENTS LIST OF FIGURES ....................................................................................................................... ix ACKNOWLEDGEMENTS ............................................................................................................ x PART I ............................................................................................................................................ 1 CHAPTER ONE: INTRODUCTION ............................................................................................. 1 Background ................................................................................................................................. 2 Breastfeeding in Historical Context ........................................................................................ 3 Breastfeeding Mothers as a Marginalized Group ................................................................... 7 Purpose and Research Questions .............................................................................................. 18 Theoretical Framework ............................................................................................................. 19 Women’s Learning and Feminist Pedagogy ......................................................................... 19 Emancipatory Learning ......................................................................................................... 20 Methodological Overview ........................................................................................................ 21 Significance............................................................................................................................... 24 Assumptions, Limitations, and Strengths ................................................................................. 26 Assumptions .......................................................................................................................... 26 Limitations ............................................................................................................................ 27 Strengths ............................................................................................................................... 28 Organization of the Study ......................................................................................................... 28 Definition of Terms................................................................................................................... 29 CHAPTER TWO: LITERATURE REVIEW ............................................................................... 32 Theoretical Framework: ............................................................................................................ 32 Critical Feminism and Women’s Emancipatory Learning ....................................................... 32 Contextualizing the Theoretical Framework: Is Breastfeeding a Feminist Issue? .............. 33 Women’s Learning from a Feminist Perspective .................................................................. 34 Emancipatory Learning Theory ............................................................................................ 46 Breastfeeding ............................................................................................................................ 60 vi Benefits of Breastfeeding ...................................................................................................... 62 Relevant Infant Feeding History ........................................................................................... 64 Breastfeeding Mothers as a Marginalized Group ................................................................. 75 Critique and Implications ........................................................................................................ 118 Intersecting Bodies of Literature ........................................................................................ 118 Why Breastfeeding Is a Feminist Issue ............................................................................... 120 Implications of the Current Study ....................................................................................... 123 Summary ................................................................................................................................. 124 CHAPTER THREE: METHODOLOGY ................................................................................... 126 A Qualitative Research Paradigm ........................................................................................... 126 Overview of Qualitative Research ...................................................................................... 127 Narrative Inquiry ................................................................................................................. 129 Background of the Researcher ................................................................................................ 132 Participant Selection Procedures ............................................................................................. 134 Ethics and Informed Consent .................................................................................................. 136 Data Collection Procedures and Methods ............................................................................... 137 Data Analysis .......................................................................................................................... 143 Trustworthiness ....................................................................................................................... 149 Credibility ........................................................................................................................... 150 Transferability ..................................................................................................................... 151 Dependability and Confirmability ...................................................................................... 152 Summary ................................................................................................................................. 155 PART TWO: THE FINDINGS PRESENTED AS THE STORIES ..........................................