University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School March 2019 “What I Hadn’t Realized is How Difficult it is,ou Y Know?”: Examining the Protective Factors and Barriers to Breastfeeding in the UK Cheyenne R. Wagi University of South Florida, [email protected] Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the Public Health Commons, and the Social and Cultural Anthropology Commons Scholar Commons Citation Wagi, Cheyenne R., "“What I Hadn’t Realized is How Difficult it is,ou Y Know?”: Examining the Protective Factors and Barriers to Breastfeeding in the UK" (2019). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/7983 This Thesis is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. “What I Hadn’t Realized is How Difficult it is, You Know?” Examining the Protective Factors and Barriers to Breastfeeding in the UK by Cheyenne R. Wagi A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts with a concentration in Applied Biocultural Medical Anthropology Department of Anthropology College of Arts and Sciences University of South Florida Co-Major Professor: David Himmelgreen, Ph.D. Co-Major Professor: Jaime Corvin, Ph.D. Daniel Lende, Ph.D. Date of Approval: March 13, 2019 Keywords: breastfeeding, protective factors, barriers, stigma, social support Copyright ©, Cheyenne R. Wagi ACKNOWLEDGMENTS I would like to thank my major advisors, Dr. David Himmelgreen and Dr. Jaime Corvin, who supported this project from its conception to its completion. They helped me to navigate the complexities of international research and provided me with reassurance. Additionally, my third committee member, Dr. Daniel Lende, for his guidance and thoughtful feedback throughout multiple drafts my proposal. I am grateful to Baby Café UK for allowing me to complete this project with their organization. I would also like to thank Trina Warman for coordinating with the National Childbirth Trust and Baby Cafés to make this project possible and the Baby Café facilitators who welcomed me into their Cafés. I owe my utmost gratitude to the mums and partners who shared with me the intimate stories of their breastfeeding journeys. Finally, I would like to thank my parents, Julie and Gil Wagi, without them I would never have been able to pursue my passion. Thank you. TABLE OF CONTENTS List of Tables ................................................................................................................................. iii List of Figures ................................................................................................................................ iv Abstract ............................................................................................................................................v Chapter 1: Introduction ....................................................................................................................1 Statement of the Problem .....................................................................................................2 Chapter 2: Review of the Literature .................................................................................................4 Breastfeeding .......................................................................................................................4 Breastfeeding: An Anthropological Perspective ..................................................................9 Baby Café Model ...............................................................................................................11 Policy Review ....................................................................................................................12 Summary of the Literature .................................................................................................13 Chapter 3: Theory ..........................................................................................................................15 Social Cognitive Theory ....................................................................................................15 Social Ecological Model ....................................................................................................16 Feminist Theory .................................................................................................................17 Linking Theories ................................................................................................................19 Chapter 4: Research Design ...........................................................................................................20 Overall Approach ...............................................................................................................20 Methodology ......................................................................................................................22 Analysis..............................................................................................................................25 Chapter 5: Case Studies .................................................................................................................26 Chapter 6: Results ..........................................................................................................................31 Participant Observation ......................................................................................................31 Interviews ...........................................................................................................................33 Breastfeeding Self-Efficacy Scale-Short Form ..................................................................62 Chapter 7: Discussion ....................................................................................................................65 Chapter 8: Critical Reflection and Recommendations...................................................................79 Critical Reflection ..............................................................................................................79 Limitations .........................................................................................................................81 i Application .........................................................................................................................83 Recommendations ..............................................................................................................83 Public Health Implications .................................................................................................88 Conclusions ........................................................................................................................90 References ......................................................................................................................................93 Appendices ...................................................................................................................................107 Appendix A: University of South Florida Institutional Review Board Approval ...........108 Appendix B: Verbal Informed Consent Form .................................................................112 Appendix C: Breastfeeding Self-Efficacy Scale-Short Form Permission of Use ............114 Appendix D: Interview Guide – Mums ...........................................................................115 Appendix E: Interview Guide – Partners .........................................................................116 Appendix F: Interview Guide – Facilitators ....................................................................117 ii LIST OF TABLES Table 1: Methods and Objectives ...............................................................................................22 Table 2: Summary Statistics of BSES-SF Data .........................................................................62 Table 3: Spearman’s Rank-Order Correlations of BSES-SF Data.............................................64 iii LIST OF FIGURES Figure 1: Application of the Social Ecological Model ................................................................35 Figure 2: Application of the Social Cognitive Theory Model .....................................................36 iv ABSTRACT The international recommendation for breastfeeding is that a baby should be exclusively breastfed for six months. Breastfeeding should be continued for up to two years and beyond with complementary foods (WHO, 2016). The United Kingdom exhibits some of the lowest breastfeeding rates in the world (HSCIC, 2012). The percentage of mothers who breastfed in the United Kingdom falls below 34% at six months, with only 1% of mothers breastfeeding exclusively at this point (HSCIC, 2012:31). This study sought to examine the protective factors and barriers for breastfeeding in the UK. Mums (n=28), their partners (n=6), and facilitators at breastfeeding support services (n=3) were interviewed (n=37) to learn more about breastfeeding experiences and related factors. Mums (n=28) also completed the Breastfeeding Self-Efficacy Scale Short-Form. Factors related to individual knowledge and beliefs, support from partners, family, and friends, clinical experiences, formal support, and stigma