Breastfeeding and Concepts Breastfeeding and Concepts of Attachment and Bonding in of Attachment and Bonding in Low-Income African American Low-Income African American

WomenWomen

Jill Radtke, BSN

8/07

Beginnings…Beginnings…

Developed an interest in breastfeeding through position as staff RN on postpartum unit– Personal Observations

One of the areas eliciting the most self-doubt in new maternal role

Race, ethnicity, age, and personality trait disparities

Strong and varied cultural, familial, medical, and personal influences and opinions

Beginnings…Beginnings…

Classes, independent studies, and GSR position introduced me to the research process and encouraged me to refine my focus:

– Developed more extensive knowledge about the issues surrounding breastfeeding

– Identified gaps in the literature– Narrowed a possible dissertation focus based on the

literature and my own interests: if and how childhood obesity is associated with diabetic breast milk intake

Currently…Currently…

While taking a women’s health seminar this semester, I was able to concentrate more on the mother’s point of view in regards to breastfeeding

Through literature searches, found a unique qualitative piece concerning how low-income black women view nursing their infants in the context of their life situations

Currently…Currently…

This piece (Cricco-Lizza, 2004) discussed how low-income black women, due to a “preponderance of loss and stress,” avoid bonding with their infants through choosing not to breastfeed

Feared losing child (uncertain environment)Too many other responsibilities

(breastfeeding an added stress)

What is known…What is known…

Black women breastfeed at lower rates than Caucasian Americans11

Compounded by low socioeconomic status, low level of education, young age, being in an urban environment11,19

Acculturation phenomenon13,19

Often cite lack of role model, “embarrassment” issues, beliefs about the infant’s hunger and health

What is not known…What is not known…

Is there an underlying reason why low-income black women breastfeed at such low rates?– Stress in life– View bond with infant differently – Reject bond—defense mechanism – Perceive self as inadequate to measure up to

society’s idealized images of breast milk and “pureness” of bond

Purity ImagePurity Image

Literature SearchLiterature Search

In the women’s health seminar, I conducted a literature search on the topic– How minorities and black women view breastfeeding– Qualitative accounts of how they make infant feeding

choice– As relevant theories pertaining to subject, reviewed:

Bowlby’s attachment theory Concept of maternal sensitivity

LiteratureLiterature

African American women have come to revere independence and nurture this trait in children2

– Phenomenon of father repeatedly leaving

Verbiage used, “good infant”—does not cry, nor display attachment behavior, “greedy,” “lazy,” “spoiled” infants cry and seek out their mothers often10

LiteratureLiterature

Taking solids early: sign of independence9

Mothers added cereal to bottle as young as 3 weeks, to keep infant quiet longer between ministering to him9

Giving bottle allowed infant to “go easily with anyone” (Cricco-Lizza, 2004, p.1204)

LiteratureLiterature

Fear of losing infant due to uncertain environment– “I don’t want to be in love with my baby…”

(Cricco-Lizza, 2004, p.1205)Other responsibilities create added burden

– Work9,10,14

– School (teen mothers) 14

“vivid” fear of attachment “addicted to me,” “spoiling”

LiteratureLiterature

Interestingly, low income black mothers that do chose to breastfeed cite independence, in themselves and infant, as a benefit of nursing9,10,14

LiteratureLiterature

• Self independence: only something that they can give to infant, provides validation in mother role9,14

• Teens mothers cite this benefit—appropriate for developmental stage 14

LiteratureLiterature

• Infant independence: “…And that breastfeeding will make her healthier, stronger, build the immune system…Yeah, breastfeeding makes her a stronger person that would lead to independence sooner or later,” (Cricco-Lizza, 2004, p.1207)

LiteratureLiterature

Nerves and stress the norm among low-income African American women22

Admission of “nerves” is a stigma22

Breastfeeding one more stress in already “maxed out” life10

LiteratureLiterature

Elsewhere in society breastfeeding is made a moral choice– Child-centered decision17

– Ideology enforced by health care system7,15,17,21

When breastfeeding may not When breastfeeding may not be the best choice…be the best choice…

Acceptable in black culture to not breastfeed– Consider underlying reasons

Many with history of sexual abuse: describe breastfeeding with words: “revulsion,” “anger,” “confusion”6

Uncertain life conditions-fear bond10

Lack confidence in living up to breastfeeding pure image7

Bowlby’s Attachment TheoryBowlby’s Attachment Theory

Bowlby’s Attachment TheoryBowlby’s Attachment Theory

British psychologistAttachment Theory circa 1958Roots in psychoanalysis but with a more

ethological perspective

Bowlby’s Attachment TheoryBowlby’s Attachment Theory

Basic theory: Infants develop attachment as they perceive primary caretaker, usually the mother, to be dependably present and better equipped to deal with an unfamiliar world than they

Evolutionary survival function: protection

Bowlby’s Attachment TheoryBowlby’s Attachment Theory

Inherent behavioral systems, including clinging, sucking, following, crying, and smiling in the infant, which are at first independent of an object focus, over time become centered on the mother as she consistently responds to these behaviors

Reciprocal response between mother and infant formulating secure attachment1,4

Klaus and Kennell, 1976Klaus and Kennell, 1976

Maternal SensitivityMaternal Sensitivity

Responsiveness to infant’s cuesNot a direct relationship with breastfeedingPersonality trait that is associated with

breastfeeding and secure attachment8,20,23

Maternal SensitivityMaternal Sensitivity

I posit that low-income African American mothers do exhibit less maternal sensitivity – Feeding response to all infant cries9

– Citing fairness of whether their own mom breastfed as a determinant of whether they should3,10

Leads to less breastfeeding and less securely attached children– Cycle perpetuated, as Bowlby predicted in his views of

dysfunctional attachment5

Tying it together…Tying it together…

Low-income African American women breastfeed at considerably lower rates than Caucasian Americans

There are possible underlying issues in this culture with regard to attachment and bonding

These views of attachment and bonding have been associated with infant feeding choice

Gap in Literature=Possible Gap in Literature=Possible DissertationDissertation

Qualitative study interviewing low-income African American mothers, together with their own mothers, to ascertain the nature of their attachment, bond, and international style and what role, if any, this plays in the decision to bottle- or breastfeed

ReferencesReferences1Ainsworth, M.D. (1969). Object relations, dependency, and attachment: A theoretical

review of the infant-mother relationship. Child Development, 40(4), 969-1025.2Belenky, M.F., Clinchy, B.M., Goldberger, N.R., & Tarule, J.M. (1997). Women’s ways

of knowing: The development of self, voice, and mind (10th ed.). New York, NY: Basic Books.

3Bentley, M.E., Caulfield, L.E., Gross, S.M., Bronner, Y., Jensen, J., Kessler, L.A., & Paige, D.M. (1999). Sources of influence on intention to breastfeed among African-American women at entry to WIC. Journal of Human Lactation, 15(1),27-34.

4Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52(4), 664-78.

5Bowlby, J. (1977). The making and breaking of affectional bonds, II. Some principles of psychotherapy. The fiftieth Maudsley lecture (expanded version). British Journalof Psychiatry, 130, 421-31.

6Bowman, K.G. (2007). When breastfeeding may be a threat to adolescent mothers. Issues in Mental Health Nursing, 28(1), 89-99.

ReferencesReferences7Bramwell, R. (2001). Blood and milk: Constructions of female bodily fluids in western

society. Women & Health, 34(4), 86-96.8Britton, J.R., Britton, H.L., & Gronwaldt, V. (2006). Breastfeeding, sensitivity, and

attachment. Pediatrics, 118(5), e1436-e1443.9Corbett, K. (2000). Explaining infant feeding style of low-income black women. Journal

of Pediatric Nursing, 15(2), 73-81.10Cricco-Lizza, R. (2004). Infant-feeding beliefs and experiences of black women enrolled

in WIC in the New York metropolitan area. Qualitative Health Research, 14(9), 1197-1210.

11Department of Health and Human Services Centers for Disease Control and Prevention. (2007). Breastfeeding practice—results from the National Immunization

Survey: Table 1. Breastfeeding rates by socio-demographic factors, among children born in 2004. Retrieved July 28, 2007, from http://www.cdc.gov/breastfeeding/data/NIS_data/data_2004.htm.

12Department of Health and Human Services Office on Women’s Health. (2000). HHSblueprint for action on breastfeeding. Retrieved July 28, 2007, from

http://www.womenshealth.gov/Breastfeeding/bluprntbk2.pdf.

ReferencesReferences13Gibson-Davis, C., & Brooks-Gunn, J. (2006). Couples’ immigration status and ethnicity

as determinants of breastfeeding. American Journal of Public Health, 96(4),

641-46.14Hannon, P.R., Willis, S.K., Bishop-Townsend, V., Martinez, I.M., & Scrimshaw, S.C.

(2000). African-American and latina adolescent mothers’ infant feeding

decisions and breastfeeding practices: A qualitative study. Journal of Adolescent

Health, 26(6), 399-407.15Hauck, Y.L., & Irurita, V.F. (2003). Incompatible expectations: The dilemma of

breastfeeding mothers. Health Care for Women International, 24(1), 62-78.16Klaus, M.H., & Kennel, J.H. (1976). Maternal-infant bonding. St. Louis, MO: The C.V.

Mosby Company. 17Knaak, S. (2005). Breast-feeding, bottle-feeding and Dr. Spock: The shifting context of

choice. Canadian Review of Sociology and Anthropology, 42(2), 197-216. 18Mahoney, M., & James, D. (2000). Predictors of anticipated breastfeeding in an urban,

low-income setting. The Journal of Family Practice, 49(6), 529-33.19Noble, L., Hand, I., Haynes, D., McVeigh, T., MaeHee, K., Yoon, J.J. (2003). Factors

influencing initiation of breast-feeding among urban women. American Journal of

Perinatology, 20(8), 477-83.

ReferencesReferences20Pridham, K.F., Schroeder, M., Brown, R., & Clark, R. (2001). The relationship of a

mother’s working model of feeding to her feeding behavior. Journal of Advanced

Nursing, 35(5), 741-50.21Ryan, K.M., & Grace, V.M. (2001). Medicalization and women’s knowledge: The

construction of understandings of infant feeding experiences in post-WW II

New Zealand. Health Care for Women International, 22(5), 483-500.22Stancil, T.R., Hertz-Picciotto, I., Schramm, M., & Watt-Morse, M. (2000). Stress and

pregnancy among African-American women. Paediatric and Perinatal

Epidemiology, 14(2), 127-135.23Valenzuela, M. (1997). Maternal sensitivity in a developing society: The context of urban

poverty and infant chronic undernutrition. Developmental Psychology, 33(5),

845-55.

Thank you!Thank you!