Shifting identities: social and cultural factors that shape decision making around sustaining breastfeeding

In the UK, women’s beliefs, attitudes and behaviours around breastfeeding are shaped by myriad influences and by changing social and structural factors and cultural mores. Whilst public health discourse equates breastfeeding with ‘good mothering’ and health professionals emphasise ‘breast as best’, these normative values compete with other standards or criteria of ‘good mothering’ held by others within women’s social networks that exert influence on them. Moreover, cultural and structural factors affecting the pattern of women’s labour market participation, specifically public policy emphasis on return to paid work aligned with policies directed at reconciling work and family act as constraints on sustaining optimal breastfeeding i.e. exclusive breastfeeding for six months as advised by the World Health Organisation (2003).
For women in this study, initiating and sustaining breastfeeding was subject of a complex process that contributed to multiple valued outcomes: nurturing thriving and healthy babies, experiencing themselves as ‘competent’ mothers, successfully managing shifting identities and negotiating competing pressures in the real life context of their daily lives and relationships with ‘significant others’. Even as women struggled to present and see themselves as ‘good mothers’, they were active agents and not just acted upon. They sought to reconcile the value they placed on breastfeeding with seeing themselves and being seen by others as ‘good mothers’. Thus, they sought out situations where breastfeeding was highly valued (such as support groups), and developed strategies to counter or avoid threats to their sense of themselves as nurturing and competent mothers that was related to, but not synonymous with sustaining breastfeeding.
Midwives and health visitors in this study encouraged women to breastfeed but not in the way that this is generally portrayed in much of the current literature. Analysis of observed interactions between women who had chosen to breastfeed and midwives and health visitors suggests more of a negotiated encounter in which these health professional considered the whole situation of the woman and her struggle to be a ‘good mother’.