Cultural differences

Why do people have different attitudes toward breastfeeding?

Attitudes toward breastfeeding are shaped by culture and personal experiences. Cultures are changing rapidly because of immigration, advances in communication, travel, marketing, and social media. In North America and Europe, cultural change has led to a decline in breastfeeding rates in the past century. Some cultural beliefs promote breastfeeding and others work against it, like the belief that colostrum is bad or that babies must feed on a schedule. Culture can also affect the breastfeeding attitudes of partners, health-care providers, and governments.  

A) Describing culture

Our culture is a set of beliefs, values, and behavioural guidelines that we learn from the people around us. Culture influences how we define ourselves, fit into society, and live our lives.

Culture also influences families as they decide on food choices, parenting styles, and so on. Cultural differences can cause conflict within families and isolate mothers and families within their communities. Good communication helps people find common ground.

Culture changes in response to internal and external forces. Recently these changes have accelerated because of immigration, advances in communication, travel, marketing, and social media.

The decrease in breastfeeding rates in North America and Europe in the past century is a good example of a change in culture. While some of this was driven by industrialization and women entering the paid workforce, the erroneous belief that infant formula-feeding is as good as breastfeeding had a significant role. Infant formula companies continue to use this marketing strategy.

B) Impact of culture on breastfeeding

People make decisions about breastfeeding based on their unique circumstances, culture, and experiences (Daglas 2012; Scott 2015).

Cultures vary widely in their support and acceptance of breastfeeding and this is reflected in the wide range of national breastfeeding rates.

Some cultural beliefs do not support breastfeeding and result in lower rates of starting breastfeeding and exclusive breastfeeding and short lengths of any breastfeeding. These include:   

Immigrants may or may not adopt breastfeeding practices common in their new countries (Bigman 2018; González-Pascual 2018).

Culture can also negatively affect the breastfeeding attitudes of:

C) Confinement and other cultural practices in the weeks after birth

Around the world, there are a great variety of cultural traditions associated with the weeks following the birth of the baby. These may include rest, traditional foods, avoidance of other foods, and rituals.

Many cultures encourage mothers to limit their activities in the first few weeks after birth. This practice has been given various names in different languages: confinement, lying-in, sitting the month, and twenty-one or forty days.

Such rest gives mothers the opportunity to recover from childbirth and get to know their babies (Dennis 2007). Mothers may benefit from limiting the number of visitors and mothers and their baby may benefit from avoiding contact with others who may be ill.

Healthy diets allow mothers to recover more quickly and give them the necessary energy to care for their babies.

Certain cultures have other rituals. Examples include (Fok 2016; Geçkil 2009; Withers 2018):

  • Avoiding cold and wind
  • Not having any contact with water
  • Warm, herbal baths for mother
  • The use of steam rooms
  • Not holding the baby
  • Massages
  • Wrapping the abdomen
  • Wrapping the baby in a yellow cloth to prevent jaundice
  • Seclusion

Some rituals can be supportive, are appreciated by new mothers, and may decrease the risk of depression but others can be onerous (Grigoriadis 2009; Wong 2009) or interfere with breastfeeding. Some may even be dangerous.

For example, some women are shunned and isolated after birth due to the passing of blood vaginally. This can result in barriers to health care and the use of substandard or dangerous housing (Sharma 2016).

References

Bigman G, Wilkinson AV, Pérez A, et al. Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review. Matern Child Health J. 2018 Jul 12
 
Bonet M, Forcella E, Blondel B, et al. Approaches to supporting lactation and breastfeeding for very preterm infants in the NICU: a qualitative study in three European regions. BMJ Open. 2015 Jun 30;5(6):e006973
 
Daglas M, Antoniuk E. Cultural views and practices related to breastfeeding. Health Sci J. 2012; 6(2)
 
Dennis CL, Fung K, Grigoriadis S, et al. Traditional postpartum practices and rituals: a qualitative systematic review. Womens Health (Lond). 2007 Jul;3(4):487-502
 
Fok D, Aris IM, Ho J, et al. A Comparison of Practices During the Confinement Period among Chinese, Malay, and Indian Mothers in Singapore. Birth. 2016 Sep;43(3):247-54
 
Geçkil E, Sahin T, Ege E. Traditional postpartum practices of women and infants and the factors influencing such practices in South Eastern Turkey. Midwifery. 2009 Feb;25(1):62-71. Epub 2007 Mar 1
 
González-Pascual JL, Aguilar-Ortega JM, Esteban-Gonzalo L, et al. Comparison of attitudes to breastfeeding among Spanish-born and Chinese-born postpartum women in Madrid. Int Breastfeed J. 2018 Oct 3;13:45
 
Grigoriadis S, Erlick Robinson G, Fung K, et al. Traditional postpartum practices and rituals: clinical implications. Can J Psychiatry. 2009 Dec;54(12):834-40
 
Scott JA, Kwok YY, Synnott K, et al. A comparison of maternal attitudes to breastfeeding in public and the association with breastfeeding duration in four European countries: results of a cohort study. Birth. 2015 Mar;42(1):78-85
 
Sharma S, van Teijlingen E, Hundley V, et al. Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal. BMC Pregnancy Childbirth. 2016 Jul 5;16(1):147
 
Thorvaldson G. Was there a European breastfeeding pattern? The History of the Family 2008;13(3): 283
 
Withers M, Kharazmi N, Lim E. Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery. 2018 Jan;56:158-170
 
Wolf J. Low Breastfeeding Rates and Public Health in the United States. Am J Public Health. 2003 December; 93(12): 2000–2010
 
Wong J, Fisher J. The Role of Traditional Confinement Practices in Determining Postpartum Depression in Women in Chinese Cultures: A Systematic Review of the English Language Evidence. J Aff Disorders 2009; 116(3):161-9
 
World Health Organization, United Nations Children’s Fund (WHO/UNICEF) Global Breastfeeding Collective. Global breastfeeding scorecard; tracking breastfeeding policies and programmes. Geneva: World Health Organization; 2017