title: Pressure and judgement within a dichotomous landscape of infant feeding: a grounded theory study to explore why breastfeeding women do not access peer support provision.
abstract: Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) is a recommended intervention to increase breastfeeding rates, a number of studies identify that engagement with BPS is problematic. Due to paucity of research in this area, this study explores why breastfeeding women do not access BPS in South-West England. Utilising a constructionist grounded theory approach, 33 participants (women (n = 13), health professionals (n = 6) and peer supporters (n = 14)) participated in a semi-structured interview (n = 22) or focus group (n = 11). Analysis involved open coding, constant comparisons and focussed coding. One core category and three main themes explicating non-access were identified. The core category concerns women's experiences of pressure and judgement around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, 'place and space of support', describes the contrast between perceived pressure to breastfeed and a lack of adequate and appropriate support. Theme two, 'one way or no way', outlines the rules-based approach to breastfeeding adopted by some health professionals and how women avoided BPS due to anticipating a similar approach. Theme three, 'it must be me', concerns how lack of embodied insights could lead to 'breastfeeding failure' identities. A background of dichotomised language, pressure and moral judgement, combined with the organisation of post-natal care and the model of breastfeeding adopted by health professionals, may inhibit women's access to BPS. A socio-cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted.
authors.affiliation: The Learning Institute, Roche, Cornwall, UK.
authors.forename: Louise
authors.identifier: 0000-0002-3895-1202
authors.initials: L
authors.lastname: Hunt
authors.affiliation: Maternal and Infant Nurture and Nutrition Unit (MAINN), University of Central Lancashire, Preston, Lancashire, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Thomson
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003376:Counseling; D004739:England; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006282:Health Personnel; D006801:Humans; D010379:Peer Group; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: breastfeeding; grounded theory; non-access; peer support; qualitative