Breastfeeding among high-risk inner-city African-American mothers: a risky choice?

Breastfeed Med. 2013 Feb;8(1):58-67. doi: 10.1089/bfm.2012.0012. Epub 2012 Jul 23.


Objective: This study identified barriers to breastfeeding among high-risk inner-city African-American mothers.

Subjects and methods: We used audiotaped focus groups moderated by an experienced International Board Certified Lactation Consultant, with recruitment supported by the community partner MomsFirst™ (Cleveland Department of Public Health, Cleveland, OH). Institutional Review Board approval and written informed consent were obtained. Notes-based analysis was conducted with use of a prior analytic structure called Factors Influencing Beliefs (FIBs), redefined with inclusion/exclusion criteria to address breastfeeding issues.

Results: Three focus groups included 20 high-risk inner-city expectant and delivered mothers. Relevant FIBs domains were as follows: Risk Appraisal, Self Perception, Relationship Issues/Social Support, and Structural/Environmental Factors. Risk Appraisal themes included awareness of benefits, fear of pain, misconceptions, and lack of information. Self Perception themes included low self-efficacy with fear of social isolation and limited expression of positive self-esteem. Relationship Issues/Social Support themes included formula as a cultural norm, worries about breastfeeding in public, and challenging family relationships. Structural/Environmental Factors themes included negative postpartum hospital experiences and lack of support after going home.

Conclusions: Several findings have been previously reported, such as fear of pain with breastfeeding, but we identified new themes, including self-esteem and self-efficacy, and new concerns, for example, that large breasts would suffocate a breastfeeding infant. The FIBs analytic framework, as modified for breastfeeding issues, creates a context for future analysis and comparison of related studies and may be a useful tool to improve understanding of barriers to breastfeeding among high-risk inner-city women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / psychology*
  • African Americans / statistics & numerical data
  • Anecdotes as Topic
  • Anxiety
  • Breast Feeding / psychology*
  • Breast Feeding / statistics & numerical data
  • Choice Behavior
  • Counseling
  • Decision Making*
  • Female
  • Focus Groups
  • Health Education / methods*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Male
  • Maternal Welfare
  • Mother-Child Relations
  • Mothers / education
  • Mothers / psychology*
  • Ohio
  • Pregnancy
  • Risk Assessment
  • Social Support
  • Spouses / education
  • Spouses / psychology*
  • Urban Population*
  • Young Adult