I am enjoying this tread about the influence of poverty on bf. I agree with
the wise comments of Chris Mulford about the constrained choices available
to
impoverished women. For women struggling to survive, infant feeding
"choices"
are often an abstraction.
I just finished an ethnography of infant feeding decisions among Black women
enrolled in WIC. I interviewed/observed 319 mothers, fathers, babies,
grandmothers, friends and other relatives over an 18 month period. From this
group, I also followed 11 primiparous key informants throughout pregnancy
and
the first year postpartum. I explored infant feeding beliefs and experiences
over time and met with these individuals in WIC, their homes, postpartum
units, NICU, malls, McDonald's etc so that I could understand their
decisions
within the context of their everyday lives. I have worked with impoverished
families in hospitals and communities in the past, but nothing prepared me
for the profound effects of poverty on the lives of these young mothers and
children.  Almost every one of the key informants had high risk pregnancies.
Loss and all-encompassing stress were pervasive. It was often hard to
comprehend how such young women could endure such difficult, difficult
lives.
The mothers struggled against tremendous daily adversity to do right by
their
babies. They had strong beliefs in the value of independence and felt
compelled to help their babies achieve early independence so that they would
be prepared to confront inevitable struggle as they grew up. They had
minimal
to no exposure to bf in their past or present lives. Bottle feeding was the
norm among their families and friends, and nurses and physicians offered
mixed messages and unsupportive practices in the hospitals. WIC was an oasis
of kindness which made the women be more open to breastfeeding messages.
This
kindness went a LONG way and about half the key informants initiated
breastfeeding (against many odds). The breastfeeding women had the most
changes in infant feeding beliefs in this study. They were surprised that bf
was not painful, reacted positively to their new roles as mothers, enjoyed
the ease of night time feeding and commented frequently about the closeness
with their babies even after weaning. Interestingly, these women modified
their ideas about independence and bf. Several bf women told me that if
their
babies were stronger, smarter and healthier from bf that they would be
better
prepared to face the challenges of inner city life. The strength of these
women was amazing and was often buttressed by their religious beliefs.
Impoverished women need our encouragement and support. Listening to their
stories and their concerns is so important to understanding and is a
precursor to any change in infant feeding practices.
Roberta Cricco-Lizza RN MPH PhD

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