Social Norms and Infant Feeding Myths: Implications for Clinical and Community InterventionsAlice Nelson1, Sherita Bullock2, Holly Widanka1, Patricia Brantingham2, Ann M. Dozier1

1University of Rochester Medical Center, Rochester, NY; 2Perinatal Network of Monroe County, Rochester NY

TABLE 1. OVERALL COMMUNITY BELIEFS AND RESULTS ACROSS TIME.

Totaln=33

2010n=14

2011n=19

Yes Heard

%

YesBelie

ve%

YesHear

d%

YesBelie

ve%

YesHear

d%

YesBelie

ve%

BF’s Impact on the MotherBF ruins the shape of the mother’s breasts. 56 23 77 18 42 26BF mothers cannot get pregnant. 25 12 54 21 5 5BF is painful. 90 67 100 62 83 71Mothers can be arrested for BF in public. 23 7 31 8 17 6BF will ruin the mother’s sex life. 11 0 23 0 0 0A mother who is BF cannot eat many of the foods she likes. 37 31 50 36 27 27BF makes the mother fat. 7 0 14 0 0 0A mother cannot take any meds while she is BF. 70 52 85 46 57 57BF ties the mother down. 39 19 54 29 27 8If a mother smokes, it is still better for her to breastfeed her baby than feed the baby formula. 33 55 54 46 36 64

BF is important for the mother to bond with baby.* NA NA NA NA 84 84A mother must wean her baby from BF if she gets pregnant again.* NA NA 25 17 NA NAA mother cannot breastfeed if she plans to go back to school.* NA NA NA NA 32 11A mother cannot breastfeed if she plans to go back to work or school.* NA NA 39 8 NA NAA mother cannot breastfeed if she plans to go back to work.* NA NA NA NA 22 22Adoptive mothers cannot breastfeed.* NA NA 46 25 NA NAMothers who breastfeed in public are harassed.* NA NA NA NA 44 50

BF’s Impact on the BabyBF influences a baby’s future sexual orientation. 0 0 0 0 0 0Night time BF causes dental problems for the baby. 14 18 15 23 13 13Breastfed babies cry a lot more than formula fed babies. 25 18 23 14 27 21BF will spoil the baby. 30 15 31 14 29 21

BF’s Impact on the FamilyA mother’s partner will find the mother less attractive if she breastfeeds. 16 3 33 8 5 0BF deprives the mother’s partner and other friends and family of their chance to bond with the baby.

25 10 39 14 13 7

Infant Feeding KnowledgeFormula is just as good as breast milk. 59 27 62 14 58 37Small-breasted women won’t have enough milk. 42 10 54 8 33 11BF takes more time than bottle-feeding. 63 47 55 31 68 58Mothers can NOT breastfeed after a cesarean section birth. 23 14 25 18 22 11After a year, breast milk loses all its nutritional value. 14 14 23 14 7 13Babies need to be fed cereal or baby food starting at 3 months old. 45 36 50 23 40 47

BF clothes and pumps end up costing just as much as formula. 39 32 46 23 33 40Adding cereal to a bottle will help a baby sleep through the night.* NA NA NA NA 63 74

A mother’s milk will “come-in” immediately after she gives birth.* NA NA 46 54 NA NABreast milk the first few days after birth is not good.* NA NA NA NA 5 0There is breast milk in formula.* NA NA NA NA 7 7

*Indicates question was only asked on one survey as represented by ‘NA’Abbreviations: BF, Breastfeeding; NA, not applicable

This study was funded by: PHS Grant # RO1-HD055191, Community Partnership for

Breastfeeding Promotion and Support (PI: Dozier).

For more information, contact:Ann Dozier, RN, PhD at 585-276-3998 or ann_dozier@urmc.rochester.edu

University of Rochester School of Medicine & DentistryDepartment of Public Health Sciences

• Breastfeeding rates among low-income US women remain low despite numerous initiatives.

• It is important to understand how myths about infant feeding may perpetuate community norms.

INTRODUCTION

• Using an assessment of community beliefs about an identified health disparity (i.e. infant feeding) as a way to identify major misconceptions among the targeted community to ultimately change community beliefs.

OBJECTIVE

• The current project aims to increase breastfeeding rates among low-income women in an Upstate New York County using a socio-ecological approach nested within a Community Based Participatory Research (CBPR) framework.

OVERVIEW OF GRANT

• Community Council (CC) members are primarily low-income, minority (African American and/or Hispanic), urban residents, at least 16 years of age and fall into one or more of these groups: men or women of childbearing age; men or women with children who have or have not been breastfed; or grandparents.

• Since October 2008 the CC has held 1.5 hour monthly meetings at a convenient local community meeting center to discuss various topics relating to infant feeding. To date, there have been 47 CC meetings.

COMMUNITY COUNCIL

The Breastfeeding Survey• The first survey deployed listed 27 statements. The following

year, the survey was revised based on discussion and included 30 statements. After reading each statement, members were asked to mark their answer to “Have you ever heard this?” (yes/no) and then “Do YOU believe this statement?” (yes/no). (Table 1.)

Procedure• Surveys were distributed at the beginning of 2 different

Community Council (CC) meetings. To not influence responses, surveys were completed anonymously and collected after completion. After the meeting, responses were aggregated and at the following CC meeting members participated in a discussion of the summarized results.

METHODS

• Debated items discussed with CC are bolded on Table 1.• Discussions about results provided opportunities for CC

members to reexamine their views and how beliefs influence infant feeding decision making.

• Those members unable to identify why they supported a belief tended to alter their view to be in accordance with accurate, more up-to-date information, and/or shifted to support the group norm.

• Factual information, even when presented by a professional, rarely convinced a member to change their belief unless a trusted family “expert” endorsed it.

• Overall, members were exceedingly hesitant to speculate about others’ beliefs, reinforcing the principle that the target population must be directly represented on CBPR teams.

KEY FINDINGS

• Relevant public health and clinical implications regarding breastfeeding include how to: identify what people actually believe; address erroneous information other than providing new information; counter the influence of personal, and not professional, advisors.

• Limitations: social desirability bias; small sample size; fluctuations in participation during survey administration

CONCLUSIONS