Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach

Abstract

Breastfeeding has health benefits for both infants and mothers, yet Black mothers and infants are less likely to receive these benefits. Despite research showing no difference in breastfeeding intentions by race or ethnicity, inequities in breastfeeding rates persist, suggesting that Black mothers face unique barriers to meeting their breastfeeding intentions. The aim of this study is to identify barriers and facilitators that Black women perceive as important determinants of exclusively breastfeeding their children for at least 3 months after birth. Utilizing a Barrier Analysis approach, we conducted six focus group discussions, hearing from Black mothers who exclusively breastfed for 3 months and those who did not. Transcripts were coded starting with a priori parent codes based on theory‐derived determinants mapped onto the Socioecological Model; themes were analysed for differences between groups. Facilitators found to be important specifically for women who exclusively breastfed for 3 months include self‐efficacy, lactation support, appropriate lactation supplies, support of mothers and partners, prior knowledge of breastfeeding, strong intention before birth and perceptions of breastfeeding as money‐saving. Barriers that arose more often among those who did not exclusively breastfeed for 3 months include inaccessible lactation support and supplies, difficulties with pumping, latching issues and perceptions of breastfeeding as time‐consuming. Lack of access to and knowledge of breastfeeding laws and policies, as well as negative cultural norms or stigma, were important barriers across groups. This study supports the use of the Socioecological Model to design multicomponent interventions to increase exclusive breastfeeding outcomes for Black women.

Abstract

Utilizing a Barrier Analysis approach, we conducted six focus group discussions, hearing from Black mothers who exclusively breastfed for 3 months and those who did not. Facilitators found to be important specifically for women who exclusively breastfed for 3 months include self‐efficacy, lactation support, appropriate lactation supplies, support of mothers and partners, prior knowledge of breastfeeding, strong intention before birth and perceptions of breastfeeding as money‐saving. Barriers that arose more often among those who did not exclusively breastfeed for 3 months include inaccessible lactation support and supplies, difficulties with pumping, latching issues and perceptions of breastfeeding as time‐consuming.

Key messages

• Black mothers face unique barriers to meeting their breastfeeding intentions across the Socioecological Model. Inaccessible lactation support and supplies, the perception that breastfeeding is time‐consuming and physiological and technical issues are important barriers to breastfeeding among Black mothers in New Haven, CT. A lack of knowledge about breastfeeding laws and policies, particularly in the workplace, poses an important barrier to breastfeeding among Black women.

• Black mothers also face important facilitators to meeting their breastfeeding intentions across the Socioecological Model. Support from mothers and partners, prior breastfeeding knowledge, a strong intention to breastfeed before birth and perceiving breastfeeding as money‐saving are all important facilitators to breastfeeding among Black mothers in New Haven, CT. Multicomponent interventions guided by the Socioecological Model are needed to improve breastfeeding outcomes in Black women.