“We’ve got to first learn that breastfeeding is for us”
Gross, Tyra Toston
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African-Americans have the lowest breastfeeding rates in comparison to other racial/ethnic groups in the United States. Few studies have examined the breastfeeding experiences of African-American women. The purpose of this qualitative research study was to explore the breastfeeding experiences of low-income African-American women using the Positive Deviance Approach. Positive Deviance is an asset-based model that works within resource poor communities to identify individuals who have achieved a desired health outcome, such as breastfeeding despite their risk factors (i.e. race and income). The Theory of Planned Behavior served as the conceptual framework for this study. Three research questions guided this Positive Deviance Inquiry: (1) How did mothers form the intention to breastfeed during pregnancy? (2) What enabled mothers to initiate and maintain breastfeeding during the first few weeks after birth? (3) What enabled mothers to continue breastfeeding for 6 months or longer? In the first study, 3 focus groups were conducted with 23 WIC breastfeeding peer counselors (PCs) to better understand breastfeeding in low-income African-American women. Three main themes emerged: Breastfeeding Intentions-“I had no idea when I was pregnant”, Breastfeeding Initiation-“Even if she doesn’t continue”, and Breastfeeding Continuation-“We’re still having a problem with our duration. In the second study, individual interviews were conducted with 11 African-American mothers identified as Positive Deviants, who were WIC recipients, had breastfed one child for at least 6 months. Four main themes developed: Deciding to Breastfeed-“When I found out the benefits”, Initiating Breastfeeding-“In the beginning, it was hard”, Breastfeeding Long-Term “Dedication, patience, commitment, and sacrifice”, and Gaps in Breastfeeding Support-“Push the issue more.” An additional theme emerged using data from both studies. Historical & Socio-cultural Complexities describes larger historical and socio-cultural variables impacting breastfeeding norms that are unique to African-American women. Findings from both studies indicate gaps in breastfeeding support that should be addressed using a socio-ecological approach. Despite low breastfeeding rates nationally, African-American women with lower-incomes are able to breastfeed with adequate social support and commitment. Lessons learned from Positive Deviants can be used in designing culturally-tailored breastfeeding interventions. Future research should examine the historical and socio-cultural complexities influencing African-American women’s breastfeeding behaviors.