Theme 4 – Despite easy access to information there is limited

None of the groups within the non-Aboriginal cohort spoke of infant feeding practices that were close to WHO recommendations. Mothers who had successfully initiated and established breastfeeding were not fully aware of how long they should breastfeed. Although most of them spoke of struggling to breastfeeding, the biggest challenge appeared to be with maintaining exclusive breastfeeding in early infancy. Mothers who had exclusively breastfed for the first few months did not know that they are recommended to continue exclusive breastfeeding for at least six months.

“I think that child health generally recommends that you do it for a few months and then after that whatever really.” (26-year-old mother)

When discussions came up about breastfeeding beyond six months, grandmothers expressed reservations. They were not comfortable with infants being breastfed beyond the first year. When one grandmother spoke of breastfeeding children up to two and three years some of them reacted negatively stating it was “horrible” and “unnatural”. The perception of breastfeeding as normal and natural until six months and unnatural beyond one year provides a glimpse into the culture of breastfeeding experienced by grandmothers in this sample.

“I fed my daughter, but I couldn’t feed my son and I can remember feeling devastated because I couldn’t feed my son but some people, perhaps in the earlier years would feed them until they were two or three years old.” (65-year-old grandmother)

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“I actually didn’t like that, that’s horrible, that’s just unnatural.” (78-year-old grandmother)

Grandmothers acknowledged that mothers of today are feeding their infants longer than they did. Prolonged breastfeeding was not favoured by the grandmothers. The aversion to breastfeeding beyond the first year was also shared by mothers.

“I think for me it’s zero to twelve months, I breastfed quite comfortably in public to twelve months, and after twelve months I was like now, people start, what you’re still breastfeeding after twelve months, yeah, I am like she’s now fourteen months, fifteen months and then I pretty much stopped.” (36-year-old mother)

Breastfeeding up to four years is common in some traditional societies (Shostak, 1981). In a post-industrial society such as Perth, feeding up to two years of age if the mother is able to, is likely to be beneficial to both mother and child. In this sample, the majority of the parents and grandparents were not aware of the WHO recommendations and reported breastfeeding rates that fell short of the WHO and local public health recommendations, in terms of both duration and exclusivity of breastfeeding in early infancy.

6.3.3 General overview of the knowledge, beliefs and attitudes towards breastfeeding of Aboriginal and Torres Strait Islander participants

“…It’s lovely enjoying imparting some of the knowledge that I know that my mum gave to me to give to my kids and recognising all those little signs and stuff. It’s good fun being a grandmother and um sort of taking on that role, and it’s a different kind of love and feeling and affection, it’s just totally different, different than when your kids were born, completely different.” (52-year-old grandmother)

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Aboriginal grandmothers expressed positive attitudes and experiences towards breastfeeding. Breastfeeding was spoken of as the normal and best option for infant feeding. However, the younger grandmothers and mothers did report issues of milk inadequacy and began supplementing breastfeeding with infant formula in the initial months.

Participants in this cohort were predominantly from Noongar Country, which is the South West region of Western Australia. Their lived experiences involve navigating the post-colonial environment in Western Australia, while trying to maintain their culture and tradition. One grandmother in the cohort was removed from her family in early childhood and learned about her family and child care traditions through her extended kin. A few of the participants had raised families in the city, while others had raised children in the country. Grandmothers’ experiences varied significantly in the ways they spoke of how child rearing is viewed and experienced by older women in their communities.

All of the mothers in this cohort had given birth to their children at hospitals in the Perth metropolitan area. Many spoke about feeling discriminated against and shamed in their efforts to breastfeed in public. Although the mothers held positive attitudes and beliefs towards breastfeeding, they preferred to formula feed when in public for fear of embarrassment.

Analysis of the qualitative data from focus groups 14-17 (see Table 5.1) for participants’ characteristics presented in table 6.5, revealed four themes. First, mothers and grandmothers feel that the current societal conditions are not suited for breastfeeding in public and they feel uncomfortable about feeding in public. Second, grandmothers, or as they referred to themselves as “old girls”, expressed a positive attitude towards breastfeeding, which would help mothers establish and continue to

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breastfeed. Third, in addition to grandmothers within the Aboriginal community, matrilineal kin or “sister girls” have a strong influence on the mother’s infant feeding decisions. Finally, while traditional Aboriginal breastfeeding practices are similar to WHO recommendations for breastfeeding, assimilation into the post-colonial and materialistic culture had led some mothers to turn to breastmilk alternatives. The themes are presented in table 6.5 and discussed below with key quotes from the participants.

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Table 5.5 Codes and themes for Aboriginal and Torres Strait Islander mothers and grandmothers as it relates to breastfeeding Family

member In vivo codes (examples) Themes

Mother …breastfeeding it is not accepting like out in public like it used to be It promotes don’t breastfeed public

…you know you shouldn’t really do that in public…

Mothers do not feel supported in their efforts to breastfeed in public.

Grandmother …in my time was less of an issue to actually breastfeed No one ever looked at you or judged you back in the day But nowadays they say you can’t [breastfeed in public] Mother I was always taught growing up that breast is best

We were always told by our mums, aunties and nannas that it’s your maternal right.

My nan just teaching what breastmilk can do

Grandmothers or “old girls” have a positive view of breastfeeding and play a key role in helping mothers increase breastfeeding rates and duration. Grandmother …we’ll tell them you will be breastfeeding…

I did try and persevere because my mother told me I pressured her a little to breastfeed past twelve months Mother I just became their [sister’s children] wet nurse

…undid my sister’s bra and chucked my niece on the lap [helped feed her niece when her sister was ill]

I got my cousins and they would breastfeed When available matrilineal kin or “sister _{girls” in general form the support network} for breastfeeding mothers.

Grandmother The younger ones want their sisters or cousins It’s more the sister girls now

It’s really hard to say [for the grandmother] let’s do this Mother She’s just adamant she’s gonna bottle feed the baby

There was no social media so it wasn’t an issue

She was working and she needed to get back into the work force Traditional Aboriginal breastfeeding practices are closest to WHO

recommendations, but inadequate societal support is causing a shift away from it. Grandmother Nyoongar mums will have their tin of milk their couple of bottles…

…so all my encouraging didn’t do much good [daughter stopped breastfeeding] I see more one sort of putting on the bottle straight away

It’s the modern world…if you can’t breastfeed…there’s all these different formulas

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6.3.3.1 Theme 1 – Mothers do not feel supported in their efforts to breastfeed in public Aboriginal and Torres Strait Islander mothers reported negative experiences of breastfeeding in public. Mothers who participated in this study said they felt embarrassed and uncomfortable when they chose to breastfeed their infants in public. One mother described her experience of being approached by a stranger and was told not to breastfeed in public. The law in Australia has incorporated the Innocenti Declaration which aims to protect, promote and support breastfeeding (ABA, 2015; WHO, 2011a; UNICEF, 2014a). However, participants felt that they could not comfortably breastfeed in public for fear of being shamed.

“…I was breastfeeding one time when he started getting better I had the cloth over me and I had this one lady come up and she said ah you know you shouldn’t really do that in public and I said look my culture has been breastfeeding for millenia before your mob come here and we still gonna be doing it millennia from today. I said this is what my grandparents have taught me to do and this is what my mum has showed me to do I said so I am doing it, but I just said to her what’s the difference between you breastfeeding your baby and me breastfeeding my baby?” (31-year-old mother).

Grandmothers felt that mothers needed more support and encouragement to breastfeed in public. However, the sense of constantly being watched and monitored does not help encourage the intimate nature of breastfeeding in public. The consensus was that, despite being promoted as the best source of nutrition for infants and the myriad of health benefits for the mother, breastfeeding in public was not acceptable.

“No, it promotes don’t breastfeed publicly, there’s more negative views of breastfeeding in public than there are positive views of it. There are positive

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views of breastfeeding but then again breastfeeding in public is not good, so it’s like mixed signals.” (29-year-old mother)

Participants felt that the issue was not specifically breastfeeding, but rather the sexualisation of the breast.

“I think the breastfeeding is not the problem it’s the breast, pulling your boob out and being shamed that’s the problem.” (Mother, age not available)

Aboriginal culture promotes breastfeeding modestly in public for a number of reasons, one of them being to avoid jealous confrontations between the mothers’ partner and other male members who may be present. Even within their homes mothers and grandmothers said they would remove themselves from the company of male members of the family to breastfeed. Where modesty is promoted, and breastfeeding is viewed as positively as in this population, more effort is required to encourage and support breastfeeding in public.

6.3.3.2 Theme 2 – Grandmothers or “old girls” have a positive view of breastfeeding