Choice or Circumstance? An exploration of breastfeeding practice among Nova Scotian mothers classified as overweight or obese and income-related food insecure

Abstract

Breastfeeding is a complex, relational practice spanning bio-physiological, social and structural considerations. Consistently, mothers across Nova Scotia report lower rates of breastfeeding initiation and duration of exclusive breastfeeding compared with mothers from other Canadian provinces. While breastfeeding is represented as a contributor to obesity prevention and supportive of food security (both timely public health issues for Nova Scotia), evidence suggests that excess maternal body weight and income-related food insecurity may negatively impact breastfeeding practice and outcomes. This qualitative study explored breastfeeding expectations and experiences among Nova Scotians also identifying as income-related food insecure and overweight or obese. Informed through feminist, post-structural methodology, this inquiry aimed to identify dominant discourses that shaped understandings of breastfeeding, excess body weight and food (in) security among participants who identified as living within these contexts, specifically how these discourses informed participants’ breastfeeding experiences and practices. Eight participants who were pregnant for the first-time with intention to breastfeed were invited to participate in three, separate, face-to-face, audiotaped interviews (prenatal, first month postpartum and 3 months postpartum) and six participants completed the study. Discourse analyses were conducted with prenatal (n=8) and postpartum (n=12) interviews. Findings suggest that the participants’ prenatal understandings of breastfeeding, obesity and food (in)security aligned with dominant discursive representations of these health issues, and informed through a socially constructed normative understanding of what it means to mother in a good and proper way. That is, participants identified that choosing to breastfeed, preventing obesity, and avoiding food insecurity are responsibilities of “good” mothering. These discourses were reinforced through exposures with institutions throughout the perinatal and postpartum period. Once participants became mothers, their experiences with breastfeeding during this time were largely shaped with a continued attendance to these dominant discourses. However, some participants resisted and reframed their conceptualization of good mothering to identify with maternal subjectivities that were both situation and context-specific. Ethical, supportive practice requires practitioners to critically reflect on how discourses shape normative maternal identities and their effects for health-related parenting practices that include breastfeeding.