attitudes toward breastfeeding in perth, australia.pdf

8/14/2019 Attitudes Toward Breastfeeding in Perth, Australia.pdf

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Attitudes toward Breastfeeding in Perth Australia: Qualitative AnalysisJ A N E A . SCOT T CO L I NW. B I N N S R U T HV. A RN O L D

School of Publ ic Heal th, C urt i n University of Technology, Perth, Western Australia, 6 001

ABSTRACT Breastfeeding is promoted as the preferredmethod of feeding for infants up to at least the age of 4 to 6months. While the majority of Australian mo thers initiatebreastfeeding , approxim ately half have term inated b reastfeedingbefore 6 m onths p0stpartum.A series of focus groups were con-ducted to identify societal attitudes to breastfeeding that mayhave a negative impact on bre astfeeding duration.Analysis of thedominant themes to emerge from the focus group interviewsindicate that (1) there is general agreement that breastfeedingin pub lic is socially acceptable, provided the w oman does so dis-creetly; (2) appropriate facilities should be provided in placesfrequented by you ng families where mothers can breastfeed inprivate, should they choose to do so; 3) fathers should beincluded in all pre- and perinatal breastfeeding classes and thecontent of the classes should be expanded to incorporate theimportance of the supporting role of the partner; (4) breast-feeding classes should address the issue of breastmilk insuffi-ciency (real and perceived) to allay the common concerns ofmothers; and (5) teenage girls and boys should be the target ofschool-based breastfeeding educa tion programs that address thepsychologica l and sexual aspects of breastfeeding , in ad dition tothe nutritive and health benefits.

I N T R O D U C T I O NBreastfeeding is recognized as on e of the most natural andbest form s of preventive medicine ' and is prom oted as thepreferred me thod of feeding for infants up t o at least the ageof 4 t o 6 months. ' In Australia, the curre nt goal is for 90%of infants to b e breastfed on hospital discharge and for 80%to be either fully or partially breastfed at 6 months of age.3How ever, in spite of the widespread supp ort for breastfeed-ing a mo ng the general public an d health professionals alike,the m ajority o f infants in Australia and o the r We stern cou n-tries have been taken from the breast before 6 months ofage.4s5

Despite the fact that the public is often confronted withthe sight of bare breasts o n public beaches, television, film,and in magazines, many people are embarrassed, or in somecases even offended, by the sight of a wom an breastfeedingin pub1ic.A~ resul t, wom en fro mw estern cul tures are oftenembarrassed or apprehensive abo ut breastfeeding in public.This embarrassment may contribu te to the early term inationof breastfeeding.

Most research in the area of breastfeeding has concen-trated o n eithe r the nutr itional and h ealth benefits of breast-feed ing or the ep idemio logy of b reas t feed ing . L imi tedresearch has been cond ucted into th e psychosocial or behav-ioral aspects o f breastfeeding, especially in Australia. How ever,in ord er to encourage and su pport breastfeeding in general,and to increase the social acceptability of breastfeeding inpublic, i t is necessary to first explore and understand publicattitudes toward breastfeeding.

T he use of more objective quantitative research methodssuch as face-to-face, telephone, or mail surveys often do notprovide useful insights into de terminants of intimate an d sen-sitive health b ehaviors such as sexual practices or, in this case,th e practice o f breastfeeding.An alternative, qualitative researchtechnique is the focus group that attempts to uncover, under-stand, and explain the feelings and opinio ns that exist in a tar-get group.'j W hile quantitative research attempts to identifywh t people do and how m ny do it, qualitative research focuseson the underlying reasons for why people do it .

Focus groups are commonly used in market research andare being used mor e frequently in health promo tion planningan d r e s e a r ~ h . ~he y are frequently used to ide ntify needs forservices and programs, to pretest materials and strategies as ameans of process evaluat ion during the implementat ionphase of programs, and, following implementation, to sup-plement quantitative impact and outco me evaluation data.6-'0

W hile various researchers have identified that certain groupsof wom en are embarrassed o r uncomfortable with breastfeed-i ng i n p ~ b l i c , . ' ~ew have explored the reasons behind theiremba rrassment. For this reason, a series of focus groups w erecon ducte d to (1) ide ntif j attitudes and beliefs related to breast-feeding not readily detected using quantitative research tech-niques and (2) generate questions and terminology for a sur-

Address for correspondenc e: Jane Scot t B.App.Sc. Grad. Dip. D~e t. M.P.H. PFK vey instrument to be used in a large prospective study ofEdinburgh Ltd. Institute for Medlcal Research 7 Walker Street Edinburgh ScotlandEH3 71Y.Tel: 44 131 220 4456: Fax: 44 131 220 4666. breastfeeding practices amon g wo me n &o m socioeconomicallyO I ~ ~ ; S O C I E T Y OR NUTRITION EDUCATION disadvantaged groups, to be c ond ucted at a later date.


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Journal of Nutrition Education Volume 29 Number 5 September October 1997 245

METHODS Photograph : A mother breastfeeding a toddler dressed inplay clothes and sandals.

A total of 10 focus groups were co nducted involving 79 par-t icipants. Group size ranged from 4 to 16 with most groupscomprising from to 9 participants. Each focus group ran for60 to 90 minutes and was led by a t rained m oderator of thesame sex as participants to avoid potential problems of awk-wardness and embarrassment. As a wide range of opinionswas desired, a num ber of different group s were interview ed:

1 Mothers of infants and small children (Mothers'group22 participants-4 grou ps);2 Fathers of infants and small childr en (Fathers'group 7participants-1 group);3 Male university stude nts (Students'group 25 partici-pants-2 groups);4. Ado lesce nt girls (Girls ' group 1 8 participants-2groups); and5 Nurs ing Mothers Associa t ion of Aus tra li a (NM AA )mem bers and counsellors (NM AA group 9 partici-pants-1 group).

With the except ion of male s tudents and NM AA membersand counsellors, participants were recruited from busy shop-ping centres in two lo w-in com e areas in Per th. University stu-dents were recruited on campus and NMAA participantswere recruited directly from a local branch of the NMAA.AUpotential participants were advised that they would be dis-cussing infant fe edin g practices. Ch ild c are was available for th egroups involving mo thers and a 10 participation fee was paidto each of the m ale university students and adolescent girls. N oattempt was made to randomly select participants as the pri-mary objective of the focus groups was to generate conceptsand ideas rather th an prov ide representative data.

Certain predefined topics were addressed in the initialfocus groups a nd these topics, as well as issues and conc ernsraised in early interviews, directed the course of subsequentinterviews. In order to allow the conversation to proceed asnaturally as possible, the topics were no t always raised in t hesame sequence o r posed in exactly the same way for each focusgr0up.A series of five photographs were used to trigger dis-cussion and explore participants' attitudes to breastfeeding ingeneral and, in particular, breastfeeding in public. The pho-tographs were specifically taken fo r use in the focus groups andwere enlarged to 20 X 30cm-size prints for easy viewing.T heyfeatured wo me n breastfeeding in a variety of situations:Photograph 1: A m oth er discreetly breastfeeding an infant o n

a public bus.Photograph 2: A m oth er discreetly breastfeeding an infant ina cafeteria in mixed company.Photograph : A mo the r discreetly breastfeeding at a privatesocial gatherin g in mixed company.Photograph 4: A mother breastfeeding an infant in the pri-vacy of her o wn h ome , wearing a bathrobethat was ope ned to reveal both breasts.

The majority of participants appeared to be candid intheir responses and comfortable with the topic discussed.Conve rsations were tape-recorded (with the consent of par-ticipants) and later transcribed.Data analysis Each transcript was read and analyzedindependently by two separate analysts US and RA) toreduce the r isk of b iased in te rp re ta t i~n .~nalysis of the focusgroup discussions followed the procedure recommended byKreuger.13Summaries of the focus groups were written at thecom pletion of each discussion. Each analyst read these sum-maries in one s i tt ing and made notes o n potent ial t rends andpatterns. Strongly held opinions an d frequently held opinion swere noted . T he t ranscripts o f the focus groups were the nreviewed with each analyst marking sections of the transcriptthat related to each of the photographs used to trigger dis-cussion. At this time, participant com men ts thoug ht w orthyof future discussion were marked. Each of the correspond-ing tapes was listened to during this process to ensure thatparticipants were correctly identified and that statementswere ac curate and com plete. Particular attentio n was paid tothe to ne and intensi ty of the oral comm ents to ensure thatcorrect emphasis was placed o n the written comm ents.At th eend of this process, a variety of d ominant themes had beenidentified by each analyst.Each analyst re-read the transcripts and listened to thetapes concent ra t ing on one them e a t a t ime.A summary ofeach theme was prepared with part icular at tent ion beingplaced on identi+ing themes or patterns across the grou ps aswell as themes that related to resp ondents with similar char-acteristics.A final repo rt was prepared that highlighted d om -inant themes an d i l lustrated the m with selected com ments .In general, there was good inter-rater reliability, and the dom -inant them es discussed in this paper were readily an d inde-pendently identified by both analysts.A limiting factor in the study is the fact that only onefocus group was held with each of the fathers' and nursingmoth ers' gro ups. Th is introduces a potential f or bias as, infocus group design, one strong individual can influence awhole group. However, while recognizing this as a designflaw, it does not appear t o have significantly influenced th eresults as, in most cases, the themes identified in these tw ogroups were common across all groups.

F IN D I N G S A N D I N T E R P R E T A T IO N SContent analysis revealed a number of distinct themes withrelevance for breastfeeding prom otion.Breastfeeding in public In most cases, breastfeeding inpublic was seen by moth ers an d fathers of young infants andchildren as bein g rou tine, necessary, and often unavoidable. In


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46 Scott et al./AUSTRALIAN BREASTFEEDING ATTITUDESgeneral, the fathers interviewed had no problems with theirwives breastfeeding in public and defended their right t o d o so:

I mean either they cry or you feed them- your baby is screaming-you don't have a lot of choice you just feed to keep the baby quiet.(Mothers' group)The male university students considered it appropriate,

unde r certain conditions, for wome n to breastfeed in public.In particular, if the child de ma nded to b e fed, it was preferableto breastfeed the child than to let the child cry an d annoy oth erpeople. However, among this group were some wh o thoughtthat while it was acceptable on public transport, where therewas no alternative, it was less acceptable in a public place suchas a restaurant. Several believed that if facilities we re available,for example, a restroom or toilet, the mo ther should leave thegroup and breastfeed in private. Ot he r students considered itinappropriate for a wom an to be exp ected to breastfeed in atoilet. Fathers, in particular, were likely to object to their wiveshaving to breastfeed in a toilet.

Adolescent girls were least likely to approve of breast-feeding in public but, while most said they wo uld like tobreastfeed their future children, they indicated that theywo uld bottlefeed w he n in public, as breastfeeding was embar-rassing. Th eir opinions expressed in response to th e pho to-graph of the woman discreetly breastfeeding on a bus weregenerally o ne of shame o r disgust. However, a few did indi-cate approval and support:

Th at is just so shamejul. That's the worst. (Girls' group)W he n asked if it would be appropriate to breastfeed on the

bus if the baby was sc reaming, most girls still indicated that itwas inappropriate and that the moth er should be prepared w itha bottle. Others were less offended by this scenario but, nev-ertheless, would still be embarrassed to breastfeed their ownchild o n a bus. Adolesce nt girls were inclined to think that awom an should find som ewhere else to breastfeed. In responseto th e photograph of the wom an breastfeeding at the cafete-ria, several thought that the act of breastfeeding would putother p eople off their food. W he n presented w ith th e possi-bility of there being no nursing roo m available, a num ber ofgirls suggested that th e m other retire to the toilet. Even then ,several indicated th at they still wo uld no t like to breastfeed inthe toilet if other w om en w ere present.

A nu mb er of mothers suggested that they had n o al ter-native but to breastfeed in public because of a lack of facili-ties. O th er m other s had resorted to breastfeeding in the toi-let rather than breastfeed in public:

W ha t else can you do i the baby is screaming hungry, in a restaurantor in a hotel or something?You go to the toilet, sit down on the lid, and

feed the baby. Whe re else are you going to do it? (Mothe rs' group)Mo rsel4 explored t he possibility that breastfeeding w om en

are banished to the toilet because breastfeeding is considered

to be an excretory func tion and breast milk is considereddirty and defiling. In the author's opinio n, it seems incon-gruous that while most people w ould brist le with horro r atthe thoug ht of eat ing or drinking in th e toi let, they acceptand even prom ote breastfeeding in a toilet as being a suitablealternative t o breastfeeding in public.

Unlike the mothers s tudied by Jones,15 w ho were gener-ally embarrassed to breastfeed in front of others, especiallyme n, wo me n in this study were no t particularly embarrassedto breastfeed in public o r in mixed company. How ever, theywere sensitive to th e feelings of others and recognized thatme n, in particular, mig ht be embarrassed o r awkward in theirpresence. Mothers were in general quite happy, and in sev-eral instances preferred to use nursing rooms, if available.How ever, in many instances, these rooms were either no nex -istent, inadequate, o r difficult to find.Discreet breastfeeding A strong theme to emerge fromall group s was the issue of discreet breastfeeding. W ith theexception of adolescent girls, there was a general acceptanceof wom en breastfeeding in public as long as it was performe ddiscreetly, that is, with a minimum of the breast showing.Ov ert public displays of breastfeeding were not consideredsocially acceptable by any of the gro ups interviewed . Even theNMAA members and counsellors, a group most likely todefend a woman's right t o breastfeed in public, did not sup-por t th e idea o f indiscreet breastfeeding, suggesting that suchbehavior did no t give breastfeeding a nice image.This suggeststhat wom en w ho breastfeed in public in a conspicuous fash-ion, that is, wit h their breasts overly exposed , will d o little t oadvance the social acceptance o f breastfeeding in public.

Most groups had a similar react ion w he n show n the pho-tograph of the wom an breastfeeding at hom e with her robeopen .The y considered i t appropriate for hom e but inappro-priate to show as much breast when in public. Indiscreetbreastfeeding was associated by some university studentsw ith left-wing radicals, greenies,* and feminists:

If you saw that in a public place you'd have every male in the popula-tion checking it ou t. It's not discreet and you're a dvertising. Tha t's whe n

you'd create a commotion (Fathers' group)A second photograph of a woman discreetly breastfeed-

ing in public received general approval, with the exceptionof adolescent girls.Embarrassment with witnessing breastfeeding Manyof the male university students indicated that while they wereno t offended by the sight of a wom an breastfeeding, they didexperience a degree of embarrassment o r awkwardness.Theywere less likely to feel embarrassed if they felt that themo the r was comfortable with breastfeeding in front of them .

An Australian slang term used to describe a com m~ tt ed onservationist. In this con-text, lt is used d~sparagingly.


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Fathers were also aware that their male friends, particularlythose witho ut children, might b e embarrassed whe n they sawa woman breastfeed.

There was general consensus among the mothers and thefathers that others were more embarrassed at the sight of awoman breastfeeding than the mother actually was withbreastfeeding in front of people. Some mothers and fathersthought that older people w ere mo re likely to be embarrassedthan younger people.While most mothers anticipated beingembarrassed breastfeeding in public before they had theirbaby, they not ed that they w ere qu ite comfo rtable onc e theyhad publicly breastfed for the first few times.

I thought I would be embarrassed when I j r s t started feeding-granted,I was embarrassed thej rs t ew days but then Ij us t got over it. (Moth-ers' group)Adolescent girls were the group least comfortable with

either the idea of witnessing a w oma n breastfeed in public, orwith being in the com pany of a wom an w ho was breastfeed-ing in public, even if they were doing so discreetlyThis reac-tion was similar to that described in studies from o the rw est -ern co untries and , in general, adolescents d o n ot considerbreastfeeding in public to be socially acceptable. CanadianteenagersI6 were slightly mo re liberal than English teenagersbut still did not consider it appropriate to breastfeed on thebus,'' in restaurants, the park, o r at th e shops. Bre ast-feeding should be confined to the privacy of the home. Inboth the Canad ian and English groups, acceptance decreasedas the presence of others, especially males, was added to thescene. Male university stud ents in this study also felt awkwa rdin the presence of a breastfeeding woman, but recognizedtheir right t o breastfeed in public. Th eir embarrassment wasminimized if they were in some way forewarned that themother was going to breastfeed in the ir presence.Breastfeeding etiquette. Another theme that emergedfrom the preceding them e in the two focus groups with uni-versity students was the conc ept of breastfeeding etiquette.They ack nowledg ed that, while it was a woman's right tobreastfeed in public, they we re less embarrassed if the w om anfirst asked their permission to breastfeed in front o f them , orat least acknowledged that she was going to breastfeed infront of them :

I'd still expect her-ifshe was in someone else's home and the kid wassc re am in cl 'd expect her to say Is it all right iflfeed? (Students'group)However, fathers strongly resented the suggestion that a

woman should ask permission to breastfeed:It's nothing to do with the otherpeople; it's her individual right that sheis going to breastfeed. (Fathers' group)

In one group, the adolescent girls scoffed at the idea ofasking othe r people's permission to breastfeed. H owev er, inthe sec ond gro up, this was suggested as a way of establishing

whether people were comfortable with a woman breast-feeding in th eir presence.Sexual role o f breasts versus functional role o f breasts.The theme of the sexual versus the funct ional role of thebreast was explored. Most young men agreed that theirembarrassm ent at seeing a woma n breastfeed stem med fromthe sexual role of the breast. Th ey and th e adolescent girlsacknowledged the inc ongrui ty o f the two roles:

Yeah , we pay to look sometimes and yet w e object to wom en , or somepeople object to wom en, breastfeeding in public. (Students' group )In response to a question about how they would feel if

their wife or girlfriend were to breastfeed in front of theirfriends, a num be r of the university students indicated that theywould not like it or that they would be embarrassed. Com-me nts such as for my eyes only suggested a certain degre eof territorialism or ownership of their partners' breasts.

A common theme that emerged among universi ty s tu-dents was their con ce rn at being considered, by eithe r themo ther o r the i r male f r i ends , to be ' 'perv ingW t o n thewom an's breasts.Adolescent girls and a num ber of the mo th-ers also thoug ht that m en were embarrassed at the sight of awoman breastfeeding because they might be thought to beperv ing o r staring at the wom an's breasts.

Th ey eel like apervert, like even ift hey are not, they stillfeel i t. (Girls'group)

Fathers support of breastfeeding. In general, the fathersinterviewed in these focus groups were very supportive oftheir partners' desire and right to breastfeed, both at hom e andin public. I n co ntras t, Freed et a1.,18 in a U.S. study, foun d thatthe majority of fathers whose partners intended to eitherbreastfeed (71%) o r bottle feed (78%) did no t believe thatbreastfeeding in public was acce ptable.This difference in atti-tudes might contribute to the lower breastfeeding initiationand duration rates in the U.S., when compared with Aus-tralia.4,5However, not all Australian fathers are as supportiveas the fathers interviewed in this focus group. Some of themothers described situations in which their partners were lessthan supportive, particularly wit h breastfeeding in public.

Fathers are known to play an important role in mothers'decisions to breastfeed and influen ce duration by serving askey supports or deterrents to breastfeeding by the mother.I9Freed et a1.18 found that partners ofw om en wh o intend ed tobottlefeed their infants were more likely to believe thatbreastfeeding was bad for a woman's breasts and interferedwi th sex, compared w i th par tners o f women wh o in tendedto breastfeed their infants. Th ey w ere also unaware of thebenefits to their child. It might be expected that these fatherswould discourage their partners from attempting to breast-

An Austral~an lang verb derlved from the word pervert. In th ~s ontext, it impliesstarlng In a voyeurist~cmanner.


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48 S c o tt e t a l ./A U S T R A L IA N B R E A S T F E E D IN G A T T IT U D E S

feed, or if their partners did initiate breastfeeding that theywould not contribute to successful breastfeeding by sup-porting them through difficult periods. Freed et al.ls contendthat it is unrealistic to expect fathers to intuitively possessbackground on the nature of breastfeeding and its benefits toinfants. They recommend that fathers be included in allbreastfeeding education courses currently taught in hospitals.Prolonged breastfeeding When shown a picture of atoddler breastfeeding, most of the recent mothers recruitedfrom the shopping centres considered the child too old to bebreastfed.A few mothers expressed very strong, negative feel-ings toward the photograph. In general, fathers also thoughtthat the child was too old to still be breastfed, but recognizedthat it was the woman's right to continue to breastfeed:

If it was a ewe that would begreat, but I don't want a child at that agehanging o f [ m y breast]. (Mothers'g ro u pThere was general consensus among the university students

that up to 2months was an appropriate length of time for achild to be breastfed. Most expressed some concern over theappropriateness of breastfeeding toddlers, especially with regardto the effect that this practice might have on the psychologi-cal development of the child. Comments such as that poorkid's going to have an enormous lot of trouble and missinga step in the maturity process were common. Concern wasexpressed also by mothers and fathers that prolonged breast-feeding would make the child too dependent on the mother.

There was almost unanimous agreement among the ado-lescent girls that the toddler was too old to be breastfed. Sev-eral thought that it would cause the child to be too depen-dent on the mother and were disgusted at the possibility ofa woman breastfeeding an older child in public. By the timethe child can walk was generally agreed upon as an appro-priate age by which a child should be weaned.

There appears to be a culturally approved age by whichtime a child should have been weaned from the breast.Thisis not necessarily measured in terms of chronological age butis more related to a child's development. Most people thoughtthat by the time a child can either walk, eat family foods, orask for the breast-in short, becomes an aware person-thatshe/he should have been weaned. Morset4 heorized that:

Breastfeeding is a dynamic re lationship involving signijicant others beyondthe nursing couple, and the attitud es of these others change toward thebreastfeeding mother over the course oflactat ion. Initially, these signijicantothers support the mother i n her breastfeeding. But whe n the infant is con-sidered old enough to wean, these others also acilitate weaning.14

Reasons for terminating breastfeeding There was aperception among some of the mothers and fathers that somewomen terminated breastfeeding because they reached a stagewhere they had done their bit and it was now time to regaintheir life. It was suggested also that some women may switchto bottlefeeding because they are overwhelmed by the intimacy

and responsibility of breastfeeding or because they are unpre-pared for motherhood and have unrealistic expectations aboutbreastfeeding. Members of the NMAA suggested that highself-esteem contributed to successful breastfeeding.

A number of mothers terminated breastfeeding because ofbreastmilk insufficiency. Members of the NMAA recognizedbreastmilk insufficiency as being a major concern for newmothers. In general, young mothers recruited from the shop-ping centers were more likely to think that breastmilk insuf-ficiency was a common problem compared with members ofthe NMAA:

Medical things tell you that it doesn't happen at all. But, that's a loadof rubbish. (Mothers'g ro u pThe tendency for women everywhere to doubt the ade-

quacy of their breastmilk was highlighted in a number ofgroups. This doubt makes mothers susceptible to the influ-ence of family and friends who readily suggest that the quan-tity and/or quality of the mother? milk may be deficient insome way. Breastmilk insufficiency was often self-diagnosedby mothers on the basis of a child crying more frequently, notsleeping through the night, or having changed its feeding pat-terns.This suggests an ignorance of the individuality of thebreastfeeding experience and events, such as growth spurts,which may result in a temporary change in feeding behav-i ~ r . ~ 'illZ1 uggests that a fussy infant can erode a mother'sconfidence in her ability to breastfeed, particularly if her levelof confidence is shaky before the birth. It is apparent thatmany women have already decided to stop breastfeedingprior to visiting a health professional for confirmation oftheir diagnosis of breastmilk insufficiency, as they often stopfeeding despite advice and encouragement to the contrary.

RECOMMENDATIONSWhile the rights ofwomen to breastfeed in public should berecognized, nursing rooms should be provided for thosewomen who wish to breastfeed in private. However, it wasapparent from the discussions that these facilities were oftenunavailable, inadequate, or difficult to find. Public places fre-quented by women and families with young children, forexample, family restaurants, cinemas, department stores, andshopping complexes, should provide attractive, well-main-tained, and easy to locate facilities where mothers can breast-feed in private, should they choose to.Town planners shouldconsider the needs of breastfeeding women when approvingbuilding plans for major public venues and require (or at leastadvocate for) the inclusion of nursing rooms. These roomsmay be adjacent to but should be separate from the femaletoilets. However, even if these facilities are provided, it shouldbe recognized that breastfeeding intervals are not always pre-dictable and that seclusion might be neither convenient norpossible at the time the infant demands to be fed.

Teenage girls and boys, while recognizing the benefits andimportance of breastfeeding, often experience embarrassment


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and awkwardness wh en witnessing a wo man breastfeed.Theyare inclined t o thin k that w om en should isolate themselvesrather than breastfeed in public.This a ttitude, if carried int oadult years, may result in th e early disco ntinu ation of breast-feeding. This g roup should be the target of school-basedbreastfeeding education programs. Classes should deal w iththe sexual and social aspects of breastfeeding as well as thenutritive and protective roles. Discussions and breastfeedingdemonstrations should be incorporated into health educa-tion, hom e econom ics, and life skills curricula.

The re is evidence that fathers participate in and influencethe choice o f feeding metho d and influence durat ion by act-ing as key supports or deterrents to breastfeeding by them ~ t h e r . * , ~ T h eegree of support provided by the father willdepend on his com mitm ent to and expectat ions of breast-feeding. How ever, few oppo rtunitie s exist for fathers to pre-pare themselves to offer the em otiona l and practical suppo rtrequired by their partners.I8 Fathers should be included inpre- and perinatal breastfeeding education classes currentlytaught in hospitals and clinics.The amount of time spent onnutritio n in the se classes should b e e xpa nded to allow for dis-cussion of the supportive role fathers can play for the breast-feeding mother.

I t would seem that women everywhere doubt the ade-quacy of their breastmilk and insufficient breastmilk is themost comm only cited reason for early term ination of breast-feeding2 In most cases, women make a self-diagnosis ofbreastmilk insufficiency o n th e basis that the baby cries, ordoes not ap pear satisfied, after nursin g.Th is suggests an ign o-rance of the individuality of the breastfeeding experien ce. Invery few cases is perceived breastmilk insufficiency substan-tiated with evidence of infant growth failure.22Breastfeed-ing education should address the issue of breastmilk suffi-ciency and insufficiency (real and perc eived) and a nticipatoryguidance should be provided to help mothers manage tran-sient breastmilk insufficiency should it occur.

C O N C L U S I O N SIt would appear that the awkwardness and embarrassmentexperienced by adolescent girls and you ng m en i n the pres-ence of a breastfeeding woman diminishes for both sexesonce they have children of their o wn . In these focus groups,both mothers and fathers of infants and young children w erequi te comfortable with the idea o f a wom an breastfeeding inpublic and gene rally viewed it as bei ng natural a nd necessaryrather than an offensive and socially unacceptable behavior.This attitude needs to be adopted by the general publicwhere breastfeeding should be seen as both socially desirableand acceptable.

A C K N O W L E D G M E N T SThis research was supported by a C omm onweal th Depart-ment of Heal th and Community Services Nat ional Heal th

Promo tion Gra nt .Th e assistance of Mr. Steve Jones, who ledthe male focus groups, is mu ch ap preciated.

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