Table 1

Included studies
Author Country Aim Participants Methodology Methods Results
Babington [50], United States · To describe child-feeding practices and Dominican mother’s knowledge and beliefs about healthy size and weight, and obesity. 10 mothers from the Dominican Republic, and 9 mothers from DR but born in the U.S. Exploratory, descriptive design with thematic analysis · Focus groups with questions related to breastfeeding, weaning and obesity asked to prompt discussion · Whilst all mothers saw breastfeeding as beneficial, US born mothers found it to limit freedom
· Formula rarely used in Dominican Republic due to cost.
· There were similarities between both groups in regard to introducing foods
Chen [30], Canada · To explore Chinese mothers’ perceptions about breastfeeding and infant health 15 purposively sampled Chinese mothers two months after delivery in Vancouver Canada Originally came from China, Hong Kong, Taiwan, and South Africa. Living in Canada from 6 months to 29 years Interpretive qualitative methodology · Semi structured one to one interview · Two key themes, 1/ the idea of harmony within change 2/ the meaning of infant health.
· Data analysed through constant comparison to identify themes · Breastfeeding viewed as natural and emphasises the importance of the mother’s health for the well-being of infant
Choudhry & Wallace [14], England · To explore the effect of acculturation on South Asian women and their breastfeeding attitudes and practices 20 South Asian women (11 UK born, 10 born in Pakistan or India), women, who were users of the Children Centres, were of childbearing age, who were expecting or had a child under the age of five and who could communicate in English, Urdu, Hindi or Punjabi. Women assessed as being either low acculturation, bicultural or highly acculturated. Descriptive qualitative study using thematic analysis · Semi-structured interviews using a combination of structured and open-ended questions to explore the women’s acculturation status and infant feeding experiences · Women experienced conflict between traditional and religious breastfeeding practice and UK cultural practices.
· All women opted for convenient feeding method
· There was a large family influence in regards to what feeding method was chosen, particularly by the mother-in-law
· Some women perceive they may be judged for breastfeeding in the UK.
Condon et al. [27], England · To examine patterns of infant feeding and weaning among ethnic minority groups Focus groups: 29 women from Bristol from ethnic minority backgrounds. This included women born in Bangladesh, Pakistan and Somalia. One group of Pakistani women and the Afro Caribbean participants were born in UK. Telephone survey: 26 women from Bristol from ethnic minority backgrounds Comparison group: 23 white British women from Bristol Focus group methodology Thematic analysis · Focus groups and telephone surveys conducted with women of an ethnic minority background about infant feeding and weaning. Two groups with Pakistani women, one group of women were born in the UK and the other group were born in Pakistan. · All women in the focus group saw breastfeeding to be the best feeding method, were aware of health benefits and seen as easier. They were also positively encouraged by family and health professionals
· Quantitative data analysed by SPSS · Ethnic minority women were more likely to breastfeed.
· Semi-structured questions analysed using content analysis
Groleau, Souliere, & Kirmayer [43], Canada · To identify the cultural factors involved in the abandonment of breastfeeding amongst Vietnamese immigrant women in Canada. 19 immigrant mothers living in Quebec, Canada. Recruited through purposive sampling. Critical theory and an interpretative approach · Face to face interviews, interpreters used for 14 women. · The decision to bottle-feed was not related to acculturation to local practices but to conflicts between Vietnamese cultural practices and the configuration of the new social space in Canada.
· Living in Canada did not allow specific family members to conduct postnatal traditional rituals thus jeopardizing mothers’ perceived health and the quality of their milk
Ingram et al. [29], England · To assess South Asian grandmothers’ health beliefs around baby feeding, knowledge of breastfeeding and their ability to support successful breastfeeding 14 Pakistani, Bangladeshi or Indian grandmothers in each focus group Ethnographic study- focus groups and interviews Thematic analysis · Topic guide facilitated, tape recorded focus groups and interviews, with demographic questionnaires, to record cultural influence baby feeding. Recordings transcribed and thematically analysed · All grandmothers felt new mothers need support during postnatal period and see this as their role.
· Grandmothers believe traditional practices and beliefs, e.g. foods, should be adhered to
· There is conflict between the beliefs of the grandmothers’ and breastfeeding practices e.g. feeding colostrum
Rice & Naksook [19], Australia · To examine perceptions, practices and beliefs among Thai women living in Australia in relation to breastfeeding, for the development of a culturally appropriate breastfeeding program in Australia. 30 Thai women living in Melbourne, Victoria who had experienced childbirth in either their homeland, Melbourne or both. Ethnographic study Thematic analysis · Interviews with participants in their own home exploring topics around childbearing, childrearing and reproductive health. · All women believed breast milk to be best for the baby for many reasons e.g. disease prevention. Formula milk was perceived as “animal milk” which could make the child stubborn.
· Participant observation method to allow observation and recording of women’s cultural beliefs, practices and experiences in Australia. · Breast feeding seen to have health and relationship benefits for mother
· The majority of women upheld practices based on traditional beliefs, such as a postnatal diet.
· There was an apparent conflict between health professionals advice and cultural beliefs
Rossiter & Yam [13], Australia · To examine Vietnamese women’s perceptions of factors that might influence their choice of infant feeding and how breastfeeding could be promoted and maintained by health professionals Convenience sample of 124 postnatal Vietnamese women who were born and reared in Vietnam and had a healthy infant born in Sydney in the 6 months before data collection Survey design collecting quantitative and qualitative data · Tape-recorded interviews in the women’s homes with semi-structured and open-ended questions which were transcribed verbatim, translated into English and coded. · The majority of mothers who breastfed knew health benefits of breastfeeding and were supported by significant others
· The majority of mothers who bottle-fed believed it was more convenient and that Australian formula was as nutritious as breast milk
· The majority of women experienced difficulties in their interaction with health professionals
Schlickau & Wilson [45], United States · To explore breastfeeding beliefs, attitudes and practices amongst immigrant Hispanic women in America Self-identified Hispanic women who participated in a “Moms and Mentors” program, who had recently relocated from Puerto Rico, Mexico and Central or South America. Ethno-nursing methods - qualitative component. Quantitative data collected to evaluate the efficacy of a model of breastfeeding education. · Interviews with broad, open-ended statements that allowed for follow-up elaboration and contrast questions in relation to breastfeeding. · Women knew they would breastfeed and it was seen as easy and convenient.
· Breastfeeding was common practice in homeland as formula feeding isn’t promoted by hospitals
· Some women didn’t follow traditional practices due to family influence or necessity.
· Women liked to be informed.
Straub Melvin and Labbo [51], United States · To examine Cambodian refugee mothers’ infant feeding beliefs, practices and decision making regarding infant feeding in the US and to explore if a culturally specific breastfeeding program is appropriate for this community. Convenience sample of 9 women who had come to the US on a refugee visa, had a child between the ages of 6 months and 5 years, had lived in the US for at least 10 years, were at least 18 years old and could speak English. Exploratory study Thematic analysis · Self administered questionnaire and a 30minute tape-recorded interview. The tape recordings were transcribed and thematically analysed · All women continued to practice Cambodian traditions in the US, either food or rituals, as they were not perceived as harmful to the mother or baby
· All women initiated breastfeeding, but 8 initiated mixed feeding in the hospital due to perceiving they had a low milk supply.
Vaughn et al. [25], United States · To determined the determinants of breastfeeding for Latina mothers in the Cincinnati area 40 Latina mothers, aged over 18years, who had babies under 4 months, were foreign born, had lived in America for less than 10 years and had tried breastfeeding at least once. Survey design collecting quantitative and qualitative data Constant comparison analysis based on grounded theory approach · Semi-structured interview and a validated Breastfeeding Self-efficiency Scale questionnaire. · Majority of mothers planned to breastfeed for at least one month and were receiving education
· Women wanted language specific breastfeeding education and support was seen as a major influencing factor.

Schmied et al.

Schmied et al. BMC Pregnancy and Childbirth 2012 12:163   doi:10.1186/1471-2393-12-163

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