How can breastfeeding support services best meet the needs of women of Bangladeshi origin living in the UK?
This thesis addresses the question ‘how can breastfeeding support services best meet the needs of women of Bangladeshi origin living in the UK?’ Breastfeeding is important for health, potentially contributing to reducing health inequalities. National surveys show that women of Bangladeshi origin have high initiation rates but low rates of continuation and exclusive breastfeeding. An initial literature review revealed that existing research relating to breastfeeding and the Bangladeshi community was descriptive and essentialist representing ethnic groups as homogenous and failing to recognise the influence of structural factors. Quantitative analysis of 357 Bangladeshi women in the Millennium Cohort Study (MCS) provided a more detailed national context for the qualitative research. A cumulative qualitative design underpinned by reflexivity was used comprising focus groups and interviews with grandmothers, fathers, mothers and health practitioners. Sampling was purposive for the family and practitioner phases and theoretically-informed for the mothers’ interviews. Analysis used ethnographic and narrative approaches to make sense of individual experiences within social context. The main finding was that the breastfeeding support needs of women of Bangladeshi origin were generally similar to the majority population. However to improve breastfeeding support practitioners need to understand where cultural context makes a difference. Practitioners misrecognised diversity of the Bangladeshi population in the UK including how ethno-religious identities as a minority group within a hostile majority were constituted and impacted on women’s lives. The family context of breastfeeding, including living arrangements, household responsibilities and family relationships mediated women’s access to time and space for breastfeeding. While practitioners recognised these pressures on women, they were used to affirm stereotypes of women as passive. This combined with lack of confidence and organisational constraints led to practitioners feeling powerless to support breastfeeding. Alongside implementing good practice for breastfeeding and culturally competent care, health services could engage with families, provide bilingual advocacy workers and involve women in designing accessible breastfeeding support services.
Breastfeeding, Bangladeshi, Minority ethnic group, Health services, Qualitative methods
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