Enf.ª Patrícia Sancho

Specialist in Maternal 
and Obstetric Health
Head of Nursing Services Gynaecology/Obstetrics Unit
Doctorate in Educational Sciences

The cultural impact on breastfeeding

HPA Magazine 20

Breastfeeding is the biological norm. As mammals, women have mammary glands that start producing milk in the second trimester of pregnancy to feed their babies. 
This means that, in general, each mother naturally produces milk with the necessary and appropriate components for her baby's proper development. However, we know that there are physical and hormonal factors that can affect milk production, although they are not very prevalent. Nevertheless, these factors are studied and defined, and there are strategies to deal with them and support breastfeeding.

Initially, issues related to breastfeeding can be seen as essentially a matter of biology. Not breastfeeding focuses on physiological causes, with insufficient milk being one of the most cited causes that led to the failure of breastfeeding processes for thousands of babies. However, we know that the culture and society we are embedded in deeply shape health and human behavior. 
Thus, it is known that culture is a powerful element in a woman's attitude towards breastfeeding. This cultural variety also explains and impacts breastfeeding rates in different regions of the world.
Currently, societies are multicultural due to migration movements, which requires healthcare professionals to be culturally sensitive in caring for mothers and babies, as well as adopting a cultural humility stance (i.e., not being too ethnocentric), which aims to minimize cultural stereotypes and empower the patient as a means of achieving equity, thus becoming a powerful tool to reduce disparities and improve health outcomes.We also know that both families and professionals face difficulties from a linguistic point of view, in health literacy, in lack of health and social equality, in prejudices and stereotypes that can impact breastfeeding. 
Given the importance of the subject, it is imperative that the teams caring for these mothers and babies know, recognize and validate the effects that sociocultural factors can have on the decision-making, initiation, and continuation of breastfeeding.
Another aspect that should be included in the equation is the historical context and its impact as a barrier to breastfeeding. 
We have, for example, the case of black women historically linked to slavery as wet nurses to breastfeed white women's babies. We know that racism, prejudice, and discrimination have an impact on breastfeeding, so this context should be considered.
The healthcare professional's own culture, personal history, the reality he or she recognizes as true, his or her degree of knowledge and updating in this matter impact and interfere with the breastfeeding process of mothers and babies.
UNICEF and WHO recommend breastfeeding for up to two years or more, with exclusive breastfeeding up to six months of age. 
Although complementary foods are introduced, breast milk is considered the main food for the baby during the first year of life. 
However, there are cultural and religious practices that discourage exclusive breastfeeding, discarding colostrum (the first milk produced in breastfeeding) and undervaluing it as the ideal food for the baby's first days of life. 
In addition, some people delay the start of breastfeeding, assuming that only after the "let-down" does the mother have enough milk and it is suitable for the baby. 
The introduction of infant formulas and devices that replace the function of the breast is another example of entrenched beliefs that lead to early weaning, depriving babies and mothers, as well as society itself, of all the inherent benefits of the breastfeeding process.
In this way, the exploration of cultural and religious practices becomes a reflection that can be a sensitive but necessary topic for discussion. 
Although there is global recognition of the superiority of human milk, little is done to support and normalize the breastfeeding process. Breasts are still hypersexualized, distancing them from their natural function and generating a negative impact on breastfeeding. 
 

The predominant cultural belief in many industrialized societies has evolved to the point where artificial feeding, which was initially created to nourish babies in institutions, quickly spread with the support of more invasive marketing policies, neglecting compliance with the current code for milk substitutes. 
To this phenomenon is added the fact that these feeding practices promote women's freedom, making them more attractive. 
In these cultures, a total reversal is observed in which artificial feeding becomes the norm and breastfeeding the exception.
Breastfeeding is a culturally influenced act that is heavily dependent on the environment that surrounds us. 
When breastfeeding is not valued in the environment in which we live, it affects its normalization. Therefore, it is crucial to promote culturally adapted breastfeeding and balance existing cultural clashes. Some cultures and religions provide guidance on foods to consume or avoid during breastfeeding, without scientific basis. 
Therefore, it is important to increase cultural awareness and make health professionals culturally adaptable, maintaining a neutral position in relation to their personal beliefs. Identifying and recognizing individualized cultural experiences, contexts, and practices is a plus. However, current scientific evidence reduces the risk of providing incorrect recommendations.
Although pain and the perception of insufficient milk are common barriers to breastfeeding regardless of a woman's ethnicity, these perceptions vary between cultures. Therefore, addressing culturally specific misunderstandings about these issues is crucial, especially during the prenatal period. 
The healthcare professional working with mothers and babies has a moral and professional responsibility to offer holistic care and updated information. 
When cultural beliefs and practices conflict with evidence-based recommendations, respectful and health-promoting dialogues, with strong personalized intervention, are mandatory. 
Communication techniques based on the LOVE nomenclature are an optimized strategy for the breastfeeding process. 
Breastfeeding is everyone's responsibility, and societies, social institutions, healthcare, governments, and protective policies must remove the burden imposed on women, especially in cultures of early weaning. 
The reduction in breastfeeding rates is a public health problem, and everyone must assume their responsibility by prioritizing what is right.  
Therefore, it is crucial to embrace socio-cultural diversity, where culturally adaptable health professionals will contribute to equity in breastfeeding. 
It is everyone's duty to ensure the best start in life for babies and ensure that mothers are not deprived of their right to breastfeed, should be supported, and not replaced in the functions that belong to them.