the experiences of mennonite who breastfeed...
TRANSCRIPT
THE EXPERIENCES OF MENNONITE WOMEN WHO BREASTFEED THEIR
CHlLDREN PAST THEIR FIRST 6 MONTHS OF L E
Judith A. Cormier
Submitted in partial fuifiliment of the requirements
for the degree of Master of Nursing
at
Daihousie University
Halifax, Nova Scotia
July, 1998
8 Copyright by Judith A. Cormier, 1998
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This work is dedicated
to my daughter
Micheiie Andrea Cormier
for her love and infinite support
as 1 continued with my education.
You are the "JOY" of my lie.
TABLE OF CONTENTS
DEDICATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
... LISTOFFIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vu
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
CHAPTER 1: INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 hrpose of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
CHAPTER II: J3ISTORICA.L BACKGROUND OF BREASTFEEDING . . . . . . . . . . . 6 Current Stanis of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Benefitflromotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Medicalkation and My Personal Experience . . . . . . . . . . . . . . . . . . . . . 10 Socioculturai Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Language/Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Summary of the Current Factors Influencing Breastfeeding . . . . . . . . . . 16
O T E R UI: MENNONITE CULTURAL ORIGINS . . . . . . . . . . . . . . . . . . . . . . 17 TheEariyYears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 BasicBeliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Mennonites in North Amerka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Farnily LXe: Customs. Values. N o m s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
. . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of Religious Beliefs and Custorns 29
CHAPTERIV: METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 FeministMethodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 . . . . . The Research Question: Locating Myselfin the Research 36
. . . The Setting and the Participants: An Ethnographie Account 3 8 Entrance into the Mennonite Community . . . . . . . . . . . . 39 Specific Interviews with the Mothers . . . . . . . . . . . . . . . 50
Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Data Analysis and Theory Generating: The InteMews . . . . . . . 52
CHAPTER V: PRESENTATION OF THE DATA . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 The Core Variable. Nature's Way: A Sacred Thing . . . . . . . . . . . . . . . . . . . . . 56
. . . . . Breastfeeding Values and Beliefs as Descrïbed by the Mennonite Women 58 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Benefits 58
EconomicBenefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Family Values and Beliefs 60
Support Provided for Mennonite Women During Their Breastfeeding Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 HusbandEather - Parents and Parent-In-Laws - Family - Cornmunity
Mernbers Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Women-to-Women Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Fathering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 EmploymentNork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
C W T E R VI: ANALYSIS OF TICE FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Surnmary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
. . . . . . . . . . . . . . . . . . . . . . Beliefs and Values Affecthg Breastfeeding 71 . . . . . . . . . . . . Health and Econornic Benefits of Breastfeeding 72
FamilyValues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Support 75
Gender and Fathering Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Work and Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
. . . . . . . . . . Breastfeeding's Impact on Oppression and Empowerment 84 Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Medicalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Conclusion and Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
. . . . . . . . . . C W T E R VII: IMPLICATIONS FOR PRACTICE AND RESEARCH 91 Beliefs and Values of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oppression and Breastfeeding 91 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Implications for the Workplace 92
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Implications for Public Poiicies 94 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Implications for Community Groups 95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Implications for Lactation Education 96
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Research 98 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion 100
APPENDIX A: CHILDREN'S CLOTHNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
. . . . . . . . . . . . . . . . . . . . . . . . . . APPENDIX B: BREASTFEEDING CLOTHDJG 102
. . . . . . . . . . APPENDIX C: LETTER OF INTRODUCTION TO PARTICIPANTS 104
APPENDIX D: INTERVIEW GUIDE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
APPENDIX E: NFORMED CONSENT . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
LIST OF FIGURES
Page
Figure1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Figure2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Figure3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Figure4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
ACKNOWLEDGEMENTS
Many people supported me as 1 completed this thesis, but none more so than my
daughter (Micheiie) and my parents (Joyce and Irving Wùliams). Without thek constant
love, support, and words of wisdom 1 could never have completed this work. There are
not enough words to THANK them, they were aiways there for me through the many
trials and tribulations one has as one d t e s a thesis, and will be there to celebrate its
completion. 1 love them dearly.
Dr. Barbara Keddy, my principal advisor, has guided and encouraged me
throughout the process, even fkom afar Thank you for helping me to leam about the
wonders of qualitative research and of the importance of hearing others' voices. To my
other cornmittee members 1 owe many thanks: to Erica van Roosmaien for helping me
think in broader perspectives, and to Maureen White for her ciinical expertise and for
helping me keep a clear sense of direction. Maureen told me for years 1 could do this;
thank you for believing in me and for being my mentor.
1 would like to thank Jackie Gilby for always being there and for helping me to
organize the last dr& of the thesis. Fran Wertman's assistance with the figures included
in this work was invaluable. There are many professors that iduenced me dong this
educational journey: J. Horrocks, J. Hughes, S. Wong, M. Arklie, K. Bowen, D.
Sommerfeld, and J. Ritchie. My clinical experience with Deni helped me follow my
dream; thank you.
1 have been blessed with the fiiendship of two very special people that have
believed in me and supported me throughout every step of this process, Erna Snelgrove-
Clarke and Judy Clarke. Everyone shouid be so fortunate to have such very dear fiends
and colieagues. Thank you both.
Ruby Blois and Reverend Henry Friesen enabied me to enter into a leaming
experience that has emiched my Life in many ways. Reverends Wdbert Friesen and Eldwin
Campbell provided me with a greater understanding of the Mennonite faith and cultural
background. To each one of you 1 extend a sincere thank you.
Finally, 1 wouid like to thank d of the Mennonite women who participated in this
study. Your participation has contributed to a greater understanding of women's
breastfeeding experiences. I feel very privileged to have been part of such a learning
experience.
ABSTRACT
B r d e e d i n g has been reported to be the optimal means of feeding an infant fiom
a nutritional, psychological, and health perspective. W C E F and WHO (World Health
Organization) encourage mothers to exclusively breastfeed their infants for 6 months.
However, many mothers choose not to initiate breastfeeding or discontinue breastfeeding
long before the infant reaches 6 months of age.
The purpose of this study was to l e m about the information and support women
need in order to breastfeed their children past 6 rnonths, from a group of women who
were able to do so. This study was conducted in a rural Canadian Mennonite comrnunity.
Seven Mennonite women who had breastfed one or more children past 6 months of age
were the participants in this study. FemllUst methodology informed by grounded theory
methodology was used to describe the women's experiences. From the analysis it was
shown that the Mennonites' religious beliefs and values, support systerns, fathering roles,
and attitudes concerning work ail intluenced the women's abilities to breastfeed their
babies past 6 months of age.
CHAPTER 1
INTRODUCTION
Breastfeeding has been reported to be the best method of feeling an Ulfant fiom a
nutritional, psychological, and health perspective. Prior to the L 940s breastfeeding was
the prirnary means of feeding in most societies (Riordan & Auerbach, 1993). Why, then,
has there been a decline in the rate of breastfeeding in the last several decades? Why are
humans the only species that offer the d k of another species to theu young? These are
questions that must be addressed by researchers who do not impose moral judgements on
mothers.
The World Health Organization (WHO) and UNICEF (1993) encourage mothers
to exclusively breastfieed their babies until6 months of age. The Amencan Academy of
Pediatrics Policy Statement on Breastfeeding (1 998) dates, "exclusive breastfeeding is
ideal nutrition and sufficient to support optimal growth and development for
approximately the first 6 months &er birth" (p.3). According to the Nova Scotia
Department of Health's survey (1994), 65.4% of Nova Scotia's newboms are
breastfeeding upon discharge f?om the hospitai. Within the first month of life 14.2% of
infants stop breastfeeding. Only 45.8% continue to breastfeed until the end of their fourth
month of life. Health care professionals are faced with questions regarding how they
could be more supportive of potential breast feeding mothers and infants in Nova Scotia.
The WHOlUNICEF hocen t i Declaration for the Promotion and Support of
Breastfeeding (1990) recognized that breastfeeding is a unique process that provides ideal
nutrition for infants and contributes to their healthy growth and development; reduces
incidence and severity of in fdous diseases, thereby lowering infant morbidity and
mortality; contributes to women's heaith by reducing the risks of breast and ovarian cancer
and by hcreasing the spacing between pregnancies; provides social and economic benefits
to the f d y and the nation; and provides most women with a sense of satisfaction when
breastfeeding is successfùl. The benefits of breastfeeding increase if the mother
exclusively breasd?eeds for 6 months and longer as solids are introduced to the infant
(Baumslag and Michels, 1995; Lawrence, 1994; Riordan & Auerbach, 1993).
In spite of this information, there has been a decline in the rate of breastfeeding
worldwide. For example, in the most heavily industnaked country in the world, 59.4% of
Amencan women were breastfeeding either exclusively or in combination with formula
upon discharge f?om hospital; only 2 1.6% of these mothers continued to breastfeed for 6
months and many of these women combined breastfeeding with supplementation of
formula (Ryan, 1997).
Researchers have reported many obstacles that women must face in order to
initiate and continue breastfeeding such as: apathy towards breastfeeding and
misinformation arnong physicians (Freed, Clark, & Sorenson et al., 1995; Freed,
MacIntosh-Jones, & Fraley, 1992; Williams & Harnmer, 1995); lack of suficient prenatal
breastfeeding education (World Heaith Organization, 1989); hospital policies (Powers,
Naylor & Wester, 1994); inappropriate interruption of breastfeeding (Freed, Clark,
Sorenson, et al., 1995); early discharge (Braveman, Egerter, Pearl et al., 1995); lack of
postpartum foiiow up care (Williams & Cooper, 1993); employrnent (Frederick &
Auerbach, 1985; Gielen, Faden, O'Campo et al., 199 1; Mlay, 1998; Ryan & Martinez,
1989;); sotieta1 support (Spisak & Gross, 199 1); media promotion of bottle feeding
(World Health AssemblyMrHO, 198 1); infant formula gift packs and other means of
advertising for formula usage (Howard, Howard, & Wertzman, 1994). Palmer (1993)
fiirther wrote that the decline in breastfeeding "accelerated as the predominately male
rnedical profession too k over the management of childbirth and infant feeding" (p. 2 1 ).
Ws-Bonczyk, Avery, Savik, Potter, and Cukket (1993) provided the following reasons
for the decline in breastfeeding: lower educational and income levels, matemal
employrnent, urbanization, and "Westernization" of the developing countnes.
Formula companies such as Mead Johnson and Ross are fùUy aware of the reasons
women give for discontinuhg breastfeeding and subsequently produce elaborate
promotional carnpaigns detailing the benefits of formula both for the mother and the child.
It is indeed profitable to the multinational formula companies that breastfeeding is found
to be difficult for some women. According to Palmer (1993), approxirnately $7 billion of
infant formula is sold yearly in the United States, which is about 380,000 tins of formula
per day. With this kind of profit rnargin it is of little wonder that formula companies do
not support women's efforts to breastfeed.
Like their counterparts in the United States, Canadian women typically leam about
infant feeding via advertising from formula companies. Their lack of information specific
to breastfeeding idluences their choices and attitudes about their own feeding expenences.
Breastfeeding rates across Canada are variable. Lnitiation rates remain low among
regional and socio-economic groups. On average, approximately 80% of Canadian
4
women initiate breastfeeding with only 30% breastfkeding their infants at 6 months of age
(Breastfeeding Comfnittee of Canada, 1 996).
The reasons Nova Scotian women give for discontinuhg breastfeeding Uiclude:
retuming to work or school, the baby was not satided, the baby was teethg, the mother
a d o r baby did not Like it, it was too demanding, the baby was losing weight, the mother
was overwhelmed, the baby did not catch on, and the rnother found it too ditficult (N.S.
Department of Health, 1994).
Breastfeeding is rapidly becoming an ancient practice. In many Western cultures,
breastfeeding has become a medicalized act that requins consultations fiom a variety of
health professionals. The joy and wondrous leaming opportunity that can be experienced
when breastfeeding women corne together for sharing and support is being lost. The
strategies currently being advanced by health professionals for the promotion of
breastfeeding are not havkg the expected desired outcomes.
In my 20 years of experience as a health professional advocating breast feeding, it
is evident that the benefits of breastfeeding are often not explained in a non-threatening,
non-hierarchial, enabling, interactive manner that encourages women to make informed
feeding choices for their Uifmts. The current approach often leaves women feeling angry,
hurt, guilty, and unsupported should they decide not to breastfeed or to discontinue
breastfeeding after a short time.
Purpose of the Study
To learn about the information and support women need in order to breastfeed
their children past 6 months, it is important to explore specific issues regarding the
practice and to Ieam from a group of women that are able to do so. The M e ~ o n i t e
women h m a smali, rural cornrnunity in Canada are a group of women that are able to
breastfeed their children for extended periods. They have a rich cultural background that
is rather unique in Canadian society, and cm provide a great deal of breastfeeding
information for other women and health professionals. For that reason 1 chose to explore
the experiences of Mennonite women who breastfeed their chiidren for extended periods
of tirne.
1 will outiine in the next chapter a brief history of breastfeeding and the current
statu of breastfeeding in Nonh America, before going on to describe the M e ~ o n i t e
culture, my entrance into this culture. and my hdings and analysis.
CHAPTER 11.
HISTORICAL BACKGROUND OF BREASTFEEDING
Today, an infant anywhere in the world is apt to receive less breastmillr than at any
other tirne in history (Riordan & Auerbach, 1993). Breastfeeding, until a few decades
ago, was the n o m for most societies as evidenced by the recommendations for increasing
a matemal milk supply found in the Egyptian medical encyclopaedia, the Papyrus Ebers (c.
1500 B.C.)(Fildes, 1986).
Prior to the 1800s (AD), the majority of women breastfed their Young. Ody the
privileged few women in society were ailowed to hand-feed or have a wet nurse feed their
infant(s). 'Wet nurses' were lactating women, generaiiy nom a lower class in society,
often slaves. Pottery figurines, paintings, and sculptures fiom the Middle East suggest
that breastfeeding was held in high esteem (Fildes, 1986). The practice of wet nursing is
referred to in some of society's oldest writings. The Old Testament (Book of Exodus)
refers to Moses being fed by a wet nurse; the epic poem Homer makes references about
wet nurses; the Koran (AD 500) describes how parents may give their children out to
nurse, and a writing fiom hdia (during the second century AD) provides instructions on
how to i n t e ~ e w for a good wet nurse (Riordan & Auerbach, 1993). Wet nursing is a
clear case of class and race bias that continued even during slavery days in the United
States when Black women were found to wet nurse white women's babies.
Over the years, many factors have influenced women's breastfeeding practices.
Some are myths, others are based on "scientism" and others are sexist or classist in nature,
or are based on the motive of profit. These factors include the discouragement of the
feeding of colostrum, Victo rian modesty beliefs, concems regarding the cleanliness of
breastrnilk, advertising of milk formulas, publications concemhg women's
accomplishments outside the home, modem attitudes, and technicai innovations.
During the early 1900s, birthing practices changed nom home births attended by a
midwife, to hospital births attended by a physician. Accompanyhg these practices were
changes in the hospital routines. Mothers and families were separated, mothers were
anaesthetized for delivery, and babies were separated fiom their mothers and placed in
nurseries, where nurses bottle-fed them while fathers and other fàmily members looked at
the babies through glass windows. Wntings by prominent male physicians advising
rnothers to limit and schedule infant feeding removed the management of infant feeding
from the mother's capable hands into those of the physician (Riordan & Auerbach, 1993).
Cadogan (1 749, cited in Kessen, 1965) stated, "Men of sense rather than foolish unlearned
women" would be in charge of infant feeding. It was the medical profession who decreed
what "good mothering" should be.
World Wars 1 and II resulted in rnany women working in paid jobs outside the
home, which greatly infiuenced the decline in breastfeeding. The introduction and
widespread use of oral contraceptives during the 1950s aiso had a vast impact on
breastfeeding. 'Improved' formulas, advertising carnpaigns, and the technologie age
continue to influence the declining breastfeeding rates around the world.
As already noted, research clearly indicates that breastfeeding is important for
irû'ants, particularly with regard to decreasing infant mortaiity and morbidity, and it is
equally as important for women. History teaches us that breastfeeding flounshes when
and where it is primarily controiled by mothers. Atîempts to increase the current
breastfeeduig rates wiIi need to be based on returning the reins of power to the hands of
the women who successfû11y b r e e e d their children. By hearing their stones we can
learn about what has been successfL1 or unsuccessfùl for thern.
1 want to reiterate, however, that this thesis is not intended as a moral judgment on
women who, for various rasons, do not breastfeed. It must always be seen as a choice
which women themselves must make.
Current S tatus of Breastfeeding
BenefitsPromotion
The promotion of breastfeeding has been a primary goal of Health Canada, the
World Health Organization (WHO), and UNICEF since the late 1970s. The strategies
utilized to promote breastfeeding did bring an increase in breastfeeding initiation rates.
However, according to Levitt et al. (19951, the rate of breastfeeding past 6 months
continues to decline. Why are the breastfeeding promotion strategies not successful in
increasing the duration of breastfeeding?
From personal expenence as a Lactation Consultant, I believe that severai issues
have to be addressed ifbreastfeeding is to become the "nad for feeding of human
infants. Prenatal classes tend to be held at Health Centres, on specified days and tirnes
throughout the week with a prearranged guideline protocol for learning that has been
mandated by heaith care professionals. This is appropriate if the woman has a means of
transportation, child care available for other children, an employer that enables her to take
time offtiom work to attend, and ifshe has socially acceptable clothing to Wear, is
9
relatively weU educated, and motivated to attend. However, many mothers are unable to
meet these requirements, so the breastfeeding idonnation is often given to those who
aiready are aware of the benefits of breastfeeding. 1 have found that we health
professionds often are "singing to the choir" or "preaching to the converted." For
example, at the NlrK-Grace Hedth Centre in Halifax, Nova Scotia. oniy 30% of mothers
attend prenatal classes despite of advertising campaigns.
Phillips (1995) pointed out the obvious: "Women's health involves women's
emotional, social, cultural, spiritual and physical weU-being, and it is determined by the
social, political and economic context of women's lives as weli as by biology" (cited in the
National Forum on Health's Report, An OveMew of Women's Health, 1997. p. 3). Ail of
these weii known factors have significant impact on breasrfeeding women. If
breastfeeding promotion campaigns are to be successful, social, political, and econornic
changes must occur. Strategies must be put into place for many reasons: to hear and
value women's voices, reduce power inequities, relieve women's double or even triple
workload, improve child care options, have equal participation of women in al1 areas of
heaith (research, planning and delivery), have pay equality, support minonty women,
protea women nom the over-medicalization of normal female growth and development
processes, and develop wornan- and family-centered care health services. Only when
these strategies are implemented can the breastfeeding rates for infants 6 months or older
increase.
Medicalization and MY Personai Emerience
Prior to the 1800s breastfeeding, and home delivery by midwives, was the nom.
Women cared for each other in the home and supponed one another with breastfeedùig
endeavours. Today, for many women breasâeeding has become a process that requires
advanced medicai treatment. Health professionals require lactation consultant certificates,
utilize technology, and fiequently prescribe medications for breastfeeding mothers. With
the formabation of hospital based birthing practices it is liale wonder that breastfeeding
has become part of that entire medicali7irtion of chiidbirth.
Information conceming findings and implications for breastfeeding mothers tends
to corne fiom quantitative research (Miiier, Miller & Chism, 1996; Samuels, Margen &
Schoen, 1985; Sechder, Krishna, Puri, Satyanarayana & Kumar, 199 1). The value placed
on the traditional positivistic rigours of quantitative research is clearly evident in these
studies which do not fit weli with ferninist research. Quantitative studies can be valuable
in clinical studies where objectivity is an assumption of the research, but they do not
provide an opportunity to look at breadeeding fiom a hoiistic or feminist perspective(s).
Quantitative studies cm explore some particular rnedicaVphysiological aspects of
breastfeeding, for example, the composition of breastmilk, often Ieading to benefits for
mothers or improved breastfeeding outcornes; but, these studies do not provide
idormation about how the breastfeeding experience affects the woman or her family or
what the woman's feelings are with regard to her breastfeeding experience. In short, the
subjectivity is disregarded and women's voices are not heard. Reductionist research tends
to be based on what researchers want to know about breastfeeding generally, not on what
has been identified as issues by b r d e e d i n g women themselves. The results of
quantitative research are often carried over into the treatment of breastfeeding concems
with liale input fiom mothers' perspectives. In my practice, I often hear "based on
research this is the treatment that should be done for this breastfeeding problem," but
rarely is the information preceded with, "what would you like to do about the issue as a
woman and mother, or what is your understanding of the experience?' Ifmothers have
breastfeeding difnculties, physicians and health care worken tend to prescribe treatment
or offer a management protocol to which the breastfeeding mothers must adhere, without
considering the context of the woman's breastfeeding experience. This type of care leaves
the women feeling powerless over their own lives, heaith, and choice of regimes. Mothers
are rarely asked for their opinions about their concerns. This power diferential can, and
often does, have negative consequences. The main consequence in this situation is usuaiiy
cessation of breastfeeding.
In order to move £Yom current approaches which often neglect the context of the
woman's breastfeeding expenence, with the participants of this study 1 shared knowledge
and expenences. This sharing expenence heiped me to hear breastfeeding women's issues
related to breastfeeding assistance, the treatments that were utilized the supports that
were provided, and how these factors aec ted their breastfeeding endeavours.
Sociocultural Aspects
When examining breastfeeding women's expenences, it is essential to explore the
reiationships between gender, race, and class in the delivery of women's health care in
general. Heaith care needs resources, and services tend to Vary according to class and
pridege in Mie. Proper nutrition, housing, heat, water, clothing, and sanitation d
influence a person's health status (Lewis, 1990). In addition culture, ethnicity, sexual
orientation, and age affect general health care needs.
According to Van Esterik ( 1997) breastfeeding is a feminist, women's, and human
nghts issue, as breastfeeding contnbutes to gender equality and empowers women. For
years women's reproductive work has been devalued. Women worldwide often are
required to make a choice between caring for their familes and meeting the needs of an
employer. Household food supplies are often distributed in a manner which pnoritizes the
adult male's needs before other family members. Women and children who do not
breastfeed are more dependent on medical professionais throughout their entire Me cycle.
Consumer spending for artificial formula increases as breastfeeding declines and health
care costs escalate accordingly. Women's breasts in many societies are seen primarily as
sex objects rather than as a means of providing nourishment and comfort for children.
Bottle feeding not only can cause infant deaths and ihesg but the waste products of
formula produas pollute the air, water, and land, and impact on the increasing worldwide
population levels. Lack of transportation, distance to clinics, decreased woman-to-woman
support, and shortened lengths of stays without adequate comrnunity foliow-up, are other
socio-economic factors that contribute to the oppression of women and support the
discontinuance of breastfeeding.
Women who value their reproductive and productive work are empowered and
have much higher seifesteem and sense of self worth. 'LMothering" work is important
work., and no woman should have to make the choice between caring for her children and
13
what is deemed by society at large as "real worK' or work for pay. But many woman are
forced to make the choice and retum to work, discontinuhg breastfeedhg, due to lack of
support for breastfeediig on behalf of ernployers, shortened maternity leaves, and
atfordable child care facilities. When a wornan successfiiiiy breastfeeds her infant, her
confidence in herseif and in her body multiplies, providing her with an overwhelming sense
of accompiishrnent. Nonetheless, for a variety of reasons many women are unable or do
not want to breastfeed. While it must remain a choice, it is often due to a lack of
understanding that some women choose not to breastfeed.
Women world wide are starting to speak out in support of breanfeeding. Boycotts
of companies, television., and magazines promoting formula are occumng; women are
forming breastfeeding coalitions and forming women-to-women support groups;
governments are being lobbied for improved maternity leaves and child care facilities; and
women are valuing their own reproductive abilities and "mothering" work. These factors
are indeed relevant to breastfeediig women worldwide. 1 listened to the Mennonite
women to learn specifically fiom them about the social and cultural factors which
impacted on their prolonged breastfeeding experiences.
"Women speak in ways that are limited by man's greater social power and control"
(Devault, 1990, p. 98). Graham and Oakley (198 1) described the constant conflict
between medical personnel and clients regardhg the nature of childbearing, the context of
childbearing, criteria of success, control of childbearing, who is the expert, and the
communication gap. These are ail pertinent to breastfeeding mothers.
Language is a powerful force. Slogans such as "Healthy Baby: Happy Family"
(Rodnguez-Garcia, Aumack & Ramos, 1990) and "Baby Friendly Breastfeeding Area"
send very mixed messages to women. Should not aii areas (that are safe) be fiiendly to
babies, and cm breastfeeding really ensure a happy €&y? What about wornen who are
poor or who are in abusive situations (to name a few oppressive social situations)?
Statements nich as, "AU mothers c m breastfeed," are not true. This message can
be devastating to mothers who may have had a mastectomy. Most mothers are able to
numire the baby at the breast but not all can totaily nourish the baby by breastfeeding.
Mothers having radiation therapy, on particular medications, or who have had reduction
or augmentation breast surgery often are unable to totaiiy nourish their baby at their
breast. This type of information is very misleading for these women.
According to Wiessinger ( 1 W6), "we cannot expect to create a breastfeeding
culture ifwe do not insist on a breastfeeding mode1 of health in both Our language and Our
literature" (p 1). Health care professionals prornoting the benefits of breastfeeding tend to
spell out the benefits of breastfeeding in a manner similar to the formula representatives
speaking of the benefits of their product. Ifbreastfeeding is to become the norm, health
professionais should be speaking of the concems they have about the use of formula (ie.,
formula fed children have more admissions to hospitals and more senous illnesses), rather
than glorifjmg breastmilk as something special. Ifbreastfeeding is to be the nom,
consumers need the knowledge that breastmilk directly kom the breast or artificial milk
(any product other than breastmilk -- cow's milk based formula, pasteurized cow's rnilk,
evaporated cow's miik, goat's III&, or soybean rnilk) are not the only choices.
Breastfeeding, expressed breastrnilk via a bottle, or providing breastmilk from another
healthy mother d have more hedth benefits than the use of an a r t i f i d miik product.
Wiessinger (1996) stated: " b r d e e d i n g is a straight forward health issue, not one of two
equivalent choices" @ 3).
Employment
Returning to work following the birth of a baby is a financial necessity for many
women. Increasingiy, however, due to social pressures, many women retum to work
because they feel more valued, capable, and successful. The women's work done at home
seems to count for iittle in much of our society (Riordan & Auerbach, 1993). Places of
ernployment usually are not supportive of breastfeeding mothen. In a study done by
Hedarom (199 1) of 42 women, it was found that negative responses fiom relatives and
CO-workers, inadequate milk expressing facilities, inadequate rnilk storage facilities, and
lack of access to the baby during work hours were concems of employed breastfeeding
women.
The World Alliance for Breastfeeding Action (WABA) encourages employers and
unions to establish work policies that support employees in both their work and family
responsibilities. These policies would include extended rnaternïty and paternity leave,
child care facilities, flexible working hours, and areas where a mother can express and
store her breastmilk. Few places of employment have engaged in these recommendations,
or established policies for breastfeeding employees, or have unions brought the concems
of breastfeeding women to the negotiation tables. Employment causes a great deal of
stress for nursing mothers and ifbreastfeeding is to become the nom, the concems of
employed breadeeding women must be addressed (hinay, 1998).
-rnaxy of the Current Factors Influencing Breastfeedb
Political, social and economic factors infiuence women's breastfeeding experiences.
Employment, socioeconomic statu, the power of language, medicalkation, and health
promotion tactics di have an impact on each woman's penond breastfeeding expenence.
It is an assumption of this study that ifwe are to have a healthy nation of children, then
women must have access to the information and support they need in order to initiate and
continue breastfeeding for greater than 6 months.
In order to provide context and to promote understanding of Mennonite women's
experiences, as mothers who continue breastfeeding for greater than 6 months the next
chapters will contain a brief history of the Mennonite culture, the methodology employed
in this study, and my entrance into this culture. The concluding chapters descnbe my
findings and provide an analysis.
CHAPTER III
MENNONITE CULTURAL ORIGINS
In this chapter 1 bnefly wili outline some of the highlights of the religious practices,
values, beiiefs, and Mestyles of the Mennonite community in order to place their
breadeeding experiences in a historical and socio-cultural context. While much of this
information is documented in the iiterature prior to the 1990s,I was fortunate to have
received first hand information fiom two members of the Mennonite faith: Reverend
Henry Friesen, a member of the Pastoral Care Team, at the IWK-Grace Health Centre;
and Mr. Lawrence Klip penstein, the Archivist wit h the Mennonite Hentage Centre in
W i p e g , with whom I have spoken on the telephone and from whom 1 have received
written information.
1 provide this overview to acquaint the reader with the beliefs of Mennonites in
general, but particularly from Canada, as the participants in this study are currently living
in Canada. But, before 1 do this, I alert the reader to the fact that this is not a critique of
religious practices. I present the facts in a straightforward marner to heip the reader
understand the background of the women 1 in te~ewed and observed.
The Early Years
The Mennonites' separate Christian identity cm be traced to the Anabaptist
movement of the 16'" century Refomation. Anabaptias believed in the baptism of mature,
voluntary believers who had received instruction, teaching, and training in the faith, and in
a communion service which included foot washing, as a symbol of humility. Anabaptists
disagreed with infant baptism, a fundamental practice of the Cathoiic Church, and
separated from the Cathoiic Church during the Refomation (Ebb, 1974; Redekop, 1969).
Basic Beliefs
The seven basic beiiefs of the Mennonite faith, according to Dyck (1967) and the
Mennonite Board of Missions are:
1. The Bible is central. "For other foundation can no man lay than that is laid,
which is Jesus Christ" (1 Cor. 3 : 1 1 - King James Version - hereafter, UV). The
Mennonites beiieve that the Bible teachhgs give new life to the church and help faith to
grow.
2. New Iife in Christ. Because hurnan beings sin and commit wrong doing, God
sent Jesus Christ to forgive sins and the gifi of living forever with God.
3. Voluntary membersbip and cornmitment to Christ. Mennonites believe in adult
baptism, and in the willingness of the person to share Jesus' words and actions.
4. Reaching out to the world. "Then said Jesus to them again, Peace be unto you:
as my Father hath sent me, even so send 1 you" (John 20:21 - KTV). "The Spirit of the
Lord is upon me, because he hath anointed me to preach the gospel to the poor; he hath
sent me to heal the brokenhearted, to preach deliverance to the captives, and recovering of
sight to the blind, to set at liberty them that are bruised" (Luke 4: 18 - KJV). Mennonites
believe in both the physical and spiritual aspects of life when preaching about the gospel.
5. Belonging to each other. "So we7 being many, are one body in Christ and every
one members one of another" (Romans 125 - UV). The church can grow in f ~ t h ,
19
service, and unity, ifits members support, encourage, and help each other, in a loving and
caruig community environment.
6. Living peaceftiiy. Mennonites are peacefùl people, who refùse to take up arms
in any warfare, and believe in non-violence and living peaceably with others. They are
anti-militaristic.
7. Helping each other. Mennonites believe in helping their members as well as the
world at large, through mutual aid in the form of money, t h e , and goods in times of
crisis. Mennonites believe in the spiritual, emotional, and physical well being of their
people which cornes from the practice of their religion.
The Anabaptist (Mennonite) movement was divided into two groups, the Swiss-
South German group and the Dutch-North German group. The beliefs are similar
between the groups but separate due to their geographic locations. In 1522, Ulrich
Swingli, became the first generation leader of the Swiss-South Gennan Mennonite group.
This group moved westward, settling in Palatinate and Alsace and later in Pennsylvania.
The Mennonites came to Nonh America after the sixteenth-century persecution had
ended, to escape fùrther discrimination, oppression, and rnilitarism (Dyck, 1967). The
Swiss Mennonites were farmers, crafts people, and Linen weaven. Many of the original
Mennonites were great scholars, but due to constant persecution they were unable to
pursue many ongoing educational opportunities.
The Dutch-North German Mennonites were led by Menno Simons. Simons was a
Roman Catholic priest, who lefi the Catholic Church in 1536, due to his disbelief in infant
baptism and other Catholic teachings. He became the Dutch Mennonites' first leader and
20
organizer, and worked diligently throughout Germany and Hoiland, strengthening the
Mennonite faith through his writings, meetings with foes, and travels whereby he spread
the Mennonite beliefs (Ebb, 1974). In 1632, the "Dordrecht Confession of Faith," which
embodies the distinctive Mennonite beliefs, was issued in HoUand. The Dutch Mennonites
moved eastward and settled in Poland and Prussia, and then moved to Russia by the 18'
century. In 1762-63, Catherine II of Russia, invited the Mennonites to rnigrate to Russia,
where they would be guaranteed complete religious keedom and exemption fiom rnilitary
service. In return, the Mennonite people would provide the Russian native people with an
agricultural mode1 for which the Mernonites had become known (Epp, 1974; Horst,
1979). The Mennonites were weu noted for their success with farming and animal
husbandry. Once settled in Russia, a penod of reduced persecution provided these
Mennonites with an opportunity to pursue ongoing educationd opportunities. Many of
the men becarne teachers, tradesmen, and physicians.
Mennonites in North America
h order to escape persecution and to find liberty, secunty, and prosperity,
thousands of Mennonites rnoved to North America. The first Mennonites to settle in
Nonh Arnenca were from the Swiss group; they settled in Germantovm, Pe~sylvania, in
1683. This was a colony of approximately 100 people. From 1707-1 756, 3,000 to 5,000
Swiss Mennonites moved to the Pennsylvania area. Following Napoleon's reign, from
18 15 to 1860. about 3,000 Amish-Swiss Mennonites emigrated fiom Alsace, Bavaria, and
Hesse to senle in Ohio, Indiana, Illinois, and Ontario. In the 1870s, due to fear of the
current Czar reneging on Catherine II's promise of military exemption, some 18,000
21
Dutch Mennonites left Russia and settled in Minnesota, South Dakota, Nebraska, Kansas,
and Manitoba. Those choosing Manitoba did so due to the Canadian govemment's
promise of land, cultural and educational autonomy, and guaranteed exemption fiom
rniiitary service.
D u ~ g the 18& cenhiry and into the middle of the 19& century Mennonite families
travelied across the North Amencan continent in pursuit of a new homeland. ftee to
practice their religious beliefs in peace. They travelled in what was known as the
"Conestoga Wagon." This wagon was used to transport the Mennonite people and their
goods during their emigration travels. The Conestoga wagon was curved up from the
centre to the sides and ends so that if heavy loads shifted they would settle to the centre.
It was drawn by as many as six horses, was covered in canvas, and had broad wheels and
wide axles which helped to reduce the wagon fiom sinking into the mud dong the trails
(Flint, 1980; Horst, 1979).
In order to escape fkom communism, which would threaten their freedorn to
practice their religious beliefs, another 25,000 Dutch Mennonites fled Russia following
World War 1, and settled throughout Canada, Paraguay, Brazil, and Mexico. These
various locations were chosen due to the availability of f d a n d and freedom tiom
retigious persecution. During World War 1, no provisions were made for conscientious
objectors to undertake other duties for the Canadian government, but during World War
II, the Mennonites worked in alternative service camps, forestry services, in hospitals. and
in service to the Red Cross. Today, Mennonites continue to support developing countnes
and relief and peace projects around the world. They are pacifists who refuse to kill
others or to cany weapons.
According to the Canadian Encyclopaedia (1996) there are 850,000 adult
Mennonite members in 4 1 countries and about 1 14,000 members of Mennonite churches
in Canada. The curent Mennonite congregation consias of two types: those of the
Conference of Mennonites, representing a newer structure of conferences, with more
modem and iiberal viewpoints, and those of the Old Order Mennonite Church, which
represent the older, more traditional, conservative traditions.
Mennonite fardies belonging to the Conference of Memoites tend to be
members of provincial, national, and continental central committees, ÛI each country.
Winnipeg, Manitoba is the headquarters of the Canadian Mennonite Centrai Cornmittee.
Mennonites belonging to these committees tend to assimilate, adjust, and integrate more
readily with society at large. According to Eldwin Campbell, a Mennonite Brethren from
Virginia, USA (personal cornrnunication, October 24, 1997), Mennonites today range
fiom the more liberal stream to the very conservative stream, the most liberal groups,
according to Mr. Campbell, being in San Francisco and California. The more liberal
groups would support abortion, divorce, and the rights of gay and lesbian people among
their congregation. Most Mennonite groupq however, do not recognize a homosexual iife
style as a life style that is normal. The more liberal Mennonite groups would support
educational leaming beyond the Grade 8 level and have high schools and institutions of
higher leaming for Mennonite members. However, in order to seek higher education than
that provided by through a Me~onite-led program, an individual would need to seek
counsel fiom their ministry. There are today Canadian Me~oni tes of French, Chinese.
Indian, and Anglo-saxon bac kground. The Mennonite associations promote witings,
research, nursing homes, retirement centres, psychiatrie units, art, f o 4 and heritage
festivals, and tounsm (Canadian Encyclopaedia, 1996).
The Old Order Mennonites adhere more strictly to the original traditions and
beliefs. They tend to Wear plain, darker coloured ciothes that may be buttonless and are
ali sewn at home. Shunning of those who do not conform to the noms is still used, which
means they must refuse to speak to delinquent members until public repentance occurs.
The German language is retained for conversation arnongst themselves, for worship
seMces and is taught in school. For the rnost part, the Old Order Mennonites are
f m e r s , believing that by maintaining the land and being self sufficient, they can remain
apart from and not be influenced by society at large.
Women do not work outside the home, but stay at home and look after the family.
Children do not attend public schools but are taught in a Mennonite school. Generally the
children leave school aRer Grade 8 (Flint, 1980). Kraybill (1977) stated, "in their minds
more than eight years was related to a change in quality; further formal education pointed
away fiom the agricultural way of Ife" (p 338). The school C U ~ C U ~ U ~ includes reading,
writing, mathematics. and religious training, in both the English and German languages.
In 19 15, the Manitoba goverment, in an attempt to standardize the education
prograrns and promote national unity, passed a law that all education would be under the
regdation of the Provincial govemment. This threat to the Mennonite school system
caused many of the Old Order Mennonites to seek new land. They settled in Mexico and
in the British Honduras, establishing settlements to the West and east of Belue (Dyck,
1967).
F d y Life: Customs, Values, Noms
Many of the OId Order Mennonites do not accept the Old Age Pension or Child
Tax Benefits 6om the Canadian Governrnent as they believe this would discourage their
dependence on each other and make them dependent on the government. They do,
however, receive health insurance benefits and pay taxes similar to other citizens. They
tend to resist change, but many do now have electricity, f m machinery, and automobiles-
In the Waterloo area of Ontario, Old Order Mennonites can be seen driving their horse-
drawn buggies and wearing their distinctive clothing during their outings to church or
market (Flint, 1980), whereas in other parts of Canada, cars and vans are used for many
purposes. In short, there is variation dependent upon geographic location and
group/congregational leadership.
The Old Order Mennonite cornmunity is patriarchal and patrilineal in its formation.
Men are recognized as the head of the home and are responsible for providing the farnily
with the necessities of Me. Women are prirnarily responsible for the home and the
children. The older people of the communîty are valued for their life experiences and
knowledge (Redekop, 1969). In some instances male and female duties overlap. In some
areas of Canada, for example, jarns and pickles made by the women or produce from the
gardens are sold at the fmers ' market by al1 rnembers of the family, male and female.
According to the Mennonite teachings, the rank order of importance for a
Mennonite f d y is: God, man, woman, and child. A woman must be submissive to her
father and her husband. Many Mennonite women Wear prayer caps as a symbol of
subrnissiveness to God and to their husband. This view stems fiom their interpretation of
the Bible. Specificdy, in 1 Corinthians 1 15-9 -W:
But every woman that prayeth or prophesieth with her head uncovered
dishonoureth her head; for that is even aii one as ifshe were shaven. For, if the
woman be not covered, let her also be shorn; but ifit be a shame for a woman to
be shom or shaven, let her be covered. For a man indeed ought not to cover his
head, forasmuch as he is the image and glory of God but the woman is the glory of
the man. For the man is not of the woman; but the woman of the man. Neither
was man created for the woman; but the woman for the man.
The prayer caps may be actual caps, either white or black, or they may be scarfs,
depending on the traditions of the group. Beliefs are tightly ingrained in aii famiiy
members, which is sirnilar in other fundamentalist religions. Catholics, for example, are
fundamentalist in their belief that the Pope is infallible. There is no room for analysis or
critique ofthe Mennonite's religious betiefs, much as there is no room for Catholics to
change any of the Pope's declarations.
Children also must be submissive to their parents. Corporal punishment is used in
order to teach children to obey and becorne conscientious believers in the faith. Another
literal interpretation of the Bible is from Proverbs 13 :24 - KTV - "He that spareth his rod
hateth his son: but he that loveth him chasteneth him betirnes." Furthermore there are at
least two more Bible quotes which guide child r e a ~ g practices: Proverbs 22: 15 - KJV -
"Foolishness is bound in the heart of a child; but the rod of correction s h d drive it far
fiom him;" Proverbs 23: 13-14 - EiTV - "Withhold not correction fkom the child: for if
thou beatest him with the rod, he shall not die. Thou shdt beat him with the rod, and shah
deliver his sod fiom heli."
Mennonites tend to live in an extended family relationship (Redekop, 1989).
Families are usuaiiy large, and the children live at home until they reach the age of
majority or rnarry. According to Mr. Eldwïn Campbell, young people are encouraged to
marry and to have chiidren. Birth control is not forbidden unless it is for the purpose of an
abortion. Again, this is similar to Catholicism. Liberal Mennonites believe in a woman's
choice regarding abortion while conservative sects do not. "Cathoiics For Choice" believe
in a woman's right to choice whereas conservative Catholics do not. My point in ail of
this is to show the reader that beliefs. even among fùndamentalist religions do Vary.
Ka Mennonite chooses not to marry, shehe is accepted by the cornmunity and
supported by farnily members if needs arise. Members of the Mennonite faith are
encouraged to many members of the same f&th because other faiths are "so different fiom
their own" (E. Campbell, personal communication, October 24, 1997). In keeping with
the traditional German work ethic, the unmamied children work for the family until the age
of legal adulthood and tum their eamings over to theu father. Often a young married
couple lives with one or the other's parents until a home is built for them. Grandparents
often live in a "Doddy house" or a "Grossdoddy (grandfather) house" upon retirement
(Davies, 1973; Flint, 1980). This is a home that is built next door or attached to a son's or
daughter's home for their aging parents. It is comparable to a more usual, Canadian
"Granny house."
Due to the large families, the oldest son is often married before the youngest
sibling is bom. For this reason, in the more conservative congregation, the youngest son,
not the oldest son, ofien inherits the family fm @avies, 1973). Today, in most
Mennonite settings, the f m or hentage is divided equaUy among al the children.
Mennonite girls start a "dower chest" very early in Me, planning for their
marriage. In this chest they place al1 the quilts, towels, and other handmade goods that
will enable them to set up their own home. Traditionaily, the bride makes her
bridegroom's wedding shirt (Davies, 1973).
Church s e ~ c e s are not only for reiigious purposes but provide a means of
socialization for the Mennonite families. The typical Mennonite church senrice lasts
approxùnately 1 to 2 hours. There is a sermon, several hymns, prayers, and a closing
benediction (Epp, 1974). In the more conservative Mennonite Churches, the women and
girls sit on one side of the Church during the seMce and the men and boys sit on the other
side. This is customary in many settings and is thought to help to keep order among the
young people of the congregation.
In some congregations the Church officials are chosen by lot. Nominations for
candidates for deacon, rninister, and bishop are made by the congregation. Hymn books
equd to the number of candidates are presented. Only one of these hymn books, for each
office, will have the in it. The "lot7' is a piece of paper with the following verse on it:
Proverbs 16:33 - WV - "The lot is cast into the lap; but the whole disposing thereof is of
the Lord."
Communion is for members of the church who have been baptized and usudy
occurs in the spring and f d . Wme is usually used unless there is an alcohol problem in a
given community. Baptism can be by submersion but most baptisms are by sprinkling,
depending on the traditions of the congregation (L. Kiippenstein, personal communication,
July 25, 1997).
Today M e ~ o n i t e s combine new medical technology with old traditional means of
healing. Midwives are still utilized where available, but many Mennonite women birth
their babies in a hospital setting. Most Mennonite women breastfeed their babies for an
extended period. However, in the more liberal congregations, breastfeeding for extended
penods of t h e is not as prevalent (EIdwin Campbell, personal communication, October
24, L997).
Mennonite women breastfeed their babies because it is a natural thing to do. It is
God's way of feeding children. God provided creatures with necessary things,
every animal has its way of protecting themselves from its enemies and for feeding
its young. Newer ideas kom scientific ways lead off from nature. Breastfeeding is
so natural. It fosten deep love between the mother and child, it provides more
security for the baby, and breastmik is healthy for the baby. God created it to be.
(Wilbert Fnesen, Mennonite minister, personal cornmunication, September 1 9,
1997)
Mennonite women through the generations were apt to breastfeed their young
because of the penecution they endured. They would have travelled a great deal, and
fiequently been uprooted, with no means of providing a easily obtained supply of animai
29
mi& for their Young. A d e water supply was not always readily avaiiable as weU. Nature
provided the safest and surest means of providing rnilk for their babies. "Nature is the best
way, God provided in nature what is best. man cannot replace this by artificial means"
(Eldwin Campbell. personal communication, October 24, 1997).
Folk remedies of the past, utiiked by the Mennonites for health purposes, include
the use of heaIing herbs such as goldthread, coltsfoot, queen of rneadow, mandrake,
millnveed, dandelion, rhubarb root, lobeiia, skullcap, cow clover, yeiiowdock, and Canada
balsarn (Ebb, 1974). The Mennonites also believe in "spirituai healing" or "Divine healing
- spirit from God" and offer prayers and songs for the sick.
Mennonite people often utilize natural remedies and herbal rnedicines for illnesses
or medicai concems. They send for these products through the mail, visit a "naturai"
physician, self medicate at health food stores, or transport the products from other
countries when visiting relatives. One of the popular products used is: "Wonder Oil"
which can be warmed and rubbed on a fussy baby's stomach or on a nursing mother's
breast .
Surnrnary of Religious Beliefs and Customs
The Mennonite religion focuses on the separation of the church fiorn the state,
Christian obedience, the confession of faith by beiievers prior to baptism, and, most
importantly, the preaching of the word of God as primary to their existence (Edmurids.
1993). Church discipline includes avoidance or shunning of the transgressor. Members of
the church can have nothing to do with the excommunicated transgressor, until hdshe
declares their transgression before the church members and sought forgiveness. This
means that farnily members must aiso avoid the transgressor, making hirn/her sleep, eat,
and iive completely alone. The Iiteral interpretation ûom the Bible is fiom
1 Corinthians 5:9-12 - KJV:
1 wrote unto you in an epistle not to company with fornicators: Yet not altogether
with the foniicators of this world, or with the covetous, or extortioners, or with
idolaters; for then must ye needs go out of the world. But now 1 have written unto
you not to keep company, ifany man that is called a brother be a fomicator, or
covetous, or an idolater, or a railer, or a drunkard, or an extortioner; with such an
one no not to eat. For what have 1 to do to judge them also that are without? do
no ye judge them that are within?"
By trying to live by the seven principles of the Mennonite faith and trying to
maintain their cultural beliefs and theological differences, the Mennonite people have been
ostracized and persecuted by society at large and have chosen for the most part to live in
geographical isolation from others. This type of sociological upheaval provides fertile
ground for the Mennonite separatist psychology to continue to flounsh even in the 1990s.
The cornrnunity of study embodied characteristics from a number of Mennonite traditions.
In the subsequent chapters 1 will explore the impact of the Mennonite lifestyle on a
group of Mennonite women who breastfeed their infants past the first 6 months of Me. 1
will present more specific demographic information about these women, but a hinorical
o v e ~ e w of the general cultural origins of this religion will enable the reader to place the
participants in a particular social and histoncal context. 1 acknowledge that there may be
interpretive difliculties in terms of my being an outsider to this group. 1 want to reiterate
that 1 am not attempting to present an in-depth treatise about the Mennonite culture, as
this would necessitate a separate document of its own. 1 have presented a very bief
hiaorical overview of the primary beliefs and values of this group of research participants
which will guide my analysis.
CHAPTER N
METHODOLOGY
Feminist Methodology
Methodology is defined by Harding (1987) as "a theory or analysis of how
research does and should proceeb' (p. 3). King (1994) summarized Moccia's work about
methodology as "a way ofviewing patterns of the whole" (p. 20), and stated from
Campbell and Bunting's (1991) work that methodology "encompasses the choice of
method, the implications surroundhg that choice and how those methods are used" (p.
20). According to King, "Research using a f e d s t methodology refers to research
questions that are pertinent to women, are of interest to women, and are developed out of
political struggles" (p. 20). Keddy (1992) wrote that feminist research is non-hieraschial,
interactive, reflective, empowering, transfomative and conscious that participants' voices
must be heard. According to the World Alliance for Breastfeeding Action (WABA)
( 1999, empowerrnent means:
the ability of people to gain understanding and control over personai, social,
econornic and political forces to take action to improve their lives; the range of
activities fiom individuai self-assertion to collective resistance, protest and
mobilisation that challenge power relations; a process to change the direction of
forces which marginalise women. (p. 3)
Breastfeeding empowers women by: confhmhg a woman's power to control her own
body; reducing a woman's dependence on the medical profession; increasing self
confidence in caring for her infant; providing chiid spacing and reducing incidences of
33
Îliness; definhg and valuing women's work; chdenging the view of the breasts as sexual
objeas; and encouraging and f o s t e ~ g women's soiidarity at al1 levels.
Cook and Fonow (1 990) identified five basic principles of feminist methodology:
continuous and reflexive attention to the significance of gender and gender asymrnetry as a
basic feature of aIi social We, including the conduct of research; centrality of
consciousness-raising as a specific methodological tool and as a "way of seeing;" rejection
of the assumption that separation between researcher and research subjects produces a
more vaiid, objective account; examination of ethical concerns that &se when ferninias
participate in the research process; and emphasis on empowerment of women and
transformation of patrÎarchy through research. Women being the centre of their
expenence is the primas, goal of ferninist research.
1 chose feminist methodology for this study, recognizing that potential tensions
could occur from adopting a feminist methodology while studying a patriarchal culture
which 1 am not attempting to transform, nor were they seeking transformation. I believed
this to be the key ethical concem. I was not trying to change the Mennonite women in any
way but to leam fiom their breastfeeding experiences. Breastfeeding is pertinent to most
women and is of interest to them no matter ifthe circumstances differ substantidly.
In the Mennonite community there is a definite hierarchial structure consisting of
God, Man, Woman, and Chiid, in that order, which is not particularly easy for a feminist
researcher. However, throughout the research, every attempt was made to conduct the
study between the researcher and participants in a non-hierarchial, interactive, refiective,
and e m p o w e ~ g manner, which ensured that the Mennonite women's voices were heard.
Working and leamkg with the Mennonite women enabled me and the women to
share events and the socio-political culture that surrounds women's breastfeeding
experiences. The knowledge generated fiom this experience wili provide data that could
assist nurses and women in their quea for satisfjhg breastfeeding experiences.
A ferninist methodology enabled my voice as a woman and nurse and the voices of
the 7 Me~on i t e women participants to be heard. Breastfeeding is increasingly becoming
more medicalized and technologically dependent. Only by hearing women's voices will
breastfeeding remain the 'womanly art' that it is supposed to be. This approach is
contrary to much of past nursing research which is modeUed upon the reductionist
paradigm of medical 'science.' It was my intent to produce data that were relevant to not
only nurses but to the broader arena of child and women's health in general. Needless to
say, there is the added benefit of adding to the scarce body of knowiedge regarding
women in the Mennonite community.
Methaa
There is no unique ferninist method according to Harding (1987). She wrote "a
research method is a technique for (or way of proceeding in) gathering evidence. One
could reasonably argue that al1 evidence-gathering techniques fa11 into one of the foliowing
three categories: Listening to (or interrogating) informants, obsewing behaviour, or
exarnining histoncal traces" (p. 2). The method chosen for this study was a grounded
theory approach. According to Streubert and Carpenter (1 995), "grounded theory, as a
method of qualitative research, is a fonn of field research" (p. 146). They aiso descnbed
the five steps posited by Stem (1980) in the grounded theory process: "coliection of
empirical data, concept formation, concept development, concept modification and
integration, and production of the research report" (p. 20). Polit and Hungler (199 1)
wrote that "the purpose of field studies is to examine in an in-depth fashion the practices,
behaviours, beliefs, and attitudes of individuals or groups as they normally tùnction in reai
life" (p. 195). Utilkation of this method of research enabled me to examine in
collaboration with the participants the practices, behaviours, beliefs, and attitudes of the
Mennonite women that impacted on their breastfeeding experiences. Hutchson stated
( 1 986), "the method is circular, allowing the researcher to change focus and pursue leads
revealed by the ongoing data anaiysis" (p. 1 19).
Iayaratne and Stewart (1 99 1) described the following strategies for implementing
feminist research which were followed throughout the study.
1. The area of research should have the potential to help women's lives. My
research has the potential to help women breastfeed their infants for extended penods of
time, hereby improving the health of women and children. The research will enable the
Mennonite women to continue with theù belief of "reaching out to the world and helping
others." Their knowledge about breastfeeding may help other women to successfully
b reastfeed.
2. Research methods should be proposed that are appropnate for the questions
and information needed. 1 chose a grounded theory method which enabled the participants
and me to descnbe the breastfeeding experiences.
3. The research study shouid be qualitied by the researcher through the use of
research skills and leamllig throughout the snidy. Through the appropriate use of research
skill,I increased my howledge of research and of the area of study.
4. Interpretations of the research should be consistent with the kdings and, if
possible, provide suggestions for change that would improve women's lives. The
participants and 1 considered interpretations that we believed would improve women's
breastfeeding experiences.
5 . Political analysis of the hdings should be attempted by the researcher. This
was necessary if the social structure is to change in order to support women to have a
prolonged breastfeeding experience.
6. Research findings should be disseminated. I intend to share the results of this
study at relevant conferences, by publishing the information, and by informing policy
makers and the public at large of the fmdings, the ultimate goal being prolonged duration
of breastfeeding for women and children.
The Research Ouestion: Loc
Weskott (1 990) stated that:
patriarchal bias in research questions is reflected in the way in which questions
about women are posed: the absence of concepts that tap women's experience,
the viewing of women as an unchanging essence independent of tirne and place,
and the narrowness of the concept of human beings refiected in limited ways of
understand human behaviour (p. 60).
The research question in this study originated fiom my expenence as a "Lactation
Consultant" and a mother of one daughter, who was exclusively breastfed for only 6
weeks of Me. At 6 weeks 1 thought 1 did not have enough miUc and on my physician's
advice 1 introduced a daily supplementation of formula. One week following the initial
bottle of formula, my daughter developed her fïrst but by no means last case of otitis
media. After many hesses, allergy testing indicated she had a severe aliergic response to
cow's milk protein. 1 now know that only one feeding of formula, containing cow's milk
protein, can cause allergies to develop in susceptible individuals. Exclusive breastfeeding
pas 6 months of age helps to protect an infant's intestinal tract fiom aiiergic responses. 1
did not know that when 1 introduced cow's milk to my daughter.
As a Lactation Consultant, over the last 5 years 1 have had the privilege of
working with hundreds of women while they are beginning and working through their
breasrfeeding experiences. Most of the women with whom 1 work have already developed
breastfeeding problems. Rarely have 1 had the opportunity to work with women who
view breastfeeding as the normal way of feeding an infant. Instead, breastfeeding is often
viewed as something to try, as difficult, and as time consumhg.
Breastfeeding is the cultural nom for Mennonite families. 1 believe that learning
about breastfeeding fiom Mennonite women's experiences will help me to support other
breastfeeding women. 1 believe that a woman's decision to breastfeed is based on
knowledge, personal experiences, beliefs, and values, that meet with her own personal
needs, wants, and desires. Increased knowledge and awareness of other women's
breastfeeding experiences would have helped me as a new mother and would have
38
enhanced both my personal and professional growth- This personal perspective was
shared with the women participating in the study.
The Setting and the Partigppnts: An Ethnog~ôphic Accoiint . .
The research was conducted in a rural, Mennonite comrnunity. Although this
research setting is in an isolated area of Canada, the results may have far-reaching
implications for medical sociology, anthropology, femuiist and cultural studies and
nursing practices. Women in this cornmunity predominateiy breastfeed their children,
s e e h g out advice and support from other women in the cornmunity should breastfeeding
concerns occur. The Mennonite women tend to breastfeed their children for extended
periods of time, often past a child's first year of Me.
It is important to note that prior to inte~ewing the Mennonite women, 1 received
oral consent from the Mennonite spiritual leaders to i n t e ~ e w five to eight Mennonite
women. The wife of one of the spiritual leaders accompanied me to the participant's
homes, to assist with travelling directions and translation(s) when the mothers felt more at
ease conversing in the German language when describing a particular aspect of
breastfeeding. 1 advised the women of the purpose of the study and asked if they were
willing to participate in the study. The participants were 7 Mennonite women, who had
nursed or were currently breastfeeding a child past 6 months of age. The women's ages
ranged from 28 to 62 years of age. Ali were married and lived in their own homes. Ail
but one woman gave birth to their babies in a hospital or chic setting. One woman
delivered at home with the assistance of a midwife.
1 interviewed the women individuaüy, in their own homes, untii saturation of
discovered information and data was obtained, as is required in a grounded theory study
(S treubert & Carpenter, 1995). 1 expenenced saturation (repetition of discovered
uiforrnation and confirmation of previously collected data) after inte~ewing 7 mothers.
At that point 1 ceased the inte~ewing process.
Grounded theory does not preclude an ethnographic account of the experiences 1
had with this community and 1 would do an injustice to both the women and the research
project i f1 did not describe the intensity of the process and the deep level of understanding
and insights 1 gained through ethnographic techniques. In order to gain trust and
understanding of the community it was necessary to spend a great deal of time doing other
anthropological type research. 1 therefore present to the reader my experiences with the
Mennonite community during the tirne of my research study, December, 1996 to March,
1998, in order to stimulate a deeper understanding of the gestalt.
Entrance into the Mennonite cornmu- As a researcher 1 was interested in
lean-ing about breastfeeding fiom a group of women who view breastfeeding as the usual
way of feeding a baby. It was diflicult to find such a group of women in one given
community setting. Through a fellow nursing colleague, 1 learned that there was a
Mennonite community, within travelling distance, where women breastfeed their babies for
extended periods of time. I was interested in approaching this group of women and
discussed with colleagues means and suggestions about how I could introduce myself to
these women. Ms. Ruby Blois was a key person in my introduction into this cultural
40
group. She advised me to contact Reverend Henry Friesen, who is of the Mennonite faith,
to see ifhe would be willing to work with me on this study.
My initial meeting with Reverend Henry Friesen lasted for more than 2 hours. He
wanted to know why 1 was interested in leamhg fiom the M e ~ o n i t e women, what 1
knew about the Mennonite cuIture, and if1 had ever, as a nurse, worked with families of
the Mennonite faith. 1 advised Reverend Friesen that 1 had worked with several
Mennonite women during their childbirth experiences, both in my current place of
employment and in other settings. 1 told him that 1 perceived the Mennonite comrnunity
to be a group of closely-knit, quiet, shy, hard-working people, fiom a patriarchal
community, with the Church being the cornmunity's centre. 1 believed that my own and
other professionals' lack of understanding of the Mennonite culture may have hindered
both professionals and the Mennonite people in their coIIaborative efforts to obtain health
care. 1 acknowledged that Mennonite women have been recognized as a group of women
that breastfeed their infants for extended periods of tirne, and elaborated on the concems
of Nova Scotia women who are unable to breastfeed for extended periods of tirne. 1
believed that as a professional I could learn fiom these Mennonite women and. perhaps,
through this knowledge help other women have prolonged breastfeeding experiences.
Reverend Friesen advised me that there were 17 groups of Mennonites ail across
Canada, and that each group had their own intricacies, which is why sorne Mennonites
dress in the "English" way and other dress more traditiondy, and why some groups
support on-going education while others do not. Most Mennonites are very suspicious of
schools and on-going education, as they are afiaid it will pull their young people away
41
from their faith. Therefore, they seifschool (Mennonite school) during elementary years
and then formai schooling ceases.
The comrnunity in which 1 was interested consined of approxirnately 50 fiunilies.
The group is consenrative and hold many of the traditional Mennonite beliefs, customs,
and values. The community is selfsuficient, with agriculture being the community's main
source of income. Members of the comrnunity are fluent in both the English and the
German languages. Many speak Spanish as weIl. There are two schools in the
comrnunity, which have students attending until Grade 8. The Mennonite religious beliefs
are part of their children's educational activities. Children speak German until they go to
school, usually at the age of 6 years, where they leam to write and speak English.
Reverend Friesen advised me that Mennonites require only enough to meet their
needs. This group of Mennonite people do have Provincial Medical coverage, but do not
rake unemployrnent insurance or Canada Pension, as they do not want to be a burden on
society. Women in this community address themselves as the wife of the husband, as is
common in many Mennonite communities. Men make the decisions of the Church, and
while women and female children go to church services, they sit on the opposite side of
the room from the men and male children. Women rnay be quite influentid with regard to
their husband's beliefs, but would never challenge a man in public or in front of the
children; they express their opinion behind closed doors only. In public forums men do the
talking for the womenfolk.
Reverend Friesen advised me that the Mennonite people are a vexy shy and
conservative cornmunity of people and that in order to meet the people of the comrnunity,
42
1 would first have to meet the religious leaders of the cornmunity and explain to them why
1 was interested in studying with the Mennonite women. He explained that the Mennonite
people upon first introduction would speak the Gennan language (either high or low
German), and only when they became cornfortable with me would they speak Engiish.
While being conservative in their religious beliefs, there is a mixture of liberalism arnongst
this Mennonite group, for example, their use of electncity and automobiles.
Reverend Friesen agreed to cal1 the religious leader, and he was able to obtain their
consent for us to visit with the Mennonite people. Reverend Friesen accompanied me on
my initial visit to the comrnunity. We visited with the three religious leaders and their
wives. A great deal of German was spoken during the initial visit, with Reverend Friesen
translating for me. Once I explained why 1 was interested in studying with the Mennonite
cornmunity, that 1 did not want to change anything, and candidly told them how nervous I
was, the Mennonite people talked freely and the dialogue flowed.
On the day of my initial talk with Reverend Friesen, I had on a two-piece suit with
a large collared blouse that went over the suit jacket. Reverend Friesen advised me that
the suit would be seen as too worldly and the omament of a colIar over the suit would be
seen as too much finery. So, on the night of my first visit, 1 wore a long-sleeved blouse
(Mennonite women cannot Wear sleeveless garrnents) and a very plain jumper and limited
jewellery.
During the initial visit 1 was strategicdly placed in the room. The women sat on
one side of the room and the men on the other and 1 was in the middle of the group. This
would have happened no matter where 1 sat, due to the clustering of the chairs. Since the
43
initial visit 1 have been to the Mennonite cornmunity numerous times and members of the
community have been to my home. 1 have had the privilege of attending a Mennonite
w e d d i taking part in Church seMces and in the children's Christmas concert, in sorting
and packing of clothes for developing countries, and have visited and s h e d meals with
rnembers of the community.
1 have visited with the men and women when they were working in their gardens
getting the produce ready for market, and have seen the women busily preparing food for
the winter months. The Mennonite women have shelves brimming with soups, jams,
pickles, juices, vegetables, fniits, and meats, al1 canned and preserved for the winter. I
have been to the bakery, where the Mennonite women prepare baked goods for sale at the
local Farmers Markets and to the carpentry shops were the men make fiirniture or custom
cupboards, which they seIl privately or make for contractors of apartments buildings in the
city. 1 have attended the school during school hours and have observed the children and
teacher during a school day.
1 have learned that the produce from working the land and frorn other agxicultural
endeavours provide the main sources of income for the community members. Some
families have hothouses and, again, sell the produce at markets. Wood is their main
source of winter heat and the cuning and splitting of the wood is a farnily effort.
The fol10 wing generahtions about home, family, chddbearing, and breastfeeding
are drawn fiom observations and discussions within the Mennonite community and fiom
the background (context) for the study interviews. The Mennonite homes are one- or
two-story buildings, built of wood, and covered with aluminum siding. The homes that I
44
visited have large kitchens, aiways with a large kitchen table to accommodate their big
f d e s at mealtime. The kitchen tends to be the centre of the home. Large meals are
prepared here, and conversation flows during mealtime. A prayer precedes every meai in
a Mennonite home.
Family is viewed as essential in this community, for without families the
community would not prosper and grow. Both male and female members of the
community are taught how to care for children. Everyone (both genders) leanis how to
cook and how to care for the farnily. Women do not work outside the home, but are kept
extremely busy caring for their home and f d y . The women are ail skilied seamstresses
and make the family's clothing. An expedant mother with Young, growing children would
make at least nine ouffits for each child, prior to the birth of the new baby, so that her
older children would have sufficient clothing until she was able to sew again (Appendk
A). The Mennonite women also make ail of their own maternity clothing. The dresses
and undergarments are made so that the mother can discreetly nurse her baby, with
minimal bother to the mother or baby (see Appendk B).
Mon of the Mennonite women deliver at the nearest regional or tertiary care
health centre. A few receive obstetrical care fiom members of the Provincial Midwife
Coalition. There are no midwives currently living in the community, but should questions
arise, the families contact the midwives in Belize for advice and assistance during the
pregnancy. A Mennonite woman wodd announce a new pregnancy initially to her
husband, and then the couple would tell the wife's mother or mother-in-law. if these
women were not available to them, the couple would tell their closest female relative, who
45
would make the announcement to the women of the comrnunity during conversation at the
Wednesday prayer meeting or some other social event. Most Mennonite women seek
medical advice by their founh month of pregnancy. Ifthey have any questions during the
pregnancy, Mennonite women consult with their mother or other femde members of the
community for advice and support. For momhg sickness or sickness of any kind the
Mennonite women often make homemade chicken noodle soup and eat dry crackers or
bread. Reverend Friesen told me that the wisdom for childbearing and child rearing is
passed down by Mennonite women from generation to generation.
Children see their mothers breastfeeding their siblings and view breastfeeding as
normal. A Mennonite woman naturally expects to breastfeed her children; they "just
know" that is how they will feed their infants. Both genders recognke breastfeeding as
being the natural way of feeding a baby and, as they view nature as God's work,
breastfeeding would be what is bea for their children. Mennonite people view
breastfeeding as being healthy for both the baby and mother, as a means of promoting love
between the mother and baby and as a more economicai way of feeding their children.
AU members of the community recognize that a new mother needs extra support if
she is to succeed with breastfeeding. The community raiiies around the new mother and
provides her farnily with three rneals a day for at Ieast 2 weeks. Meals would be provided
for a longer period of tirne ifthe mother was unable to prepare meals at the end of that
time. Child care of older children is provided by grandparents, other farnily members, or
fnends for as long as the new mother requires. It is common in this community for a new
mother to have help with meal preparation, household chores, laundry, and child care for 2
46
to 3 months foliowing the birth of her baby. "Maids7' (which are usually family members)
come in to assist the mother with her usual household responsibilities until she feels well
enough to do things on her own. The range of help varies with each mother. It usuaiiy
depends on the number of children a new mother may have. If it is her first child she may
receive help for ody a week or two, but ifit is her third or more child, she would require
help for an extended period of t h e .
The grandmothen often stay with or are near by should the new parents need any
assistance. The new mother usually just needs to tend to her own and her baby's needs
during the £kst weeks postpartum. The grandmothers fiequently bath and settle the baby
after a nursing, so the mother can get her much needed rest. Husbands attend the
childbirth and participate a great deal in child care following the birth of a new baby, as
weli. He wiU ensure that his wife has sufficient help in the home, often taking the older
children out during the day to grandparents or other members of the community, picking
them up at night, and assisting his wife in getting the children ready for bed. Husbands
realize the importance of their wives getting enough rest during the early days postpartum,
and ensure that their wives have enough support during the day so that they can have an
aftemoon nap and feel rested enough to feed the baby. They recognize that newborns
feed fiequently and are up several times during the night, therefore they recognize the
importance of the mother resting during the day.
The newboms tend to rest with the mothers in the same bed or in a cradle placed
near the mother's bed. Most kitchens also have cradles or cribs in them for easy access to
the baby. Mennonite women speak of the need to be near their babies. They Say that
47
infants need to be near their mothers, to hear their hart beats, and to be touched and held.
They have voiced their concems over hearing so rnany babies crying in the hospitais, and
wonder why mothers are not holding and cornforthg their infants.
Although breastfeeding is the nom in this Mennonite comrnunity, the Mennonite
women can have the same breastfeeding problems as other women, but due to the support
they receive fiom their husbands, other women, and the community at large, they are able
to continue to breastfeed for extended periods of t he . There is a strong network of
woman-to-woman support available for new mothers regarding al1 aspects of childbearing
and child rearing.
M e ~ o n i t e women may have breastfeeding difficulties, but due to their vast
breastfeeding experience, they are able to recognize the problerns right away, tend to
them, and support each other in maintainhg and continuing the breastfeeding experience.
A new mother can c d her mother, a sister, or fiiend, with any breastfeeding difficulty, at
anytime. During the night if there is a breastfeeding concern, the new mother knows she
can cal1 someone who will help over the phone or sorneone will corne to provide
assistance and support. The most common breastfeeding concems that the Mennonite
women have voiced are sore nipples, engorgement, perceived lack of milk supply, and
yeast infections. These dificulties are identical to those of other breastfeeding women in
Nova Scotia. The difference is that these women view these problems as something that
can be dealt with through the help and support of other knowledgeable and expenenced
breastfeeding mothers.
48
The remedies that Me~oni te wornen have used for breastfeeding problems include
the following: for engorgement, potatoes are md a poultice of the grated potatoes
is applied to the breast; for a perceived lack of milk supply, hot chocolate d k is taken;
for a gassy baby, the mother checks her diet for gassy foods, and may rub the baby's
stomach with "Wonder Oil" or "Schiagwasser;" and for yeast infections vitamin B and
acidophilus are used. Some mothers wiii toughen their nipples prior to nursing by washing
with a roughened cloth, and if sore nipples develop, an experienced brdeed ing mother
will watch and see if the latch can be improved.
Breastfeeding mother-baby dyads and chiidren of ali ages are included in al1
cornmunity fùnctions. Mennonite women do not breastfeed openly in public in view of
men other than their husband, but when at home nurse in whatever room is most
convenient when the baby needs to feed. Their special nursing gannents, as previously
mentioned, provide easy access to the breast for the baby with minimum exposure of the
breast.
The church has a room where nursing mothers may take their children for feeding.
While nursing, both the male and the female children tend to sit with the mother at the
back of the church, to enable them to go easily f?om the room if the need arises. If
children need a nap during the service, mothers prepare palets for the children with
blankets and the children settle on the church pew or on the fioor. During services, both
rnothers and fathers hold sleeping children and settle them as the need arises. Children are
included in the wedding ceremony and are most welcomed at the reception. Older
49
children are assigned childcare duties, so the younger children can enjoy themselves, as
well as their parents, during the reception.
Children participate in d aspects of the Mennonite comrnunity. They participate
in bread making, baking, and other household chores. They are taught these skills in an
unhumed and hassle-fiee environment. 1 observed much laughter and fun when children
are taught these skills. Parents, grandparents and other community members make t h e
for children. During rny visits, 1 fiequently saw toddlers readily and without hesitation
c h b ont0 the knees of both male and female members of the family. Since there are no
televisions, children play with people and are entertained by stories, songs, and with
building blocks and homemade dolls. Mothers breastfeeding a new baby often sing and
read to other children while they are nursing the new baby. It appeared to be rerniniscent
of a by-gone era, a time without television and computers, when fun was defined more
simply.
The sense of family is very strong in the Mennonite community. Mennonite people
value and recognize the importance of good hedth. One mesure that they have taken to
achieve good health is to ensure that their young are provided with the benefits of
breastmilk. The social supports systems and the values and beliefs of this culture support
the feeding endeavours of breastfeeding mothers and babies.
The Mennonite culture views breastfeeding as normal. Breastfeeding women are
provided with functional, educational, emotional, and financial support while
breastfeeding. M e ~ o n i t e women do not have the womes of childcare or of employment
concems during their breastfeeding experience. They are provided with the physical
50
basics oflife (shelter, heat, food, water) by theu husbands and the community at large. AU
of these seem to be concems for women in soaety at large when attempting to breastfeed
their Young.
Specific interviews with the mothers. A letter of introduction was given to each
participant (Appendk C). In-depth semi-stnictured interviews and participant observation
were the methods 1 utilized to collea specific data. The guiding questions (Appendix D)
were given to those mothers who requested information about the general areas of
discussion, pt-ior to starting the i n t e ~ e w (Swanson, 1986). Throughout the interviews,
both the researcher and the participants learned and shared with each other. Language
bamers were easily remedied with the help of the translater, and the participants were
eager to ensure that I understood everything that was said. The i n t e ~ e w s took from 1 to
2 hours to complete. 1 in te~ewed each woman twice, to ensure that the information 1
obtained was complete and what 1 recorded was indeed what they had said. On the days
of the interviews 1 ensured that 1 had no other tirne commitrnents and always arranged
with the farnilies a convenient time for visiting. Swanson aated "nothing is more
fiustrating than to have to terminate or reschedule time with a respondent who is just
beginning to disclose an important or pnvate uiformation to the in te~ewer" (p. 72).
The i n t e ~ e w s were recorded through the use of extensive field notes. Notes were
also made of what was happening around the mother during the interviews. As we
engaged in conversation, the women would also ask me questions and we equally shared
information. Chenitz (1986) stated, "the use of inte~ewing with participant observation
increases validity since it assures the tmth in the observation is checked with the active
questionhg of the i n t e ~ e w situation and vice versa" (p. 88). Transcripts of the field
notes were made on the day of the in te~ew(s) and these were discussed with the
participants folIowing the second i n t e ~ e w . Throughout the expenence and during the
andysis of the data I had to take care that 1 did not introduce Western beliefs, values, and
treatments into their breastfieeding experiences. Aithough 1 am a neophyte researcher, 1
believe 1 was grounded in the data in such a way as to have been tmly accepted and
trusted in the comrnunity as much as any outsider could have been. In that regard I was
very fortunate.
Ethical Considerations
Approvai of the study was obtained fkom the spintual leaders of the Mennonite
cornrnunity. A proposal of the study was given to the Human Ethics Cornmittee of
Dalhousie University who granted permission for the study to begin. Each participant was
given a verbal explmation regarding the purpose of the study and an introductory letter.
Participants were asked to sign an informed consent form (Appendix E). Confidentiality
was assured. Participants were notified that their names would not appear in any written
or published report. AU participants were told that they could withdraw fiom the study at
any time. Participants were told that this study would not benefit them directly but it
could help other women outside the Mennonite community. I was careful to let the
Mennonite women know that 1 was not personally evaluating their lifestyle nor their
religious beliefs.
Data Analvs's 1 and Theory Generatine: The I n t e ~ e w ~
The a h of grounded theory, according to Streubert & Carpenter (1995), is to
discover complete theoretical explanations about practices, behaviours, beiiefs, and
attitudes of an individual or group as they fùnction in real iXe. Stern (1980) wrote of the
£ive principles of grounded theory which were utilized throughout the study:
1. The conceptual framework is generated fiom the data rather than fiom
previous studies;
2. The researcher attempts to discover dominant processes in the social scene
rather than describing the unit under investigation.
3. Every piece of data is compared with every other piece of data;
4. The collection of data may be modified according to the advancing theory;
that is, false leads are dropped, or more penetrating questions are asked as
needed;
5 . The investigator examines data as they arrive and begins to code,
categorize, conceptualize, and to write the first few thoughts conceming
the research report almost Rom the beginning of the study (p. 21).
The goal of grounded theory is the discovery of a core variable (Streubert &
Carpenter, 1995). More specificaily, the purpose of this study was to glean £Yom the
in te~ews a description of the core variables that enable Mennonite women to breastfeed
their infants past 6 months of age. According to Hutchinson (1993), "The core variable
serves as the foundational concept for theory generation and the integration and density of
53
the theory are dependent on the discovery of a significant core variables" (cited in M ~ n . h d
& Boyd, 1993, p. 193).
The six essential characteristics of a core variable are: it recurs f?equently in the
data; it links the various data together, because it is central, it explains much of the
variation in aU the data; it has implications for a more general or formal theory; as
it becomes more detailed, the theory moves forward; and it permits maximum
variation and analyses" (Strauss, 1987, p. 36).
As suggested by Streubert and Carpenter (1995), the data were collecte& coded,
and analysed fiom the initiation of the study. The method was circular, as information was
obtained and the date were coded into three levels. The fïrst level identified categories.
the second grouped categories, and the third descnbed the social psychological process.
Three main steps occur in the formation of a concept: reduction, selective sampling of the
literature, and selective sampiing of the data. Through utilization of these aeps the core
variable emerged. Once the core variable was identified, the researcher used theoretical
codes and memoing to move the concept on a more theoretical level. "Theoretical
completeness is achieved as the core variables are expanded, saturated, delimited, and
integrated into a well construaed substantive theory" (Stem & Pyles, 1986, p. 17).
1 endeavoured to achieve the conditions influencing data collection and analysis as
outlined by Corbin (1986) during the study: the researcher must be trained to complete a
grounded theory study; the researcher must be experienced and knowledgeable conceming
research; the researcher must be self confident; and the researcher must be able to tolerate
arnbiguity. The final result is a grounded theory report that fits the voices of these
women, and is understandable, and is generalizable to at least Mennonite women who
breastfeed their infants past their first 6 months of life.
In terms of the authenticity and truthtiilness of the responses, 1 can only say that at
al times there were more than two people present. This, in and of itseE will present
challenges. 1 do not know if the women presented me with the tmth as prescribed by their
religious beliefs or if they were tmly talking about their feelings. However, this could be
said of any kind of research, since research is aiways political in nature. By that, 1 mean
that the personal is truly political and that the search for "objectivity" is a ditncult one.
Obviously, in f e d s t research, objectively is not a desired goal, rather, I am interested in
subjectivity and, more specifically, situated knowledge that is contextually bound. With
the presence of at least two persons in the room at all times, it appeared that truth telling
was sincere and presented as they perceived their world.
CHAPTER V
PRESENTATION OF THE DATA
The experiences of the Mennonite women present a view of breastfeeding which
contrasts with a number of current views about b r d e e d h g . From a biological
perspective, the main purpose of breastfeeding is the nurturing of children, which
coincides with the Mennonite women's beiiefs surroundhg bredeeding. From other
cultures, however, breastfeedhg and the mamrnary glands themselves have very Werent
rneanings. According to Dettwyler (1995), in the United States bredeeding is shaped by
four underlying assumptions: "(1) the primary purpose of women's breasts is for sex (i-e.,
for adult men), not for feeding children, (2) breastfeeding serves only a nutritionai
function, (3) breastfeeding should be Limiteci to very young infants, and (4) breastfeeding,
like sex, is appropriate ody when done in private" (p. 174). AU of these assumptions are
culturally imposed. Every year women, particularly in the Western countries, spend
millions of dollars on breast augmentation or reduction surgery, in order to make their
breasts more physicaily appealing.
Promoters of breastfeeding often speak only of the nutritional values of
breastfeeding, rather than the emotional, developrnental, psychological, social,
immunologicai, and child-spacing benefits of breastfeeding. Breastfeedig is a very
individualized process of interaction between each child and mother. As long as health
care providers continue to set rules and regulations for women and children in order to
obtain breastrnilk, breastfeeding wili not become the n o m in society.
HaWig had the joy of working and learning about breastfeeding with the
Mennonite families, 1 beiieve that their stories will clearly indicate that breastfeediig does
involve much more than nutrition. Breastfeedmg provides a means for child spacing in
this community, and it does involve emotional, social, psychologicd, developmental, and
imrnunological benefits for the comrnunity. The following sections will descnbe the
breasdeeding expenences of 7 Mennonite women who have all exclusively breded more
than one child past 6 months of age.
The Core Variable, Nature's Way: A Sacred Thhg
The teachings of God and the Bible are central to a Mennonite's Life and provide
the structure for everything they do. Living off the land and providing for oneself fiom
the abundance provided by "the Lord" and the land are important values for the
Mennonite people. It is important to remember that these findhgs are f?om the Mennonite
women's voices, not £?om others, tike myself. fiom other backgrounds or beliefs. To that
end, 1 often use quotations around words or phrases which I heard repeatedly.
The Mennonite comrnunity in this study is comprised maidy of a group of men,
wornen, and children from an agricultural background. They are conservative in dress and
appearance and follow the betiefs of the Mennonite Church as outlined in Chapter m.
Women and men are familiar with the birthing process, having tived on f m s for the
majority of their lives. They are very used to seeing f m animais birth and suckle their
young. They view Nature and all of Nature's wonders as part of "God's plan."
Therefore, breastfeeding a human infant is a normal process. In their view, "in God's
infinite wisdom," breasts were made for the nourishment of the young of every species. It
is as basic as that. The Mennonite wornen wonder why one would question such wisdom
or tamper with this natural feeding process. They betieve that ifGod provided the mother
with a means for nouishing her infant? why would the mother not want to do this? The
following are descriptions of how the Mennonite faith affects the Mennonite women's
decision to breastfeed.
It looks like to us that this is the way God intended. It is the normal way of feeding a baby, it is the way most babies are fed. I was dways sure 1 would breastfeed, it is just the way it would be done. Most of us keep animais, we see animals nursing. Ln the city you would not see this. 1 never doubted - I wanted to breaseeed. It is handed down noni generation to generation. Mother was always good at nursing babies. She breastfed twins successfully.
Breastfeeding has to do with faith. To love your children. So it is important to breastfeed. My mother breastfeed her children. It is always good to see a mother hold and cuddle her baby while nuning.
God planned for women to breastfeed. It is the best nutrition the baby could get. My mother did it, rny gmndmother did it, there was no question that 1 would b reastfeed.
God has made me so that 1 could breastfeed. The Creator planned it that way. 1 always knew 1 would breastfeed rny children.
God made us that way. Just natural. God planned for women to breastfeed.
1 think breastfeeding is better for children. 1 grew up thinking I would breastfeed my children. God has planned for women to breastfeed. Breastfeeding is a sacred thing. God planned for this to happen. Breastfeeding is a nice way to feed the baby.
Everything a person of the Mennonite faith does or says centers around the core
beliefs of hisher f ~ t h . A Mennonite's belief in hidher faith provides h i d e r with the
foundation that provides direction for everything that is done in Ise. Breastfeeding is seen
as the normal way of feeding an infant. It is "Nature's Way" of providing for its Young.
58
Breastfeeding Values and Betiefs as Described by the Memoite Women
The process that enables breastfeedùig to become "Nature's way: a sacred thing,"
which is the core variable in the study, was made up of three "CO-variables" or themes, as
they are known in grounded theory. These thernes included: (a) health benefits, (b)
economic benefits, and (c) values and beliefs, as displayed in Figure 1.
Healtb and Economic
Reinforcement of Values and Beliefs
Fimre 1 : Variables making up the core variable of the study, Nature's way, as identified by the participants.
HeaIth Benefits
The Mennonite women are aware of the health benefits of breastmilk and readily
identified this theme. This knowledge cornes f?om Living the experience, not fiom reading
or attending prenatal classes. Mennonites are very informeci about their own health needs
and seek out Uiformation throughout their membership on various concems. They believe
that their children are not il1 as often as other children outside the community, and they see
how content their chiidren are following a feediig. The following describe some of the
Mennonite women's views concerning the health benefits of breastfeeding.
Breastfeeding is healthier for the baby. It is a way for the mother to relax with her baby. A love bonding between the mother and baby.
Breadeeding is the best, most nourishing and cheapist way to feed a baby. It helps with the love bonding of the mother and baby.
Breastfeeding is important because the babies don't get sick as ofien, the breastmiik is always ready, and it prevents pregnancy.
It is the best nutrition for my baby. It helps with allergies.
Although the Mennonite women did not identiQ aii of the medically researched
benefits of breastfeeding, they readily recognized that breastrnilk does impact on their
children's health. Knowing that breastmilk c m irnprove their children's health was one of
the factors that enabled and supported these women to initiate and continue to breastfeed
for longer durations of t h e . The health benefits of breasfeeding have been passed down
fiom one generation of Mennonite women to the next as the following story indicates.
1 had two babies die, one at 3 months, and one at 4 months. When 1 had another
baby my Doctor told me 1 shouldn't breastfeed, maybe my rnilk wasn't good
enough. 1 would have stopped. 1 didn't want to h m my baby, but both my
mother and my mother-in-law said that breastrnilk was what was good for my
baby, so 1 breastfed the baby, everything was fine, and I was glad 1 did.
60
Expenenced bredeeding mothers are aware of the benefits of breasâeeding, often more
so than many health care professionals: much can be learned by Listening to women's
voices as they describe lived experiences regarding the benefits of breastfeeding.
Economic Benefits
The Mennonite women in this study, Oce many other women worldwide, are not
independently wealthy and must work very hard to help support their famites. As the
foilowing quotes indicate, the Mennonite women are aware of the economic benefits of
breastfeeding.
Breastfeeding is normal. Breastfeeding is less expensive than formula. Formula is very expensive.
Formula is very expensive. It is cheaper to breastfeed.
Breastfeeding is the best, most nourishing and cheapest way to feed a baby.
It is cheaper to breastfeed. Formula would be a big expense.
Mennonite women recognize that formula feeding would have a detrimental effect
on their family's financial resources. Their findamental beliefs require them to live within
their means and in a manner that keeps them as close to nature and "God's way" as
possible, therefore, breastfeeding is well supported and pursued as an economicai means
of nourishing a child.
Family Vaiues and Beliefs
The Mennonite people have a strong belief in the value of children and family, and
believe that the community as a whole is responsible, through their faith, to help the family
and individual members to grow and prosper. They believe that breastfeeding enables a
61
"love bond" to develop between the mother and child that wiil help the children and family
to develop into productive, contibuting members of the cornmunity. The Mennonite
women described their values and beliefs about b r d e e d m g ' s effect on the f d y .
Breastfeeding is a tirne for love. It is a pleasant time to hold the baby and pray for the baby. The baby is close to your heart. It is a relaxing t h e . Couples need to understand it is not the baby that causes problems, the baby had no choice. It is the parents that are causing issues. If the mother is not happy, the husband will not feel like coming home. The husband must love and care for his wife and f d y.
Breastfeeding gives me good feelings about me, my baby and family. Love for the baby.
Who would not want the best for the baby? Breastfeeding is the best for babies. It gives you happy, pleasant feelings. A love bonding with the baby.
Mennonite women value their breastfeeding experiences, believing that it
strengthens their bond with their children, which will enable them to nurture their children,
helping them to become valued members of the comrnunity. The three themes of health
benefits, econornic benefits, and values and beliefs support the core variable of
breastfeeding being "Nature's Way" (see Figure 1). It is these three themes that the
women identified as significant in their views regarding breastfeeding. In the next sections
of this chapter 1 bring forth more information regarding the issues that ailow the women to
cany through with their ideals of breastfeeding.
Support Provided for Mennonite Women During Their Breastfeeding Experience
House and Kahn (1985) reported that the functions of support are emotional,
instrumental, informational, and aflinnational. In my experience as a Lactation
Consultant, each of these aspects of support is needed ifbreasâeeding is to be successful.
62
Lack of support, as perceived by the mother, is often one of the key rasons cited for the
discontinuance of breastfeeding. Many women have never seen another woman
breasâeed. They do not know of the solutions or remedies for breastfeeding problems
that experienced breastfeeding women know. Many women do not have extended f b l y
nearby, nor know their neighbours, nor have a fnend that is an experienced breastfeeding
mother, and often find themselves isolated and alone when they return home with their
Uifant. But these fortunate wornen have many supports in place upon which they can rely.
HusbandFather - Parents and Parent-In-Laws - Familv - Community Members Suppofl
In the Mennonite community there are supportive practices that enable women to
breastfeed their children in line with what they perceive tu be "Nature's way" are provided
by husbanddfathers, parents and parent-in-laws, and other brdeeding women (Figure
Other Women
/ Supportive Practices \ for
F i g r e 2: Networks s~ppohng b r d e e d i n g practïces of Mennonite women.
The types of s ~ p p o n s provided to new mothers and the knowledge passed down
from generations of breastfeeding mothers contributes to the success that women have
with b r d e e d i g . The Mennonite women descnbed their support systems.
HaWig a baby is a busy tirne. It is easier with the fia, but with more chiidren, it is a busy time. My husband, my parents or my parents-in-law care for my other chiidren, and do the household work for the first two weeks. My mother would help with the new baby's care, bathing, and such. My family and fnends bring in meals for the kst 2 weeks. At 2 weeks it is pretty much the same, 1 start to make easy meals then, using my canned goods, but laundry and child help is still provided by my f d y and friends. By 6 weeks, 1 am doing most everything by myself, but 1 have a small family (3 children), so I don't need much help. If1 had a large f d y 1 would have a maid (another fêmily or community member) come in to help me for as long as 1 needed it. My husband helps me out a lot. He is able to care for the children, and helps me get the rest 1 need.
1 get advice and encouragement from my mother. I often call her about many thùigs, breastfeeding, if the baby gets sick, toilet training, lots of things. She gives me encouragement to keep going, tells me 1 am doing well, offers to help in any way she can.
My husband encourages me to have a nap everyday after lunch (noon meal). If possible tums telephone off (ifnot expecting an important c d ) . My husband helps with everything. He is a great heip with the children.
When 1 first come home with a new baby we are proud as parents to be home with new baby. The farnily shares in the new baby. 1 stay in bed and rest, no housework, no dishes, no meals, for about the first week. My mother and mother- in-law help. My husband's job is to help with the children. My husband would put the children down for naps and get them ready for bed. My husband and family make sure 1 get enough rest. My mother always gave me advice and encouragement. By 6 weeks 1 would be making simple meals (ricd vegetables/canned meat) and by 6 months 1 would be doing everythhg.
1 have lots of supports. My husband, mother, family members and Wends. People bring in meals for as long as 1 need them. My family helps with the children. i have a maid corne in when 1 need help with the house and the laundry for as long as 1 need them. Things are busy at al1 times with a new baby. The busy things just change. My husband and mother support me when times get rough to keep going.
My whole community supports me. My husband never lets me corne home alone with a new baby. My sister helps me with the laundry for a whole year. The children's g r d a t h e r cornes and gets the children for the day. My mother, sisters, and niends give me encouragement to continue to breastfieeding- They will come whenever 1 need them.
You don? have to do everything by yourself. My husband, sister, and mother help me with everything that has to be done. Child are , laundry, meals, housework, everything. The older children usualiy go to grandparents for a week or so. By 6 weeks 1 do nearly everything by myself except the laundry. Then usudy once a year 1 get someone in to help me with the heavy housecIeaning. B r d e e d i n g is important, the baby cornes first. lfdishes have to be done, they would wait. If 1 needed help or encouragement, 1 would cal1 my mother for advice.
If the Mennonite women have problems or concems about breastfeeding, they do
not need to seek out the help of a health care professional. Instead, they seek help from
their mother, sisters, or fnends who are the "breastfeeding experts," and utilize their past
experiences, remedies and cures for breastfeeding difFcu1ties. As indicated by the
foUowing stories, the M e ~ o n i t e women have the same breastfeeding diaculties as
women al1 over the world have, the difference being they have "voices of experience" to
help them.
If 1 am having trouble with breastfeeding 1 would call my mother or a Wend. Some of the breastfeeding remedies I have used are: Vitamin B if the milk supply decreases and Brewer's yeast - or if the mother is depressed. Eating peanuts wili increase the milk supply, must take off the tip of the peanut or it will make the baby gassy. Prior to menstnial cycle, the milk may taste bad, but you must try to keep the baby at the breast, just for a day or so, and then it is fine. Drink hot chocolate milk ifthe breastmilk supply is down. For engorgement, use a breast pump, you cm freeze the m i k ifit gets too old you just dump it, because there is lots. If the baby is gassy, use Tums and syrup or grippe water. Beans are left alone when breastfeeding, but would use them for protein ifa great deal of blood was Iost during delivery, cabbage and tomatoes can aiso cause gas.
1 always had too much miik - except for one t h e when I had pneumonia My baby was 1 month old. My mik supply was down. 1 was on antibiotics. I was at a sewing g a t h e ~ g and my sister-in-law noticed this. No bottles were used. 1 drank hot chocolate milk, and my supply came back.
1 had few problems with breastfeeding, but for engorgement ifyou massage the breast towards the Npple you make more rn&, so you should always rtxb away f?om the nipple to take the rnilk supply away. If the baby is fussy, it is easier to nurse if the baby is alrnost asleep, then baby would breastfeed more easily.
I f 1 had problems 1 would c d my mother. She Lives far away but I would c d her. For a breast infection 1 would use acidolphilus up to six tablets a day. If the baby has gas 1 would use "Wonder 01" or "Schlagwasser," you rub it on the outside, and put on a warm diaper. Carnomile tea will also help with gas.
As these stories indicate, emotionai, instrumental (child care, hancial, housework,
Iaundry, and meai preparation), atfirmational, and informational support is provided for
the Mennonite women by their husband, family, fnends, and comrnunity. Support is a key
element in maintainhg a successful breastfeeding experience.
Fat hering
The Mennonite culture is a patriarchial culture which supports male domination
and female submissiveness, however, the manner in which both genders are socialized into
viewing parenting and breastfeeding lends support for the success of nurturing and
nourishing a child by 'Wature's way."
One Mennonite woman's response to how breastfeeding is norrnalized between
genders was:
Other children are included. They are glad for the Mom and baby. A mother breastfeeding has to spend a lot of t h e with the baby. When Young, it teaches males that breastfeeding is naturai. They see it at home not as excited, they can be calm then, as they have seen it at home. It teaches children that breastfeeding is a sacred thing.
66
Ehrensalt's study (1987) indicated that men see fathering as something they "do,"
whiie women perceive rnothering as something they "are." 1 heard from the women in this
study that in this Mennonite community both the men "are" fathers and the women "are"
mothers. Both genders care for, anticipate needs, entertain, feed (older children), change
diapers, arrange for child care, and do organization, thinking, and problem solwig
required for childrearing. No child care responsibility, other than breastfeeding, belongs
exclusively to one or the other gender. 1 observed Mennonite fathers meeting their
children's needs. They did not have to be asked or told what to do, or where to find
things, or who to call, or what time the appointment was for or for whom. They just went
ahead and did the things that needed to be done, the interesting thing being that the
Mennonite women allowed this to happen and made no comments or criticism of their
work, but expected their partner's participation. From personal observation and
expenence of many parental situations, 1 have often found that women want help ffom
their partners but wili not release the reins of control. They want the task done as they
would do it. This often leads to such comments as: "never mind, just let me do it,"
"that's not how you do it," or "unless I do it, it won't get done right." 1 never once heard
comments such as these kom the Mennonite people. Child rearing is a team effon, with
both parents meeting the needs of their children. The support and belief in breastfeeding
by the Mennonite men is an important factor in the success of breastfeeding for the
Mennonite wornen.
The support provided by other breastfeeding wornen, parents and parent-in-laws,
and husbands enable the Mennonite women to breastfeed their children for extended
periods of time. These types of support systems are unfominately lacking for many
women in other cultures and need to be investigated tiirther ifother women are to be
supported with their breasdeeding endeavours.
The remahhg social situation that affects breastfeeding is the work done by
breastfeeding women. Mennonite women, dthough not in a wage eamhg type of
employment, do work very hard. They are responsible for the children while the husband
does other work, the preparation of meals for large families, household tasks, the sewing
of clothes and bedding, and for the garden which tends to produce a harvest for the famiy
and the local Farmers' Market. The women do ali the baking, canning, and preserving of
food for their families. The difference between this type of employment/work and the type
where women seek employment outside the home for pay is that the Mennonite women
are able to include their children in ail work activities and meet their children's needs as
they arise.
Mennonite women stated the following about work/employment.
I don? work outside the home. Not a working job, 1 work at home. The attitude needs to change of Society, so that mothers can be at home with their babies, then they would breastfeed too. It felt fumy to be asked by my doaor if1 was going to breastfeed. 1 wondered why he would ask that - of course 1 was going to breastfeed -- don? most women breastfeed?
When you breastfeed you have less tirne to do other work. You have to arrange your work so breastfeeding would fit in.
Breastfeeding just had to be done - when the baby needs to be fed - you just have to stop what you are doing and feed the baby - some days you are reaily busy but you know that your baby must eat.
Breastfeeding is the m o a important thing. The baby cornes first. If dishes had to be done, they would j u s wait.
You just do it, the baby lets you know when she wants to be fed. So you stop what you are doing and you feed the baby. 1 jua have to fit ali the household chores around breastfeeding, sornetimes i f1 am really busy, like when the gardening and carming is ready to do, 1 sornetimes get a bit harateci, but I know 1 must feed my baby, so it gives me a change to relax as weli. My other children play around me when 1 am nursing, because they are Little, we all aay in one room when I am nursing and I have to close the door, so 1 can see them and keep them sde too.
Mennonite women indeed do work, as dl mothers do. Working in their homes and
community, it is possible for their children's needs to take pnority over any potential
employei's needs. Their children are readily available, child care is accessible, travehg is
a non-issue, and they are not constrained by workplace policies and politics.
Breastfeeding is the nom. The other facets of their lives weave in and around the needs
of the breastfeeding dyad. In many other societies where breastfeeding is not so
successful, the reverse scenerio is seen. Breastfeeding must fit into the needs of society
and employers rather than those of the mother and baby. The support systems and the
values of this community enable women to work and care for their children, they are
interco~ected, to make a whole system that supports breastfeeding (Figure 3).
Grounded in the Fathering S haring Mennonite Faith,
Figure 3 : Supports which enable breastfeeding as the normal practice for Mennonite
women.
In surnmary, the factors that the Mennonite women identified that irnpacted on
their breastfeeding successes were: their beliefs, values, and views that breastfeeding is
the nom; the support nom their husbands, family, other women, and the community at
large; and their ability to incorporate their children's needs into t heir working
environment.
CHAPTER VI
SUMMARY AM) ANALYSIS OF THE FINDINGS
Sumrnary
This study has shown that many factors contribute to a Mennonite woman's ability
to breastfeed her children past 6 months of age. The Mennonite beliefs and values
iduence al1 members in their community. Remaining close to nature and foUowing
natural patterns is a fundamental Mennonite philosophy. The participants in this study
placed breastfeeding within this context by describing breastfeeding as cWature's way" for
providing nourishment to a child. The support provided by their partner, family, other
wornen, and community members emerged as a factor in enabling Mennonite women to
continue breastfeeding for prolonged periods of tirne.
A Mennonite wornan's ability to incorporate breastfeeding as a main pnority into
her daily work life also aids her in continuing an extended breastfeeding experience. The
way in which male partners parent and the manner in which breastfeeding is spoken of by
members of both genders enables breastfeeding to be viewed as the normal means of
feeding a child in this community. Finally, the rare ut iht ion by the Mennonite wornen of
medicai care, tec hnology, and other heait h care professionals as breastfeeding resources,
in cornparison to their wide utilization of lay support and advice on breastfeeding, offers a
view of breastfeeding success which is rarely reported in the health professions literature.
These factors will be addressed in the analysis.
Analysis
Beliefs and Values AEecting Breastfeeding
One might argue that religion and f ~ t h have nothing to do with one's health
activities and even less to do with breastfeeding. The hdings of this study suggested that
the Mennonite women's fiiith has enabled them to unite and develop values, goals, and
health care practices which impact on their chi ldbea~g and child r e g practices.
The church is the centre of a Mennonite woman's life, both as an individual and as
a member of the Mennonite community. Thei. faith impacts on their family's health by
providing a major source of social support and by Uifluencing and normaliong f d y
values, goals, social practices, and health behaviours. Breastfeeding is nomalized in this
community.
Wright, Watson, and Bell (1 996) defined a belief as "the bruth of a subjective
reality that influences biopsychosocial-spiritual structure and fùnctioning" (p. 4 1). Ka
person truly believes in something, that beiief becomes a part of the person, or ifa person
believes certain things to be true they are true in their consequences. The M e ~ o n i t e
women tiindamentally believe that breastfeeding is the best way to nourish their infant(s)
and find it difficult to comprehend why others would contemplate any other type of
feeding method. As one women said:
1 couldn't understand why the Doctor was asking me SI was going to breastfeed. Doesn't everyone breastfeed?
Although this was a naive response (as this comrnunity is not totaily cut off fiom
the rest of society), it does reflect a simplistic view. Mennonite women learn fiom an
early age that when they have children, they will breastfeed, it is "Nature's way." They
have the benefit of having many role models, knowledgeable advisors, and a whole
comrnunity of people who value breastfeeding and view breadeeding as the normal way
to feed an infant.
Researchers have reporied that religious beiiefs infiuence farnily planning,
childbearing and child rearing practices and provide people with consistent patterns for
living out theu core beliefs and ceremonies which give believers a sense of togethemess
and quiet in a time of chaos (Loveland-Cherry, 1996; Taggart, 1994). Other cultures have
found that religious beliefs and values have also iduenced women's and children's
breadeedig experiences. Islamic women of Cairo, Egypt, for exarnple, believe that
success with breastfeeding is a religious blessing, and weaning in this culture, traditionally.
does not occur until into or through a child's second year of me. Moslem women of
Israel, due to religious beliefs, also support the duration of breastfeeding past 6 months of
age (Azaiza, 1995), and West Indian mothers' infant feeding praaices (on the island of St.
Croix) are influenced by folk and religious beliefs (Corbett, 1989). Similady, religious
beliefs and values provide the Mennonite community with a way of looking at
breastfeeding that impacts on the breastfeeding culture within this community.
Health and Economic Benefits of Breastfeeding
The Mennonite women, as previously mentioned in Chapter V, are aware of the
many health and economic benefits of breastfeeding. If breastfeeding is to be valued,
women of al1 cultures need to become aware of the benefits of breastfeeding and
incorporate these benefits into their health care beliefs, values, and practices. Ahrendsen
73
beliefs, values, and practices. Ahrendsen (1996) identified that breastfedmg provided the
following health benefits for Uifants, women, and society.
Infant benefits:
- Protection against infections, Unesses, and allergies, enhanced development and
intelligence and long tenn health benefits.
Matemal benefits:
- Delayed fertiiity; decreased breast, uterine, ovwian, and endometrial cancer;
improved ernotiond health; decreased osteoporosis; and irnproved postpartum
weight loss.
Societal benefits:
- Optimal child spacing; decreased child abuse; irnproved vaccine responses;
financial savingdand ecological benefits.
At one time or another throughout the study the Me~oni te women identzed these
benefits of breastfeeding. The health and economical benefits of breastfeeding are widely
known and valued amongst the Mennonite women, families, and community.
Van Esterick and Butler ( 1 997) indicated that breastfeeding saves a family financial
resources not only in the cost of formula and bottles, but on medical expenses, fuel, and
loss of work benefits due to sick leaves for child care. For cornrnunities and countries at
large, breastfeeding reduces infant morbidity which reduces the cost of overall heaith care
needs (Jason, Nieburg, & Marks, 1984). Health care professionals will need to continue
to study cultures such as the Mennonites to l e m more about how to help other women
act on the knowledge regarding the benefits of breastfeeding.
Family Values
The Mennonite faith places strong value and belief in the importance of family and
children. Greenspan (1997) reponed on a discussion of essentiai childhood needs amongst
such participants as Kathryn Barnard, T. Barry Brazelton, Une Bronfenbremer, Eugene
Garcia, Irving Harris, Asa Wiard, Sheila Waiker, and Bany Zukerrnan, about the seven
needs of childhood:
Every child needs a safe, secure environment. . . Consistent, numiring relationships with the same care givers. . .wealth and a high level of education are not arnong these qualities; what is essential are maturity, responsibility, responsiveness, understanding, and dedication. Rich, ongoing interaction. . . An environment that allows them to progress through the developmental stages in their own style and their own tirne. . . Children must have opportunities to experiment, to find solutions, to take risks, and even to fail at attempted tasks. . . Children need structure and clear boundaries. . . To achieve these goals, families need stable neighborhoods and cornrnunities. . . (p. 264-267)
The Mennonite women identified breastfeeding as a "love bonding between the
mother and baby." Oxytocin, a hormone released by the mother's pituitary gland in
response to breastfeeding, "acts as a naturai tranquilizer, helping the new mother cope
with the stress of caring for a newborn" (Black Jarman, & Simpson, 1998, p. 107).
The Mennonite faith provides for the development of values and beliefs that enable
a cMd to grow and prosper. In my experience throughout the study, 1 have never seen a
Mennonite child, woman, or man hungry, cold, without shelter, or love. The children are
played with, read to, and interacted with. A television set is not provided as a means of
childcare in these homes. Al1 of the seven needs listed above affect breastfeeding
75
practices. A Mennonite child knows he/she wiU be supported not only by their parents but
by the comrnunity at large. Ifa family has a need, the cornmunity rallies to support the
f d y . Many children and women of other societies are not provided for in such a manner
and ofken go to bed cold and hungry or in pain. I have not found this to be so in this
community of study. Extended breastfeeding provides the foundation for meeting the
needs of children within the Mennonite f d e s .
s4ma
The Mennonite women are supported in their breastfeeding endeavours by their
partner, family rnembers, other experienced bredeeding women, and the cornmunity at
large. The help provided to new mothers from lay personnel in the community is one of
the community's greatest strengths. Eng and Young (1992) found that the changing
trends in health care have caused a much greater reliance on the help of !ay persons for
support for many people.
Zirnmerman and Comor (1 989) reported that the greatest influences on a person's
health behaviours were supportiveness, encouragement, and modeling by farniiy members,
fiiends, and CO-workers. Studies have show positive effects of support for breastfeeding
fiom partners, f d y , and fiends (Bar-Yam & Darby, 1997; Freed, Fraley & Schanler,
1993; Lothian, 1994; Small, 1994).
Support, according to House and Kahan (1985), consists of four fûnctions:
emotional (reassurance, empathy); instrumental (financial, physicd activities, provision of
basic needs -- shelter, food, etc.); informational; and aiErmational (feedback, evaiuation,
appraisal). Isabelia and Isabella (1994)' studying tirst time mothers' perceptions of
Swedish women it was found that informational support about breastfeeding tended to
corne fkom the doctors and nurses (Bergman, Larsson, Lomberg, Moller, & Marild,
1993). Bucher and Matsubara (1993) found that lactation consultants were the moa used
resources for providiig information and for answering questions, and hus bands, fiiends,
and f d y were important for personal facets ofbreastfeedmg and for building confidence.
AU too often many breastfeediig women do not have a strong support network.
Brandt (1989) found that support networks were both relational and stmctural. The
relational properties of support are: affect (caring, security, empathy); affirmation
(agreement of another's actions or thoughts); and aid (problem solving, providing
information or services such as money, transportation, and childcare) (Kahan &
Antonucci, 1980). The structural properties of a support network include the size, the
location, the diversity of resources, personal intercomectedness, and stability (Brandt).
Knowing about a breastfeeding mothers' support network and utilizing those resources or
helping her to develop a support network can make a major dserence in a mother's
breastfeeding experience.
Bergh (1993) found that the identified matemal obstacles to breastfeeding in South
Afîica were insufficient motivation, knowledge, anxiety, fatigue, and ernployment.
Obstacles to breastfeeding identified by health professionals were lack of support for
mothers, inappropriate lactation management, lack of knowledge, negative attitudes, and
stafshortages. Lack of support and life-style were identined as obstacles by society at
large. In contrast, the prirnary means of motivating women to breastfeed were to provide
increased information and education, along with increased contact with other
breastfeeding mothen.
As a lactation consultant, 1 concur with ali of these identifieci obstacles to
breastfeeding, which al1 relate to support or lack thereof On a daily basis I see mothers
that are not supported by their partners or fàmily members in their efforts tu breastfeed.
Or 1 see rnothers that feel "forced" into breastfeeding by f d y mernbers or health
professionals, when they reaiiy do not want to breastfeed. 1 see mothers that have limited
knowledge about the dynamics of breastfeeding or those that have been given
misuifonnation. Mothers corne to clinic settings without financial support, which means
they are stmggling with housing, heat, and food problems, along with breastfeeding
problems.
Health professionals struggle with providing care d u ~ g phases of re-engineering
and downsizing, shortened lengths of hospital stays, and the lack of theory based
knowledge regarding the lactation process. Many of these professionals do not support
breastfeeding and are appded when families insist upon a different standard of care that
puts the families' needs ahead of the professional's needs, beliefs, or values. Parents are
often more inforrned about the breastfeeding process than many heaith professionals.
Many societies, particularly in the western world, have a long way to go before
breastfeeding becomes the normal way of feeding children. Many people are still repulsed
by a mother nursing her baby in a public place, but h d women scantiiy clothed at a beach
attractive and acceptable. Toddler storybooks continue to advocate for bottle feeding
through illustrations of animais bottle feeding their Young, and popular Christmas
catalogues continue to show dolls with their bottles rather than with breastfeeding pillows.
C o n s i d e ~ g the power of support, it is iittle wonder that the Mennonite women
are so successful with breastfeeding. The four functions of support (functional, emotional,
informational, and aiErmational) are unconditionally met by their spouse, family, tiiends,
and community members.
Gender and Fathering Issues
The study participants described that breastfeeding is viewed by both genders as
the normal way of feeding and nurturing an infant. Fathers are very much involved with
the care of the children, and support their wife's breastfeeding endeavours. Sexual issues,
jealousy, exclusion, and resentment do not appear to enter into the equation; breastfeeding
needs to occur so the infant will be nounshed, and whatever needs to be done to enable
the breastfeeding process is done by both genders who recognize the benefits of
breastfeeding for the child, mother, and their society.
According to Lorber (1994), gender as a social institution is composed of gender
statuses, gendered division of labour, gendered kinship, gendered sexual scripts, gendered
personalities, gendered social control, gender idec 3gy. and gender imagery. Gender is
composed of sex category, gender identity, gendered marital and procreative status,
gendered sexual orientation, gendered personality, gendered processes, gender beliefs, and
gender display. Each of these factors can and does tirnit or create oppominities for both
women and men. From birth onwards gender becomes an issue for women and men. One
of the first questions asked at delivery is: "is the baby a boy or a girl?"
79
Gender systems are binary systems that do not have equal basis are hierarchical in
nature, and place males and fernales at cross purposes or up against one another. In my
experience within the Canadian health care system, women are unialiy viewed as infierior
to their male counterparts, receive less recognition and rewards for accornpiishments,
educational achievements, and personal experiences, and receive less tinancial
remuneration for work done than do their male counterparts.
Matemal reproductive fbnctions have long been associated with positions of
vuinerability by science. policy, and law. Numiring, comforting, encouraging, or
facilitating interactions are viewed as a women's "naturai" or "ferninine" proclivities, not
something learned, skilled or required, or valued (Daniels, 1987). Would this be so if men
were giving birt h and producing breastmilk?
As early as 1949 Mead wrote "whatever men do - even if it is dressing doiis for
religious ceremonies -- is more prestigious than what women do and is treated as a higher
achie~ernent'~ (p. 159). Cultural values and beliefs such sis "mental labour is more
prestigious than manual labour, and science is more prestigious than caring for children,"
provide society with powertùl messages and understandings of what is to be valued
(Gaskeil, 1992, p. 1 17). Al1 too often women's work is seen as inferior, simply because it
is done by a woman (Phillips & Taylor, 1980).
If breastmilk was viewed as a scarce commodity or could be replicated by the male
species, headed by a male-dominated corporate leader, it is likely that breastmik would be
viewed as "liquid gold and there would be only one sociably acceptable way of feeding an
infant -- breastfeeding! hstead, in many societies, breastfeeding is treated as something to
80
try but if it does not work it is accepte& after ail, the fdure is due to some weakness on
the woman's part, never due to lack of support f?om a partner, the work place, family. or
society .
Many women make the decision to breastfeed or formula feed based on gender
biased values and beiiefs. Frequently the decision reflects the values and beliefs of their
male partner rather than on their own needs or their infant's needs. Sullivan (1996) found
that rnany women in Canada choose not to breastfeed because it is too embarrassïng and
their male partners oppose breastfeeding. Women's breasts are viewed by many as being
sexual objects "owned by the male partner, not as biological organs made for the purpose
of nurtunng children. Freed, Fraley, and Schanler (1992), found fiom interviewhg men
whose partners planned to formula feed that these men were more likely to think
breastfeeding is bad for breasts, makes breasts ugly, interferes with sexual relations, and is
not acceptable in public. Movies, videos. catalogues, books, magazines, and
advertisements support the exploitation of the female body. If breastfeeding is to become
the nom, the Mennonite women's experiences suggest that improved education about the
importance of female reproductive abiiities must be taught and incorporated into both
genders' way of living, fiom a very early age. Since many males, particularly in western
societies, have not had the opportunity to view a breastfeeding experience as normal, it
appears that there is a definite need to examine the role of male partners in supponing
b reastfeeding .
Factors that have been found to influence a woman's decision to breastfeed are the
father's level of education and his approvd of breastfeeding (Littman, Mendendorp, &
Goldfub, 1994). Fathers have claimed to be excluded, jealous, and resentflll when
breastfeeding is chosen as the method for Uifant feeding (Bar-Yarn & Darby, 1 997;
Gamble & Morse, 1993; Jordan & Wall, 1993; Voss, Finnis, & Mamers, 1993), which
again speaks to the need for ongoing education about the realities of breastfeeding for
fathers, the adult couple relationships, and ways to enhance father-infant relationship S.
Breastfeeding is a gender and ferninia issue. Breastfeeding enables women to
challenge the male-dominated medical mode and the formula producing companies, to
develop a stronger sense of abilities, and to redefine women's work and the value of
women's work.
The paradox in this study or the distinct contradiction of this study is that men in
this Mennonite cornmunity are generally considered superior, yet the opposite is so in
childcare practices. There is a daytime gendered nature of work and a night time division
of "women's work." During the day the wornen are usually totally responsible for the
children, but at night when the men return frorn work, they participate in the childcare
activities, preparing and settling children for bed, reading, and meeting the general needs
of their children and wives. This is uniike the experiences of many women in other
societies who are expected to provide total childcare and housekeeping duties while the
male partner meets his own needs and leaves many if not ail of the childcare duties to the
femaie partner.
Work and Breastfeeding
These Mennonite women described working very hard maintaining their home and
parenting their children. Unlike many women who stay at home in other communities, the
82
family, and comunity at large. These women are aware of the health, social, economic,
and ernotional benefits of b rdeeding ; of how to pump and store milk; and of the various
physicai concems that can arise fiom breastfeeding. The Mennonite women do not need
protective legislation and strategies for bnplementing employer/employee breastfeeding
policies; they do not need to promote and inform their community members about the
benefits of breastfeeding; they do not need to form advocacy groups for breastfeeding;
they do not need to search for safe child care for their children; and they do net have to
worry about keeping enough food on the table. Ifd women could receive these types of
supports, the breastfeeding duration rates may improve.
In today's world many women combine their breastfeeding expenence with
employment. Women return to work for a variety of reasons: to keep food on the table
and a roof over their heads; to fiind their own, their children's or their partners educationai
endeavours; to obtain or maintain a certain status, which increases their sense of worth
and seifesteem; and for the fellowship with peers. The retum to work by breastfeeding
women has been cited by many researchers as the main reason for the decline in
breastfeeding worldwide (Baden, 198 1 ; Corbett-Dick & Bezek, 1997; Moskowitz &
Townsend, 1992).
Riordan (1993) identified five social supports that an employed breastfeeding
woman needs in order to maintain lactation:
- a person who cares about her and what she wants for her baby - a role mode1 - a knowledgeable advisor - a person who obviously values breastfeeding - a person on whose shoulder she c m lean or cry. (p. 41 5 )
83
Many employed b r d é e d i n g women are chdenging the system and breaking new
ground when they combine brdeed ' ig with employment endeavours. Employers fuid
themselves faced with a whole difFerent array of unique employee needs and requests such
as extended matemity leaves, flexible tirne schedules, breast pumping and breastmik
storage equipment, allotted breastfeeding o r pumping breaks, provision of cordortable,
clean pumping or feeding rooms, and child care facilities near or on the employment site.
Co-workers' values and beliefs in breastfeeding are also tested when a
breastfeeding mother retums to work. Working in a matemity health centre, 1 find that
fellow coileagues returning to work ofien are given only minimal support for maintahhg
lactation. Work loads fi-equently too heavy to support pumping or feeding breaks, lack of
pumps, pumping rooms, and milk storage, lack of on site child care, and dexibility of
working schedules ail contribute to the stress of returning to work.
Cornments such as "this is our lunch room, we don't want you pumping here"
exclude women fiom social interactions with their peers. "Don't spi11 that breastmilk in
the f'kidge," and "are you still nursing that baby, isn't it time to quit?" are comrnents 1 have
heard ail too ofken by nurses tqing to extend their own lactation experience.
Hills-Bonczyk, Avery, Savik, Potter, and Duckea (1993) found that women who
were successful in combining breastfeeding and employment were older, better educated,
worked fewer hours per week outside the home, and held more professional positions.
Many breastfeeding women are not aware of their legal rights as breastfeeding employees.
Haider and Begurn (1995) reponed that many women were unaware of their maternity
Haider and Begum (1 995) reported that many women were unaware of their maternity
entitlernents and therefore took nursing breaks as part of their meai breaks or took
unsanctioned breaks.
Based on heaith care literature and in the context of other cultures, employment is
not the only factor causing the decline in breastfeedmg. The lack of govemental, societal,
corporate, and public knowledge and support surroundmg breastfeeding contnbute to the
decline in the breastfeeding initiation and duration rates for many women.
Breastfeeding's Impact on Oppression and Empowerment
While many might argue that fundamentaiist religious beliefs and values are
oppressive for women, the Mennonite women as participants in this study did not view
themselves as being oppressed. They did recognize that many would view them as so, but
when asked about how the lack of educatioa lack of opportunity for seeking paid for
work/employment, and the expectation to breastfeed affects them, one woman replied:
I have fiends that are not of the Mennonite faith. One friend in particular. She works and works. She has a good job and makes lots of money. She is educated. But she has no children, no one to corne home to. She is often hstrated with her work. She is always so tired. Money and education did not make her happy. 1 feel sad for her. Not everyone would beiieve in what 1 do, but by my faith, 1 am doing the nght thing. I am happy being at home with my children. 1 c m not think of a more important job, or anything more fulfilling than to be with my children.
While this is a view that clearly does not address issues of women who either cannot
conceive or do not want to have children, I believe that women who value and are vdued
for their role as mothers and for their childbearing and lactation abilities by thek partners,
families, and comrnunity are fortunate. However, it must be pointed out that ifthis was to
occur as it does in this community, it would necessitate going back to a less technologicai
85
upon automobiles, selling of wares, utiliring health care services, telephones, and electricity.
We cannot revert to the past; the changes are too rapid.
Not everyone believes in a God, nor is a Christian, nor views breastfeeding as a
sacred right. Many see breastfeeding as a ploy to keep women in the home and bonle
feeding of artifid baby mitk as a liberator of women. However, the practice of
breastfeeding cm be empowering for women and has the potential to improve upon the
issues of gender inequalities. According to the World AUiance for Breastfeeding Action
(WABA, 1995), bredeeding empowers women in the following ways:
Breastfeeding confirms women's power to control their bodies, and challenges the bio-medical mode1 and business interests that promote bottle- feeding. Breastfeeding reduces women's dependence on medical professionals and validates the tried and trusted knowledge that mothers and midwives have about infant care and feeding. Breastfeeding encourages women's seKreliance by increasing their confidence in their ability to meet the needs of their infants. Breastfeeding helps child spacing, reduces the risks of anernia and provides protection against ovarian and breast cancer, osteoporosis and multiple sclerosis. Breastfeeding requires a new definition of wornen's work - one that more redistically integrates women's productive and reproductive activities, and which values both equally. Breastfeeding requires stnictural changes in society to improve the position and condition of women. Breastfeeding challenges the view of the breast as primarily a sex object. Breastfeeding encourages solidarity and cooperation among women at the household, community, national and international level. (p. 3)
Ifwomen are provided with information about the benefits of breastfeeding in a non-
threatening manner and are given supports, whether at home or upon retum to employrnent,
they could more easily make an informed infant feeding choice based on knowledge that
86
rneets theu own individuai needs and beliefs. Having the ability to make and act upon an
informed choice is an empowering act for any woman.
Lanmiaae
Mennonite families speak of breastfeeding as being normai, and they speak tieely
about the benefits of breasdeediig. They do not speak of formula, as it would be rare to
6nd a need for formula within this group of individuals.
Language is a powerftl tool in any given context. Medical jargon and slang adds
another whole dimension to language. Ifbreastfeeding is to become the norm in our society
we need to leam how to speak and write about breastfeeding in an entirely dxerent manner.
There is much to leam fiom the language used in comrnunities where breastfeeding is the
norm. Promotional carnpaigns usually state that breastfeeding is the best, most ideal, and
optimal method for feeding an infant. Instead of promoting breastfeeding as best,
formuIa/artificial feeding methods should be addressed as incomplete, deficient, and iderior
(Wiessinger, 1996). Parents need to be aware of the hazards of artificid formulas so they
cm make an informed decision about infant feeding.
Bottle feeding is not a comparable alternative to breastfeeding. Both infant
morbidity and mortality are increased with the use of artificial formula. If breastfeeding is to
be promoted, heaith professionals need to be chdlenged to use axioms such as "breast is
best and bottle is last resort" (Hughes, 1996, p. 245). The way in which one speaks about
breastfeeding greatly impacts on a new mother's perceptions of whether breastfeeding is
important or not. If health care professionals do not speak of it as being the normal way of
feeding an infanf why would families looking for Our advice and guidance consider
breastfeeding at ail?
Medicalization
Medical professionals and technology have been two of the main factors that have
influenced the feeding patterns for human infants. In the Mennonite conununity medical
advice is not considered essential for breastfeeding. The women described the support and
advice fiom other experienced bredeeding wornen as contributing more to theù successful
breastfeeding experiences than the advice from medical personnel.
Today, with the growing interest in breastfeeding, universities offer courses in
lactation for health professionals, and management from matemity institutes encourage staff
to obtain certification certificates in breastfeeding. Many rnembers of the public now want
or demand to be seen by a Lactation Consultant during hospitaiization and will pay for this
s e ~ c e upon discharge. Around the world, cornpanies are being formed, to provide
lactation counselling and teaching opportunities for professionals, some for astronomical
fees.
Breastfeeding has become a "big business" in the western countnes during the
1990s. In order to be properly "set up" for breastfeeding, it seems that mothers are
instructed to have a nursing bra, a nursing sling, a nursing pillow, a breast pump, correct
storage equipment, and the correct nursing attire (nighties. etc.) Breastfeeding not only
requires a "specidist," which implies it is difficult, but it is also expensive. Medical
professionals profiting from the visits to clinics by mothers having difficulty, as well as
corporate and private businesses have added yet another ethical challenge for health care.
In many countries where breastfeeding is the n o m women do not anticipate
problems, they simply put the baby to breast and they usudy do weii. Nurshg coUeagues
fiom other countnes with whom 1 work cannot understand ail the fuss about positioning and
latch. 1 am told that babies just latch to the breast; it is what is expected (personal
communication with nursing coleagues). I believe many women in Our society have leanied
and have become socialized into beiieving breastfeeding is difncult, and therefore
brevtfeeding becomes more complex than it needs to be.
Women-to-wornen breastfeeding support, such as La Leche League, are all too ofien
not supported by professionals. Members of these groups are Mewed as breadeeding
"fanatics." After ali what could not professionaliy taught hormonal women know that
trained, highly educated professionals would not know? Due to lack of knowledge, ofien
physicians have advised women to supplement infants with formula without completing a
breastfeeding assessrnent and to discontinue breastfeeding due to materna1 mastitis (which is
the least effective intervention). Health care providers ofien hesitate to incorporate research
based knowledge about treatrnents into the care of a breastfeeding mother-baby dyad
(personal experience).
Professionals who are knowledgeable in the lactation process are essential, but their
need should be the "exception," not the "normal." The phenomenon which views the
professional as the "breastfeeding expert" devalues and disempowers women. Professionals
must ensure that they convey their beiief in a woman's ability to breastfeed and instil
confidence in a woman so that she will be able to breastfeed successfÙlly.
89
Experienced breastféeding mothers are the ""experts" and health care professionals
would do well to learn from them. The Mennonite women incorporate breastfieeding into
every aspect of their iives. 1 have learned more about the "art of breasdeediig" Corn these
women than 1 have learned in ali my years of studying about the lactation process.
Conclusion and Summa-
This study, which was based on feminist and grounded theory methodology, was a
collection of knowledge about the factors that enabled the Mennonite women of this snidy
to have prolonged breastfeeding experiences. I believe the dialogue that took place during
this study enabied and empowered the participants and the researcher to gain further insight
and understanding into the breastfeeding process.
A model was formed (Figure 4), which showed the factors that enabled the
Mennonite women to have proionged breastfeeding experiences. The model illustrates the
factors that impacted on the women's breastfeeding expenences: "Nature's way - values
and beliefs, health benefits, economic benefits; supportive practices -- husbands, parents and
parent-in-laws, and other women; and social situations -- employment/work. Each of these
factors complemented and intertwined with each other to provide a foundation for the
breastfeeding mother and baby dyads.
What became clear throughout this analysis is that, in contrast to breastfeeding
experiences in many situations, for the participants in this study breastfeeding is not just a
feeding process between a mother and child, but is a social, political, economical, biological,
and psychological event. The beliefs, values, and views conceming breastfeeding of each
individual woman, the support available fiom partners, family, women, and community, and
90
the ability to incorporate theû chiidren's needs into their working environment are ail factors
that wiil impact on the motherhaby dyad's success with breastfeeding.
Because the subjective is important in qualitative research, 1 have incorporated many
of rny own professional experiences in this analysis. 1 have made my own voice a distinctive
aspect of this last chapter as 1 believe that it locates me in the research in an appropriate
iàshïon.
Paid Employrnentl Work Outside of Beliefs Parents
Paren ts-in-iaw Other Women Health System
Fimtre 4: Factors which enable Mennonite women to have prolonged breastfeeding
experiences.
CHAPTERVII
IMPLICATIONS FOR PRACTICE AND RESEARCH
The analysis of the findings from this study have brought fonvard several areas that
must be addressed if breastfeeding for an extended period of tirne is to become the nom
arnongst other Canadian women. In order to address these concems representatives fiom al1
levels of society must be involved: goverment, employers, Unions, Educational
Institutions, and women, children and families fiom ail cultures. According to Lawrence
(199 1) there are several factors that need changing in order to support breastfeeding
women. These include: employment pradces, support by fnends, the heaith care system,
comunity groups, the workplace environment, and lactation education. Al1 of these issues
have been considered throughout this study.
Beliefs and Values of Wornen
Studying cultures dEerent fiom our own has real value when trying to understand
the ways in which women value the act of breastfeeding theû Young. The beliefs and values
of the Mennonite women support breastfeeding as being "Nature's way" for providing
nourishment to children. This is not always so in other cultural groups. Knowing and
having an understanding of a breastfeeding woman's cultural background enables one to
provide assistance in a manner that will be beneficial rather than detrimental to the
breastfeeding expenence.
Oppression and Breastfeeding
The findings from studies have shown that women who are younger, less educated,
underprivileged, and underserved tend to have less successful breastfeeding experiences
(Ryan, Rush, Kneger, & Lewandowski, 199 1). These facton speak to more than
breastfeedmg. They speak to the facton that have been associated with oppression:
poverty, power, and education. These identified groups tend to be women who are unable
to be self sufficient, and ofien lack dignity, pnde, and hope. It is of iittle wonder that they
are unable to or even want to breastfeed, If ali women could have access to food, shelter,
clean and safe water, education, medical care, and job opportunities, the potentiai for
irnprovement in the breastfeeding rate woridwide would improve greatly. Nurses need to
have a more global understanding of these factors and incorporate their findings h o the
plan of care if they are to help a mother have a successfùl breastfeeding experience. Nurses
must learn how to be more politicaiiy active and must actively lobby for these basic rights
for al1 women. Nurses are one of the largest groups of employed women, and they must
recognize their power, and lean to collectively use their voices to improve the lot of
wornen.
Implications for the Workplace
Although the Mennonite women do not work outside the home in paid employrnent
situations, they do indeed work very hard maintaining their home and caring for their
children. The way in which they managed to do their work and maintained breastfeeding
provides us with much information for other workplaces. The Mennonite children were
always present, and childcare was provided by severai members of the farnily or community
if the need arose. Partners, family members, and cornmunity members valued breastfeeding,
so it was expected that breastfeeding would take precedence over other activities. Many
members shared in the child raising activities. The responsibilities for child care did not rest
93
enbrely on the breastfeeding mother's shoulders. Therefore, the mother had both the mental
and physical resources te meet her children's needs and her work responsibilities.
Van Eaerick (1996) identified the following goals for women working outside the
home:
- uiform all women of the benefits of bredeediig and of their matemity
entitlements,
- ensure that national legislation is in place to protect the nghts of working women,
- increase the public's knowledge about the benefits of breastfeeding,
- encourage unions to advocate for breastfeeding women's rights,
- encourage the establishment of mother-fiiendly workplaces and breastfeeding
policies for emplo yees,
- support cultural practices that enable working mothers to breastfeed.
Nurses cm do a great deal towards achieving these goals. Currently at the
M-Grace Health Centre approximately 30% of the women delivering at the Health
Centre attend prenatal classes. Therefore, the v a t majority of women go through the
pregnancy without receiving any idormation about the benefits of breastfeeding and of their
matemity benefits. Measures must be put into place that wiil provide al1 women with this
information, in a timely manner, in their language of choice, and in a means that meets their
own learning needs. Brochures, videotapes, posters, and classes must be made available for
women as they register at the Health Centres for delivery.
Employees leaving for matemity leaves should receive a package congratulating
them on their upcoming delivery and providing them with infiormation conceniing the
seMces available to them during their stay in hospital, during their maternity leave, and
upon retum to work (breast pumps, pumping rooms, and miUc storage facilities) that will
support their breastfeeding endeavours. Governments must be made aware of the
responsibilities employers have towards their b rdeeding employees. Nurses should be
working with other women in lobbying for a minimum of 1 year paid maternity leave,
without any threat or fear ofjob loss and working with their unions to incorporate
breastfeeding issues h o their bargainhg sessions.
Prenatal classes need to be taken to the communities rather than expecting families
to corne to health centres and they must refiect the consumers' cultural and ethnic
background, knowledge, and understanding of the birthing and lactation process. In these
classes there need to be open, fi-ank discussions about the parenting responsibilities of the
parent or parents. Members of both sexes must integrate the Uicreased work responsibilities
of havhg a child if the mother is to be successfiil at breastfeeding, and if for whatever
reason, the woman is without supports (partner, family, peers), she must be assured that
supports must d be put into place prior to discharge fiorn hospital.
implications for Public Policies
The current health care system in Nova Scotia does very Little to support
breastfeeding families. The average length of aay for new mothers delivering vaginally is 2
to 3 days, with some leaving hospital within 24 hours of delivery. While this is not
necessarily a bad thg , as many new parents do better in their home environments if
sufficient supports are in place, the health care systems have not ensured that these supports
are in place. Public Health Nurses at one time visited every new mother upon discharge;
95
now new parents receive a phone caii, and oniy ifproblems are identified do parents receive
a visit.
Currently in Nova Scotia, care for young families and children is seen by Home Care
Nova Scotia as the Iast area of need for implementation of suppon. Socialization and
support of domestic labour such as laundry and housekeeping services for new mothers
would enable a mother to concentrate on her own and her famiy's health and health
practices (breastfeeding), rather than on housekeeping tasks.
Nurses must learn to lobby govemment for the rights of women and children if
breastfeeding is to succeed. Paid matemity leaves for up to 1 year and access to safe and
affordable child care facilities are but two areas which should be addressed by nurses if we
are to assist mothers in their breastfeeding endeavours.
Implications for Cornmunity Groups
Breastfeeding coalitions that are formed from community grassroots are ofien the
most effective means of providing support to breastfeeding women. Nurses are often key
people that enable community women to recognize their strengths and faciiitate the
development of support groups that provide woman-to-woman support for breastfeeding
and other women health concems. Hedth professionals helping to fonn these coalitions
need to have an understanding of how a family's values and beliefs, support systems,
fathering beliefs, and employrnent impact on breastfeeding in order to assist in the formation
of a coalition that will benefit breastfeeding families. They wiii require fùrther education
concerning the benefits of "lay" women-to-women support. In my experience, many health
care professionals avoid or fail to support the efforts of women helping other women. La
96
Leche League has been a group that has long supported breastfeedmg women worldwide,
yet many professionals view this organkation as a bit fanatical. If the group is not formed
by a professional it seems not vdued.
Hospital based nurses, often due to fear of loss of jobs, become quite fiightened if
non-nursing personnel start up support clinics or if the hospitalhealth care institution tries to
make links with community resources and they fd to provide parents with information
about the resources in the community, providing parents with information about those
resources available in the hospital instead. Nurses sometimes protect their "tuff' to the
detriment of the women and children they are supposed to be helping. Empowering women
to help themselves and sharing with other women with similar expenences e ~ c h e s the
expenences of ail concemed. Breastfeeding women helping other breastfeeding women
helps to normaiize the complete process. Professionals should be cailed upon only if the
scope of the issue goes beyond the knowledge of the members of the suppon group.
Implications for Lactation Education
Ifbreastfeeding is to become the normal means of feeding for a child, people must be
socialized about infant feeding practices in a very difEerent manner than is currently
happening. Breastfeeding needs to be part of a child's education from a very early age.
Health books and heaith courses in elementary schools need to include breastfeeding as part
of the program. Junior and senior high school courses such as biology, home economics,
economics. and environmental studies should address the impact that breastfeedig has on
the human species.
University programs for physicians, nurses, dieticians, physiotherapists, dentists,
Iawyers, occupational therapists, teachers, and public relation students, to name a few,
should incorporate knowledge about the lactation process. The current level of knowledge
about breasûeeding among professionals is sadly lacking, particularly in the heaith care
arena. Nurses must lobby the universities to provide multi-discipiinary courses in the
lactation process.
Heath care institutions providing care for childbearing families must also ensure that
their staff have adequate education conceming the lactation process. This is important not
only for maternity or pediatric settings, but for general medical and surgical settings as well.
Breastfeeding women require surgeries, have car accidents, and require medicalization, the
sarne as other individuals, and their breastfeeding process ifofien jeopardized due to lack of
knowledge by the health care professionals. This speaks to the importance of this
knowledge being incorporated in health professionais' basic educational courses.
The general public must also be made aware of the benefits of breastfeeding. During
"World Breastfeeding Week" nurses should be making every attempt to bring this
information to the public, through television, radio, newspapers, and interviews. Booths can
be set up in shopping mas, bookstore, libraries, and schools, providing this information.
Posters on buses and on billboards could be set up, and restaurants and other public
businesses could be encouraged to put up baby friendly signs that would welcome
breastfeeding mothers and children. Al1 of these means would greatly increase the general
public's awareness of the benefits of breastfeeding.
Research
Nurses must continue to provide leadership by initiating research into the many
facets of breastfeeding. ûther cultural gr~ups must be studied in order to obtain an
improved understanding of the societal implications of the lactation process. Nurses need to
have a better undentandhg of the meaning of breastfeeding and of the supports available for
wornen in other cultures and subcultures, such as lesbian couples, and societies. AU of the
factors associated with breastfeeding - social, political, economic, biological, psychological,
and environmental -- need ongoing research ifour understanding and knowledge of the
breastfeeding process is to continue. As nurses we need to be able to help breastfeeding
women trust their own bodies and remain confident in their ability to nourish their children
at the breast .
As nurses we mue work to bring about policies that will: enable women to take
their children to work with thern; provide for on-site child care options; provide women
with 12 months of matemityhursing leave; encourage authors, publishers, and movie
makers to show mothers nursing their infants as part of normal We; and for policies that will
provide safer and more accurate information about breast surgery to women of child bearing
age.
In order to help women initiate and maintain breastfeeding nurses must be able to:
speak of the benefits ofbreastfeeding and of the harms of artficial milks in order to control
the mass production of infant formulas; obtain resources for the promotion of breastfeeding;
continue ongoing research about the lactation process; and then teach about the findings in
order to provide the children of tomorrow with the benefits of breastmilk. As Lang (1994)
99
so aptly stated about health uiformation: "if we cannot name it, we carmot control it, or
finance it, or research it, or teach it, or put it into public poiicy" (p. 6). Likewise for
breastfeeding. If we want breastfeeding to become the nom for infant nutrition, as health
care professionals, we need to be able to clearly articulate its importance in ali forums.
In the Mennonite cornmunity the importance of "lay" support fiom other
breastfeeding women was key to the success of bredeeding. Further research is needed
into lay support if other women are to have extended breastfeeding expenences. The values
and beliefs of male and iesbian partners towards breastfeeding requires further study, in
order to leam more about ways in which breastfeeding can be supported. The impact
breastfeeding has on siblings also requires further snidy. Very liale information has been
documented about the influence breastfeeding has on a older child's behaviours and later
hedth choices.
Research needs to be initiated into breastfeeding and shift workers. Do the needs
and therefore the support systems diier if one is trying to maintain lactation and do shift
work? Do employee benefits and policies need to reflect these needs? AU are questions for
further breastfeeding research.
As well, research needs to be completed regarding the impact that Lactation
Consultants are having in improving the success of breastfeeding for women and children.
Their increased knowledge about bredeeding must be utilized to bring fonvard hovative
suggestions and ideas that will enable breastmilk to be available for al1 children, even those
children of HIV infected mothers. Human milk banking with world wide recipients may be
the answer, but further research is required.
Conclusion
The theory of breastfeeding as nature's way, as was generated in this study, provided
a detailed description of the experiences of Mennonite women who breastfeed theu children
past 6 months of age. The factors that the Mennonite women described as being influentid
on their decision to breastfeed were viewed as important by the women themseives, their
partners, their families, and their community.
Ifali breastfeeding mothers could have the types of supports available to them that
the Mennonite women have, 1 beiieve that many would have a more successful breastfeeding
experience. Nurses, together with other women, must carnpaign society, govemment
officiais, and employers to providhg the necessary supports for women (basics of M e -
food, water, shelter; fair wages; education; safe child care agencies; flexible working hours;
pumping and milk storage facilities; longer matemity laves) that wili enable women to have
a prolonged breastfeeding expenence, that will in tum benefit society by improving the
health of women and children.
Finally, having had the pnvilege of leamhg fkom the Mennonite mothers, 1 would
iike to share their experiences with other women in hopes that by sharing their stories, we
can al1 learn more about how to help women be successful with their breastfeeding
experiences. Women hearing each other's voices is what feminist research is al1 about.
BREASTFEEDING CLOTHWG
APPENDLX C
LETTER OF Di'I'RODUCTION TO PARTICIPANTS
Heilo. My name is Judith (Judy) Cormier and I am a Master of Nursing -dent at
Dalhousie University School of Nursing in Halifax, Nova Scotia. 1 am interested in
leamhg about the Mennonite women's exclusive breastfeeding expenence past their
infant's first 6 months of Me.
As a nurse that works with new mothers and babies, I am interested in leamhg
about your breastfeeding experiences, your support systems, concerns, cuaoms, beliefs,
values, and womes so that nurses and other health professionals cm better understand
your experiences and provide increased support to breastfeeding wornen and their families.
Kyou agree to participate in my study, 1 will be asking you to sign a consent fonn
and participate in a 1 to 2 hour interview. This interview wiil take place at a time and
location of your convenience. The interview wiii be taped or notes taken and then
typewritten. 1 will corne back to visit with you and check in to find out if you agree with
my anaiysis and to ver@ information. The tape(s) wili be erased or retumed to you when
the study is completed, as well as a typewritten transcript.
1 look fonvard to meeting with you.
Sincerely,
Judith (Judy) Cormier
INTERVIEW GUIDE
The foliowing are a few questions that may help to provide some initial direction for Our i n t e ~ e w . 1 welcome your questions and feedback, at any tirne during Our discussion. As a nurse and mother of one daughter, there may be experiences that we have in common. 1 very much want to learn and share with you throughout Our tirne toget her.
As we talk, other questions may arise. 1 encourage you to ask me questions as well. Ifat any tirne you do not wish to answer a question or discuss a certain area you may refuse to do so. Although 1 am certain that 1 will Ieam much more fiom you than you will from me about breastfeeding, 1 hope that Our time together will be a valuable experience for us both.
Please explain if your decision to breastfeed is based upon a religious belief.
Tell me in your own words about your most recent breastfeeding experience: When during your pregnancy did you decide to breastfeed your baby? Who or what things helped you to make the decision to breastfeed? Have you ever breastfed a newbom and an older child together? What was it like when you first came home with a baby? What was it like at 2 weeks, 6 weeks, 3 three months, 6 months? Was there anything different about breastfeeding during these tirne frames?
What feelings do you have when you are breastfeeding your baby?
What do you think about when you are breastfeeding your baby?
When you breastfeed your baby: Who gives you advice and encouragement? What does this advice and encouragement look like? Did you encounter any problems with breastfeeding? If so, are there any remedies that you use for breastfeeding problems? Was getting enough rest a problem? How did you fit breastfeeding into your day? Tell me about your day. Did breastfeeding change your day in any way?
Why is breastfeeding imponant to you?
7. Ifyou are unable to breastfeed or a &end is unable to breastfeed, would you consider breastfeeding each other's baby? Ifnot, how would your baby be fed?
8. Did you ever consider any other ways of feeding your Uifant? When would you £ira introduce foodddrinks other than breastdk to your baby? What wouId these foodddrinks be?
9. How do or d l you know when your baby is ready to wean?
10. If you were going to describe your breastfeeding expenence to other mothers, what information, advice would you give them?
MORMED CONSENT
1 understand that: the purpose of this study is to explore the experiences of Mennonite women and their feelings surroundhg the exclusive breastfeeding of their infants past 6 rnonths of age. 1 understand that participation in this research project is voluntary. As a participant in this research project 1 wilI be asked to participate in an interview with the researcher, Judith A. Cormier. The interview wili last between 1 and 2 houn. and 1 understand that 1 may withdraw from the study at any tirne.
I f1 have any concems about the research or the researcher's conduct, 1 may contact Professor Barbara Keddy, Dalhousie University School of Nursing at (902) 494- 222 1. 1 will be reimbursed by the researcher, if? long distance telephone expenses are incurred for any cails.
The interview will be conducted in an agreed upon setting and at my convenience. The i n t e ~ e w will be tape-recorded (or field notes will be taken) and transcribed. At any time, upon request, the tape recorder may be turned off. The tapes will be erased or given back to me d e r transcription. Al1 information shared d u ~ g the study wili remain arictly confidentid. My name or other identifling information will not be used in any written reports.
1 will be asked to respond to general questions related to my personal breastfeeding experience. My contribution in this study may help other Nova Scotia women to exclusively breastfeed their infants past 6 months of age.
1 agree to participate in this study.
Mot her ' s Signature (Participant) Date
Researc her ' s Narne
Do you want the tapes/transcripts retumed?
Date
Do you want the results of the study shared with you?
1 O7
Yes
Yes
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