SOCI AL REPRESENTATI ONS ABOUT SUPPORT FOR BREASTFEEDI NG I N A
GROUP OF BREASTFEEDI NG W OMEN
Fabiana Sw ain Müller1 I silia Apar ecida Silv a2
Müller FS, Silva I A. Social represent at ions about support for breast feeding in a group of breast feeding w om en. Rev Lat ino- am Enfer m agem 2 0 0 9 set em br o- out ubr o; 1 7 ( 5 ) : 6 5 1 - 7 .
Th is st u dy aim ed t o get t o k n ow t h e social r epr esen t at ion s abou t su ppor t f or br east f eedin g in a gr ou p of br east feeding w om en, as w ell as t o ident ify t he act ions in t heir social env ir onm ent t hese w om en per ceiv e as support ive in t heir breast feeding processes. Dat a were collect ed t hrough a qualit at ive approach, using recorded sem ist r uct ur ed int er v iew s, or ganized in accor dance w it h t he Collect iv e Subj ect Discour se and analy zed under t he prem ises of Social Represent at ions Theory. Result s showed t hat t he represent at ions of wom en in t his st udy about support for breast feeding consist of act ions available in t he hospit al, fam ily and w ork cont ext s. I n t hese w om en’s per spect ive, suppor t is a br oad phenom enon t hat involves aspect s of encour agem ent , pr om ot ion and pr ot ect ion t o br east feeding.
DESCRI PTORS: br east feeding; social suppor t ; w om en’s healt h
LAS REPRESENTACI ONES SOCI ALES DE UN GRUPO DE MUJERES/ AMAMANTADORAS
SOBRE EL APOYO A LA LACTANCI A MATERNA
Est e est udio t uv o com o obj et iv o conocer las r epr esent aciones sociales de un gr upo de am am ant ador as sobr e el apoy o par a am am ant ar y , t am bién, ident ificar las acciones del ent or no social que son per cibidas por esas m uj eres, com o apoyo en sus procesos de am am ant ar. Los dat os fueron recolect ados por m edio de un abordaj e cu alit at iv o, en en t r ev ist a sem iest r u ct u r ada gr abada, y or gan izados con f or m e la pr opu est a del Discu r so del Su j et o Colect iv o y an alizad os seg ú n las con cep cion es d e la Teor ía d e las Rep r esen t acion es Sociales. Los result ados m ost raron que las represent aciones de las m uj eres de est e est udio, sobre el apoyo para am am ant ar, son const it uidas por las acciones disponibles en el cont ext o hospit alario, fam iliar y de t rabaj o. Baj o la ópt ica de la m uj er , el apoy o es un fenóm eno de gr an am plit ud que engloba aspect os de incent iv o, de pr om oción y de pr ot ección al am am an t am ien t o.
DESCRI PTORES: lact ancia m at er na; apoy o social; salud de la m uj er
REPRESENTAÇÕES SOCI AI S DE UM GRUPO DE MULHERES/ NUTRI ZES SOBRE O
APOI O À AMAMENTAÇÃO
Est e est udo t ev e com o obj et iv o conh ecer as r epr esent ações sociais de u m gr u po de nu t r izes sobr e o apoio par a am am ent ar e, t am bém , ident ificar as ações do ent or no social que são per cebidas por essas m ulher es, com o apoio em seus processos de am am ent ação. Os dados foram colet ados por m eio de abordagem qualit at iva, em ent r ev ist a sem iest r ut ur ada gr av ada, e or ganizados confor m e a pr opost a do Discur so do Suj eit o Colet iv o e analisados segundo os pr essupost os da Teor ia das Repr esent ações Sociais. Os r esult ados m ost r ar am que as r ep r esen t ações d as m u lh er es d est e est u d o, sob r e o ap oio p ar a am am en t ar , são con st it u íd as p elas ações disponív eis no cont ex t o hospit alar , fam iliar e de t r abalho. Sob a ót ica da m ulher , o apoio é um fenôm eno de gr ande am plit ude que engloba aspect os do incent iv o, da pr om oção e da pr ot eção à am am ent ação.
DESCRI TORES: aleit am ent o m at er no; apoio social; saúde da m ulher
Escola de Enferm agem , Universidade de São Paulo, Brasil:
1RN, Mast er ’s st udent in Nursing, e- m ail: m uller_m et ne@t erra.com .br; 2RN, Ph.D. in Nursing, Full Professor, e- m ail: isasilva@usp.br.
I NTRODUCTI ON
S
t udies on breast feeding support suggest t heneed for a st ruct ure t o support w om en, so t hat t hey
ar e pr epar ed t o ov er com e t h e dif f icu lt ies an d cope
w i t h t h e a m b i g u o u s f e e l i n g s i n v o l v e d i n t h e
br east feeding pr ocess( 1 - 6 ).
Th is is st r en g t h en ed n ow ad ay s b y t h e f act
t h at , d u e t o cu lt u r al, social an d econ om ic f act or s,
br east f eedin g is n ot a u n iv er sally adopt ed pr act ice.
Alt h ou gh r esear ch in Br azil h as r ev ealed a gr ow in g
t rend in breast feeding rat es, t hese st ill rem ain dist ant
fr om ideal lev els.
Of f i c i a l p r o g r a m s d o n o t s e e m t o h a v e
i n co r p o r a t ed p r o g r ess y et i n t er m s o f k n o w l ed g e
p r od u ct ion on w om en ’s b r east f eed in g ex p er ien ces,
illust rat ing t he great dist ance bet w een t he developed
con cept s an d clin ical pr act ice. Appr oach es cen t er ed
o n w o m e n a n d t h e i r e x p e r i e n c e s s t i l l r e m a i n
t heor et ical const r uct ions, w hich neit her pr ofessionals
in t h eir p r act ice n or h ealt h p olicy m an ag er s h av e
learned a lot about( 5).
Br e a st f e e d i n g p r o m o t i o n , p r o t e ct i o n a n d
support act ions need t o incorporat e elem ent s of a new
p a r a d i g m t h a t t a k e i n t o a cco u n t su b j ect i v i t y a n d
m at ernal individualit y t o reform ulat e t he breast feeding
care m odel. Thus, one of t he pillars of t he breast feeding
consolidat ion m ovem ent am ong wom en in our societ y
is support , which deserves special at t ent ion due t o t he
lack of a con cep t u al st r u ct u r e t o u n d er st an d w h at
a c t i o n s , a t t i t u d e s a n d p r a c t i c e s i n t h e f i e l d o f
professional relat ions or in t he breast feeding m ot her’s
environm ent can effect ively support t he breast feeding
pr ocess t hese w om en ex per ience.
Co n s i d e r i n g b r e a s t f e e d i n g a s a s o c i a l l y
const ruct ed pract ice, it is quest ioned here if t he support
b r east f eed in g w om en ar e of f er ed is n ot in f lu en ced
t oo b y m ech an ism s t o com m u n icat e an d con st r u ct
t h e w or ldv iew of t h e social n et w or k t h at su r r ou n ds
t hem in t his pr ocess. I t is also consider ed t hat it is
w om an her self w ho can best define t he qualit y and
com posit ion of t he support breast feeding wom en need
t o be offered. They should be heard about t heir needs,
so t hat t his pr ocess is as successful as possible for
bot h m ot her and br east feeding infant .
Thus, t his st udy aim s t o get t o know t he Social
Repr esent at ions of a gr oup of br east feeding w om en
about suppor t for br east feeding and ident ify act ions
in t he social env ir onm ent t hese w om en per ceiv e as
suppor t iv e in t heir br east feeding pr ocesses.
METHOD
Qualit at iv e r esear ch pr inciples w er e used t o
d e v e l o p t h e s t u d y, c h a r a c t e r i z e d b y e n a b l i n g
r esear cher s t o capt ur e how indiv iduals r eact t o and
t hink about t he quest ions t hat are focused on, allowing
k n o w l ed g e o n t h e d y n a m i cs a n d st r u ct u r e o f t h e
sit uat ion from t he perspect ive of who is living it( 7). Th e c o n c e p t o f So c i a l Re p r e s e n t a t i o n
d esig n at es a f or m of sp ecif ic k n ow led g e, accessed
t h r ou g h it s cog n it iv e elem en t s ( im ag es, con cep t s,
cat egories and t heories) , but underst ood t hrough t he
cont ext it is produced in( 8). Thus, social represent at ions can be u n der st ood as f or m s of pr act ical k n ow ledge
t hat guide daily act ions at an int erface wit h t wo forces:
t hat of t he cont ent s circulat ing in our societ y and t he
force deriving from t he social int eract ion process it self
an d p r essu r es t o d ef in e a g iv en sit u at ion so as t o
m aint ain collect ive ident it ies( 9).
METHODOLOGI CAL PROCEDURES
The fieldwork was carried out at t he Teaching
He a l t h Ce n t e r Sa m u e l B. Pe sso a ( CSE- Bu t a n t ã ) ,
But ant ã Healt h Coordinat ion in São Paulo Cit y, Brazil,
bet w een May an d Nov em ber 2 0 0 7 . Th is ser v ice n ot
only per for m s im por t ant healt h car e act ions for t he
r eg ion al p op u lat ion , b u t also d ev elop s t each in g at
differ ent educat ion lev els and in v ar ious pr ofessional
ar eas, and is consider ably act iv e in healt h r esear ch.
St u d y p a r t i ci p a n t s w e r e 1 4 w o m e n w i t h
children of up t o 6 m ont hs old, wit hout any rest rict ion
as t o age, parit y, socioeconom ic condit ion, race or color,
who were breast feeding exclusively or not . The num ber
of part icipant s was defined by t heoret ical sat urat ion of
qualit at ive dat a, t hat is, t he m om ent in sim ult aneous
dat a collect ion and analy sis w hen no m or e new and
significant elem ent s are perceived, t hus reflect ing t he
f u l l r an g e o f d i m en si o n s o n e seek s t o ex p l ai n , i n
accordance w it h t he obj ect ives of t his research.
Th e w o m en w er e i d en t i f i ed b a sed o n t h e
regular appoint m ent s of children up t o 6 m ont hs old at
t he pediat rics and child care sect or. On t his occasion,
before t he m edical or nursing appoint m ent , t hey were
asked about t heir int erest t o part icipat e in t he st udy.
Af t er t h eir accep t an ce an d sig n in g of t h e f r ee an d
in f or m ed con sen t t er m , t h ey w er e in t er v iew ed at a
place t hat perm it t ed bot h com fort and privacy. I nit ially,
dat a, socioeconom ic profile and breast feeding sit uat ion
a s t o t y p e , f r e q u e n c y, d u r a t i o n a n d r e a s o n f o r
int roducing anot her food it em or liquid int o t he baby’s
diet in case of non- exclusive br east feeding.
Next , based on t he guiding quest ion “ t ell m e
what it has been like t o breast feed your baby since he
w as bor n unt il t oday ”, t he int er v iew ee’s per cept ions
about support t o breast feed in t he hospit al cont ext and
at hom e were looked at in furt her dept h, and also about
h er fam ily an d pr ofession al r elat ion s, ask in g h er t o
ex plain sit uat ions in w hich she needed suppor t and,
finally, w hat she perceived as breast feeding support .
Th e c o l l e c t e d d a t a w e r e o r g a n i z e d i n
accordance wit h t he proposal of t he Collect ive Subj ect
D i s c o u r s e , a t e c h n i q u e t h a t s e e k s t o e q u i p
r esear cher s t o pr ocess t he int er v iew ees’ answ er s t o
open quest ions, especially when one ult im at ely seeks
t o i d e n t i f y s o c i a l r e p r e s e n t a t i o n s( 1 0 ). Th u s , t h e int erviews were t ranscribed in full and t he const ruct ion
of t he st at em ent s followed five st eps: 1 – reading t he
in t er v iew s t o get fam iliar w it h t h e gen er al con t en t s
r ep or t ed ; 2 – id en t if y in g k ey ex p r ession s in each i n t er v i ew, w h ich ar e ex t r act s of t h e in t er v iew ees’ sp e e ch p e r t i n e n t f o r t h e r e se a r ch p r o b l e m ; 3
-at t ribut ing t he cent ral idea, which is charact erized by t he abst r act ion of t he essence cont ained in each of
t h e select ed k ey ex p r ession s; 4 – j oin in g t h e k ey
e x p r e s s i o n s o f c e n t r a l i d e a s w i t h a s i m i l a r o r
com p lem en t ar y sen se an d 5 – com p osin g t h e f u ll
st a t e m e n t s i n t h e f i r st p e r so n , w h i ch r e p r e se n t
collect iv e opin ion s on t h e r esear ch pr oblem , w it h a
t it le t hat sum m arizes t he cont ent of all key expressions
j oined t her e( 10).
Th e pr oj ect w as appr ov ed by t h e Resear ch
Et hics Com m it t ee at t he Universit y of São Paulo School
of Nursing and at t he Teaching Healt h Cent er Sam uel
B. Pessoa, in line wit h Resolut ion 196/ 96 on research
in v olv in g h u m an bein gs. Th e st u dy obj ect iv es w er e
e x p l a i n e d a n d p a r t i c i p a n t s w e r e g u a r a n t e e d
anony m it y and secr ecy of t he r esear ch r esult s. They
w er e al so i n f o r m ed t h at t h ei r p ar t i ci p at i o n i n t h e
r esear ch w as v olu n t ar y.
CHARACTERI ZATI ON OF THE W OMEN
The 14 wom en who part icipat ed in t he st udy
l i v e d i n t h e Bu t a n t ã n e i g h b o r h o o d . Ag e s r a n g e d
bet w een 19 and 38 y ear s, and m ean educat ion t im e
was 7.5 years. Ten wom en had a paid j ob and worked
in t he ser vice sect or, specifically in car e deliver y and
cl ean i n g ; t h r ee w er e u n em p l o y ed an d o n e w as a
h ou sew if e. Fam ily in com e v ar ied b et w een 4 0 0 an d
1 , 2 0 0 r eais. As t o br east feeding per for m ance, eight w o m e n g a v e e x c l u s i v e b r e a s t f e e d i n g ( EB ) , o n e
p r e d o m i n a n t b r e a s t f e e d i n g ( PB ) a n d f i v e
br east f eedin g ( B) .
RESULTS AND DI SCUSSI ON
Based on t he analysis of t he verbal m at erial,
f i v e d i s c o u r s e s e m e r g e d o n t h e b r e a s t f e e d i n g
experiences of t he st udy part icipant s, w hich revealed
t heir r epr esent at ions on suppor t w it hin t he hospit al,
fam ily and w or k cont ex t , as w ell as t he elem ent s in
t he social env ir onm ent t hey per ceiv ed as suppor t iv e.
Th e e s s e n c e o f t h e d i s c o u r s e s w a s t h e
a c k n o w l e d g e m e n t o f t h e s u p p o r t o f f e r e d b y
p r o f essi o n al s an d p ar t n er s, r ep o r t s o n w el co m i n g
t hrough fam ily organizat ion, t he experience of conflict ,
t he search for support in planning t heir ret urn t o t heir
pr ofessional act iv it ies and, finally, a sy nt hesis of t he
w o m e n ’ s r e f l e c t i o n s o n w h a t t h e y c o n s i d e r a s
br east f eedin g su ppor t .
Fr o m a p s y c h o s o c i a l p e r s p e c t i v e , t h e
p ost p ar t u m p er iod is con sid er ed a com p lex f em ale
experience, perm eat ed by different changes, including
at t endance t o t he newborn’s feeding needs. I n act ual
p r act i ce, b r east f eed i n g t est s t h e el em en t s o f t h e
w o m a n ’s i m a g i n a r y, co n f i r m i n g , st r en g t h en i n g o r
alt er in g t h em t h r ou g h h er ex p er ien ce, in v olv in g a
ser ies of m at er nal or new bor n fact or s( 11).
Th e r e p o r t s o f t h e s e w o m e n c o n t a i n e d
t r aj ect or ies of ov er com ing t he difficult ies t hey faced
t o o r g an i ze b r east f eed i n g an d p er cep t i o n s o n t h e
su p p or t r eceiv ed in t h e h osp it al, f am ily an d w or k
cont ext s. The scenario of support needs revealed t he
ex ist en ce of a space for in t er per son al r elat ion s an d
com m u n icat ion w it h t h eir peer s ( h u sban d, r elat iv es
an d f r ien d s) an d p r of ession als, con t r ib u t in g t o t h e
e l a b o r a t i o n o f s o c i a l r e p r e s e n t a t i o n s a b o u t
br east f eedin g su ppor t .
Discour se – Suppor t : t he pr ofessional at y our side
When she was born, m y breast got very full, t he m ilk
cam e behind m y arm , t hen t hey ( nurses) cam e and t aught m e t o
m assage, breast feed bot h sides and always give m ilk unt il t he
everyt hing in det ail ( ...) . They cam e and helped, showed how we
had t o do it so t he baby wouldn’t t ake only t he nipple, so as not t o
get hurt ( ...) if t hey hadn’t helped m e I wouldn’t have breast fed,
because it hurt s at first . ( ...) I liked t heir care a lot , t he way t hey
t aught . She says what you need t o, I ’m here at your side ( E2, E3,
E4 , E6, E8 , E1 1, E1 2, E13 ) .
Their per cept ion on t he suppor t r eceiv ed in
t h e h o sp i t a l co n t e x t se e m e d t o r e st o n e f f e ct i v e int eract ion bet w een t he w om an and t he professional.
The env ir onm ent , infor m at ion and t he qualit y of t he r elat ion w it h h ealt h pr of ession als m ade t h e w om en
feel t hat t heir needs w er e at t ended t o and t hat t hey
r eceiv ed su ppor t .
A s t u d y o n r o o m i n g - i n c a r e f r o m t h e
p er sp ect i v e o f so ci a l r ep r esen t a t i o n s sh o w s t h a t , d ep en d in g on h ow t h e car e r elat ion occu r s in t h e
h osp it al con t ex t , t h e w om an st ar t s t o r e- elab or at e h e r ca r e r e p r e se n t a t i o n s. I n t h i s r e si g n i f i ca t i o n
m ovem ent , t he hospit al st art s t o be seen as a “ place o f h e l p ” , m a k i n g t h e w o m a n f e e l w e l c o m e d ,
r espect fully at t ended and w ell infor m ed( 12).
I n t he hospit al cont ex t , one can under st and
a n d t r a n sl a t e t h e su p p o r t t h e st u d y p a r t i ci p a n t s
r epor t ed as inst r um ent al suppor t , including pr act ical h e l p , k n o w l e d g e t r a n sm i ssi o n a n d b r e a st f e e d i n g
en cou r ag em en t .
Th e d i f f e r e n t i a l t o p e r ce i v e t h e h o sp i t a l
experience as posit ive and support ive of breast feeding is t he ident ificat ion of affect iv e elem ent s inv olv ed in
t he int eract ion wit h t he healt h t eam .
On e m a y sa y t h a t t h e se f i n d i n g s a r e i n
accordance wit h t he definit ion of support som e aut hors
propose, which can be underst ood based on t he ext ent t o w hich int er per sonal r elat ions ar e est ablished t hat
see t o cer t ai n ( m at er i al , i n f o r m at i o n al , af f ect i v e) needs, m aking individuals believe t hat t hey are want ed
and part of a social net work( 13).
Wit h r espect t o t he influence of suppor t for
t he init iat ion and dur at ion of br east feeding, r esear ch h as d em o n st r at ed( 4 ) t h at , al t h o u g h t h i s m ay v ar y d ep en d in g on t h e social an d cu lt u r al con t ex t s t h e w om an is inser t ed in, for m al suppor t ex er t s posit iv e
i n f l u e n c e o n t h e i n i t i a t i o n a n d d u r a t i o n o f
breast feeding, and pract ical help seem s t o be t he m ost e f f e ct i v e m e a n s f o r h e a l t h p r o f e ssi o n a l s t o o f f e r
br east f eedin g su ppor t .
Discour se – My husband is a com panion
Even if t he husband is not present , I t hink he is t he
person we m ost need support from . I have his full support , we
t alk a lot . Because at first I got kind of nervous, and what he said
calm ed m e down, it helped m e a lot , he said, it will get bet t er
t om orrow ( ...) he t alked about how I want ed t o be a m ot her and
t hat gave m e st rengt h ( ...) . He is a very dedicat ed fat her, he was
ver y pat ient , he w as t he m ain incent ive. ( ...) He is m y t r ue
co m p a n i o n , i f i t w e r e n ’ t f o r h i s su p p o r t I h a d st o p p e d
br east feeding ( E1, E3, E6, E8, E10, E13) .
Th e h u s b a n d ’ s i n v o l v e m e n t i n c a r e , t h e
dedicat ed at t ent ion, t he m anifest at ions of affect ions and j oy m eant a posit iv e st im ulus for t he w om en in
t h i s st u d y, g i v i n g t h em secu r i t y an d w i l l p o w er t o con t in u e br east f eedin g.
Au t h o r s a f f i r m t h a t t h e r e l e v a n ce o f t h e
fat her’s part icipat ion is relat ed not only t o his role of play in g an d st ay in g w it h t h e ch ild, bu t also t o t h e
childr en’s dev elopm ent and t he fam ily balance( 14). Mor eov er, t h ey believ e t h at a lar ge par t of
t he qualit y of t he fat her’s involvem ent wit h t he children and fam ily is r elat ed w it h cult ur al and social fact or s,
such as t he valuat ion of gender equalit y, liv ing w it h his par t ner, hav ing a har m onious r elat ionship, being
part of an econom ic syst em t hat allows him t o sust ain t he fam ily and working cooperat ively on housework( 14).
Th e s t u d y p a r t i c i p a n t s c o n s i d e r e d t h e
p ar t n er ’s su p p or t act ion s an im p or t an t elem en t of su p p or t f or b r east f eed in g , an d t h ese act ion s p oin t
t ow ar d s t h e p r act ical t r an sf or m at ion of f at h er h ood t o w a r d s so ci a l i zi n g h o u se w o r k a n d sh a r i n g ch i l d
care( 6). How ever, it w as ident ified in t heir st at em ent s how m uch t he husbands evoked t he st at us of wom an
in t he sense of v aluing her or r em inding her of t he r esponsible ex per ience of being a w om an. This giv es
t he idea t h at , by ev ok in g t his st at u s, t he h u sban d/
p a r t n e r g u i d e s h i s a t t i t u d e b y h i s g e n d e r represent at ions, t ranslat ed as “ t he social const ruct ion
of subj ect s as fem ale or m ale”, in w hich t he idea of fem ale nat ur e is based on biological fact s t hat occur
in t he w om an’s body, such as t he capacit y t o car r y childr en, giv e bir t h and br east feed( 15).
The father’s behavior can be a product of m an and wom an’s socializat ion, deriving from a cult ural and
social construction society has legitim ized for centuries, in which wom en are valued because of t heir biological
capacit y, w it h r ecom m endat ions t o t ake car e of t heir
children personally and, m ainly, breastfeed them( 16).
Discour se – A suppor t net w or k is est ablished for t he w om an t o br east feed
Wh en I g ot h om e it w as m ar v elou s! Me an d m y
daught er, we were received wit h a lot of affect ion ( ...) I felt
welcom ed ( ...) . I get support , one person goes t here t o prepare
need t o st op br east feeding, I can st ay w it h her unt il she is
sat isfied. ( ...) My daught er helped m e a lot t o t ake care of her,
clean t he house, do t he housework ( ...) . My sist ers always adm ire
her, t hat helped m e a lot , I feel m ore confident because t here’s
som eone wit h m e. My m ot her is t here on t op of t hings all t he t im e
( ...) she has done everyt hing so t hat m y breast feeding is good
( ...) . The sist ers from church gave m e everyt hing, t hey bought
food, clot hes for t he baby, everyt hing I needed. I also have a
good friend who is always t here for m e, m ainly when I feel I need
t o unload, t alk. My m ot her- in- law ( ...) is like a m ot her t o m e. ( ...)
She is great , gives m e em ot ional support and helps m e in daily
life ( ...) . ( E2, E3, E6, E7, E8, E11) .
I n t h i s d i sco u r se, t h e d escr i p t i v e essen ce r ev eals t hat t he baby ’s ar r iv al dem anded st r at egies
t o cop e w it h t h e n ew sit u at ion , n ot on ly f r om t h e m ot her but also from t he fam ily. A m ovem ent occurred
t o conciliat e t he form er and new t asks, which ent ailed changes in t he fam ily or ganizat ion.
The int er v iew ees’ r epor t ev idenced t hat t he suppor t t o ov er com e t he set of difficult ies t hat hav e
t o b e o v er co m e i n t h e p r i v at e con t ex t , esp eci al l y dur ing t he fir st w eek s, com es fr om ot her w om en in
t h e f a m i l y. I t se e m e d t o b e o n e o f t h e d e ci si v e el em en t s t o f a ce p u er p er al t r a n sf o r m a t i o n s, t h u s
p e r m i t t i n g t h e a d a p t a t i o n t o t h e n e w r e a l i t y o f
m o t h e r h o o d a n d f a v o r i n g b r e a s t f e e d i n g . Th i s percept ion can be st rengt hened by ot her st udies t hat
also reveal fam ily relat ions as an im port ant reference for wom en in breast feeding support , in which t he fam ily
wom en’s act ions exert a decisive influence on support an d car e deliv er y t o t h e pu er per al w om an an d t h e
infant( 6).
A c c o r d i n g t o t h e w o m e n ’ s s t a t e m e n t s , su p p or t f r om r elat iv es an d f r ien d s is b ased on an
im plicit valuat ion of wom en as breast feeding m ot hers. On e of t h e m ost r elev an t su p p or t elem en t s in t h e
fam ily cont ext was pract ical help, t he fact t hat fam ily m em ber s assum ed t ask s w hich, t heor et ically, w om an
a ssu m es i n t h e f a m i l y d y n a m i cs, a l l o w i n g h er t o dedicat e m ore t im e t o t he baby and, consequent ly, t o
b r east f eed in g .
An o t h e r r e l e v a n t e l e m e n t w a s e m o t i o n a l
support , acknowledged by t he relat ives’ m anifest at ions
o f a f f e c t i o n a n d f o n d n e s s . I n t h i s r e s p e c t , r esear cher s( 14) affir m t hat t hese elem ent s, w hich t he w om an per ceiv es an d r eceiv es, ar e f u n dam en t al t o m a i n t a i n h e r m e n t a l h e a l t h , co p e w i t h st r e ssf u l
sit uat ions and per iods of changes in her life.
Th e av ailab ilit y of r elat iv es an d f r ien d s t o
su p p or t t h e ex p er ien ce of m ot h er h ood allow ed t h e w om en in t his st udy t o feel t hat t heir br east feeding
e f f o r t s w e r e b e i n g a ck n o w l e d g e d . Th e w o m a n ’ s
prot ect ion by a fam ily support net work showed t o be a r elev ant fact or for t he m ot her ’s behav ior t ow ar ds
her childr en, w hich per m it s bet t er condit ions for t he dev elopm ent of t he m ot her - child r elat ionship( 14).
Discour se – Seek ing t he r ight t o br east feed aft er get t ing back t o w ork: w here is t he support ?
I am going t o t ake 4 m ont hs and 20 days of m at ernit y
leave, I have list ed m y nam e at kindergart en ( ...) I ’m going t o t ry
t o m ake him cont inue breast feeding,( ...) up t o t he age of 1 year,
but I give a bot t le som et im es, so t hat he get s used t o it . Societ y
does not support wom en who work and are breast feeding. I know
I am en t it led t o on e h ou r per day t o br east f eed ( . . . ) t h ey
( em p loy er s) p u t u p m or e d if f icu lt y ( . . . ) if it w er e f or m y
supervisor, who is breast feeding would leave at t he norm al t im e.
Som et im es I get st ressed because she does not underst and our
side ( ...) . I am suffering beforehand because, if I could, I wouldn’t
go back t o work, but we can’t ( ...) . The biggest support societ y
could give is if com panies would st op seeing m ot hers as idle.
( ...) To achieve exclusive breast feeding, t he six- m ont h m at ernit y
leave should actually becom e the law. After two m onths the m other
already st art s t o give ot her foods, because she has t o gradually
adapt t he baby’s t ast e t o go t o kindergart en. I t is a lot of suffering
( E2, E5, E6, E7, E8) .
Par t icipant s w ho w or k ed indicat ed t he need
t o r et ur n t o t heir pr ofessional act iv it ies as t he m ain reason t o int roduce ot her m ilk in t he baby’s diet before
t h e age of 6 m on t h s. Resear ch er s( 5 , 1 7 ) believ e t h at con ciliat in g br east f eedin g w it h ex t er n al act iv it ies is
one of t he m ost difficult fem ale t asks in current societ y, as it involves conflict for decision m aking and, in daily
life, t he desir e t o be a good m ot her can clash w it h
ot her roles t he w om an represent s in societ y, such as t hat of a w or k er for ex am ple
Acco r d i n g t o t h e w o m e n ’ s r e p o r t s, t h r e e relevant point s st and out in planning ret urn t o ext ernal
act ivit ies: guarant eeing t hat t he child will accept ot her food t han m ot her ’s m ilk, guar ant eeing/ pr oviding car e
for t he child during her absence and dealing wit h t he c o n f l i c t o f w a n t i n g / b e i n g a b l e t o m a i n t a i n
b r east f eed in g .
Th e e a r l y i n t r o d u c t i o n o f t h e b o t t l e i s
considered a st rat egy wom en have found t o m inim ize
t he im pact of t heir dist ancing and gradually accust om t he child t o t he absence of t he m ot her’s breast , besides
t est ing and guar ant eeing accept ance of ot her food( 5). I n or der t o guar ant ee/ pr ov ide car e for t heir childr en
dur ing t heir absence, k inder gar t ens w er e m ent ioned a s t h e f i r s t o p t i o n b u t , w h e n f a c e d w i t h t h e
Wit h r espect t o t h e w or k en v ir on m en t , t h e
w o m en w h o p a r t i ci p a t ed i n t h i s st u d y a l so f a ced difficult ies t o m aint ain breast feeding. Their st at em ent s
r ev eal t h e em ploy er s’ lack of k n ow ledge or n eglect of law s t hat pr ot ect m ot her hood, gener at ing conflict s
in t he work relat ion and m at ernal anguish t o st and on t h ei r r i g h t s. Th i s ack n o w l ed g em en t i n d i cat es t h at
br east f eedin g pr om ot ion dem an ds m ech an ism s t h at go bey ond legal issues.
Accor ding t o t hese w om en, societ y does not su ppor t w om en w h o w or k an d br east f eed, w h ich is
not only a represent at ion, but also an observat ion of
t he r ealit y pr esent in t he lives of w or king w om en. Th e par t icipan t s’ r epor t s r ev eal t h at , w h en
t h ey f eel pr essu r ed by t h eir bosses, t h ey ou t r aged and in conflict , m ediat ed by t he pr essur e exer t ed by
t heir im m ediat e superior, knowledge about t heir right s and t he sat isfact ion w it h br east feeding.
I n t his sense, st udies about issues relat ed t o br east feeding and r et ur ning t o w or k r ev eal t hat , for
w or k in g w om en , “ w or k does n ot for give”, in dicat in g t h at br east f eedin g w om en f eel t h at pr essu r e in t h e
p r o f e ssi o n a l e n v i r o n m e n t m a k e t h e i r a ct i o n s t o m aint ain br east feeding m or e difficult( 5)
.
On e ca n i n f er t h a t , i n t h e p u b l i c sp h er e,
breast feeding wom en find t heir role as m ot hers subj ect t o t he dem ands of t he product ion sect or, as if it were
possible t o break wit h t he roles wom an represent s in societ y.
Th e st u d y p a r t i ci p a n t s d em a n d st r u ct u r a l support t hat enables t hem t o m aint ain and conciliat e
br east feeding w it h t heir pr ofessional act iv it ies. Ther e
ar e few ex am ples of com panies w ho offer a suppor t st ruct ure t o m aint ain breast feeding and lact at ion aft er
r et u r n t o w or k . Wh en av ailab le, k in d er g ar t en s ar e not alw ay s near by and, in m ost cases, do not hav e
t r ain ed st af f t o d eal w it h ch ild r en u n d er ex clu siv e b r east f eed in g .
The inconsist ency of support in t he hom e and work environm ent s in order t o conciliat e breast feeding
an d ex t er n al act iv it ies m ak es it h ar d f or w om en t o m a i n t a i n e x cl u si v e b r e a st f e e d i n g . Su p p o r t f r o m
r elat iv es, t he par t ner, k inder gar t ens and guarant eed
occupat ional right s are st ill dubious, oft en ent ail m ore co n f l i ct a n d g u i l t t h a n l i g h t er w o r k j o u r n ey s a n d
m at er nal r esponsibilit ies( 5 ).
Ev en if t h ey h av e en v ir on m en t al con dit ion s
and m at erial resources t hat favor t his pract ice, wom en feel t h at h u m an r elat ion s, in t h eir pr iv at e or pu blic
cont ex t , act ually pr ov ide t hem w it h back up t o adapt and put t heir proj ect s in pract ice in order t o cont inue
breast feeding. Different from support act ions report ed
in ot her discourses, wom en who breast feed and work feel alone t o cope w it h issues relat ed t o t he decision
on con ciliat in g t h e r et u r n t o w or k w it h m ain t ain ed b r east f eed in g .
I n view of t he represent at ions of m ot herhood an d t h e v alu at ion of w om en as m ot h er s, t h e st u dy
p a r t i c i p a n t s r e c e i v e d s u p p o r t f r o m t h e i r f a m i l y net works t o allow t hem t o t ake care of t heir children.
How ever, neit her suppor t m ovem ent s by r elat ives or h u sb a n d s w e r e m e n t i o n e d i n o r d e r t o co n ci l i a t e
pr of ession al act iv it ies w it h con t in u ed br east f eedin g,
nor t he guarant ee of care for t heir children when t hey go out t o work.
D i s c o u r s e – Th e p e r c e p t i o n a b o u t br east f eedin g su ppor t
Support is im port ant . Som et hing we need bot h at hom e
and out side. So t hat we have m ore energy t o breast feed.( ...)
Fam ily support is im port ant , and professional support t oo, but
wom en need t o want t o breast feed, so, when I don’t find support ,
I look inside m yself, I give m yself support . I t hink breast feeding
is inside m e ( ...) and knowing t here’s som eone we can count on
m akes us feel at ease, som eone who helps t o t ake care of t he
baby, give a bat h, arrange t he house, t he food, t aking t he children
t o school. I t m eans som eone t o be t here wit h you when you m ost
need it , w it h ex per ience in life, w ho list en and t alks, giv ing
em ot ional and psychological support . Support is affect ion from
t he part ner, a word of consolat ion ( ...) . I f I didn’t get support I
t hink I would m anage t o breast feed, but not t he way I ’m doing it
( E3, E5, E7, E8, E9, E11, E13, E14) .
Th e w o m en ’ s d i sco u r se r ev ea l s t h a t t h ey
a c k n o w l e d g e t h e n e e d f o r a n d i n f l u e n c e o f
breast feeding support in t he privat e as well as public sp h er e.
I t is in t er est in g t o h ig h lig h t t h at , alt h ou g h wom en ident ify and acknowledge t he need for support ,
t hey also r epr esent t he br east feeding ex per ience as unique and indiv idual. I n t his per spect iv e, suppor t is
consider ed a det er m inant fact or in t heir ex per ience, w hich giv es t hem t he oppor t unit y t o ex per ience and
d ev elop self - con f id en ce t o liv e t h e ex p er ien ce in a m or e pleasan t way.
Dif f er en t br east f eedin g su ppor t act ion s an d
t h e i r c o m p o n e n t e l e m e n t s w e r e m e n t i o n e d a s sign if ican t t o ach iev e t h e br east f eedin g ex per ien ce.
Hence, fr om t he w om en’s per spect iv e, suppor t m ay be underst ood as a social phenom enon t hat covers a
set of act ions t hat should be offer ed as a w hole and
in accor dance w it h t heir needs.
I n t he per spect iv e of t he st udy par t icipant s,
live in and t o t he act ions t hat give t hem t he opport unit y
as w ell as t h e ph y sical an d em ot ion al con dit ion s t o
breast feed. The experience of t his realit y presupposes
t he exist ence of int erpersonal relat ions t hat value t heir
m at er n al an d f em al e r o l e i n so ci et y, an d o f so l i d
inst rum ent al and st ruct ural support , allowing t hem t o
f u n ct ion as m ot h er s an d w om en in t h e p u b lic an d
pr iv at e sph er e.
FI NAL CONSI DERATI ONS
These st udy r esult s r ev eal t hat suppor t is a
br oad phenom enon, com pr ising alr eady consolidat ed
a sp e ct s, e m b e d d e d i n b r e a st f e e d i n g p r o m o t i o n ,
p r o t e c t i o n a n d s u p p o r t c o n c e p t s a n d a c t i o n s .
Accor ding t o t he w om en’s per spect iv es, suppor t can
b e u n d e r s t o o d b a s e d o n t h r e e d i m e n s i o n s :
inst r um ent al, affect ive and st r uct ur al. I n t he hospit al
cont ext , t he inst rum ent al dim ension includes pract ical
a n d i n f o r m a t i o n a l e l e m e n t s o n h o w t o m a n a g e
breast feeding. I n t he fam ily cont ext , t he inst rum ent al
d im en sion m ain ly r ef er s t o f in an cial h elp an d h elp
wit h housework, allowing t he wom an t o dedicat e m ore
t im e t o t he baby and t o br east feeding. The affect iv e
dim ension cover s elem ent s of int er per sonal r elat ions,
in t h e p u b lic an d p r iv at e con t ex t , em p h asizin g t h e
way support is offered. The st ruct ural dim ension refers
t o act ions in t he social cont ex t , especially access t o
k i n d e r g a r t e n s a n d o p p o r t u n i t i e s t o co n ci l i a t e o r
m aint ain breast feeding in t he public space, part icularly
in cases of paid w or k.
Th e b r east f eed i n g su p p o r t act i o n s so ci et y
o f f e r s w e r e n o t a c k n o w l e d g e d , a s o p p o s e d t o
ob st acl es t o b e ov er com e f or t h ese w om en t o b e
v alu ed in t h e p r of ession al en v ir on m en t as w or k in g
wom en and m ot hers. The needs t hese wom en express
represent a challenge, t hat is, t he need t o reconsider
t h e pr act ices of ev er y on e in v olv ed in br east f eedin g
pr om ot ion, pr ot ect ion and suppor t ; t her efor e, healt h
se r v i ce s sh o u l d o f f e r a ct i o n s b a se d o n w o m e n ’ s
percept ions, at t em pt ing t o est ablish a part nership wit h
t h e i r f a m i l y n e t w o r k , a s w e l l a s i n t e g r a t i o n w i t h
av ailable social dev ices.
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