When Breastfeeding and Culture Meet

Adapted from “Culture: Some Introductions,” from Rocky Mountain Leader, LLL of Colorado/Wyoming’s Area Leaders’ Letter, Summer 2014

The other day, I met a work colleague, Stan, in the middle of a doorway. We laughed as we passed each other, because he had to duck to avoid hitting his head on the overhead hinge, and I could easily walk under his arm as he held the door. We joked that what we had just done was completely outside the other’s realm of experience. At 5 feet 1 inch (1.5 meters), I never hit my head on anything. At 6 feet 5 inches (1.95 meters), Stan never walks under another person’s outstretched arm. After we parted ways, I imagined life as Stan: he must see the tops of other peoples’ heads; he’s never lost in a crowd; he doesn’t have to climb on the kitchen counter every day!

This doorway scene about Stan and me is a fitting analogy for beginning to think about culture. Culture is the essence of those attitudes and core values that define who we are and what we believe. Culture shapes our lives in so many ways, and yet, many of us don’t often think about it until we meet someone who is very different from us. In fact, I work with Stan all the time, but it took getting quite close to him to reflect on how different his life experience is from mine.

Everyone, meet culture

If you were the same size as the majority of the people in your town, it would be hard to imagine what life with a different height is like. But when you really think about it, or have an experience as I did with Stan, you realize that no one is seeing exactly what you see, and everyone experiences his height differently. One thing unites us, though: everyone has a height.

Culture is the same way: we all have it. As we embark on an ongoing discussion about diversity and breastfeeding support, keep in mind that just as Stan and I see the world from different perspectives, so do people with varying backgrounds. All of us have a cultural background that has shaped our attitudes about breastfeeding and children.

Culture, meet breastfeeding

Articles about culture and breastfeeding ^1,2 often contain assertions like these:

• Some Japanese kindergarten admission forms might ask whether a child has weaned from the breast.^1,2
• In Korea, some believe that declaring a baby to be beautiful could invite the jealousy of the gods.¹
• Women in Kenya are told to avoid nursing after arguments to prevent “bad blood” from entering their milk and impacting their babies.¹
• Women of East Asian and Southeast Asian cultures may follow a custom called “doing the month”—staying home, avoiding drafts and dressing warmly for 30 days after having a baby to overcome a perceived vulnerability to cold, wind and magic ²
• Traditional groups in Papua New Guinea and the Gogo tribe of Tanzania encourage women to be celibate while breastfeeding. A mother may have to choose between her breastfeeding goals and her desire to be close with her husband, who is often not expected to also remain celibate. ¹
• One study of 120 cultures showed that 50 cultures delayed breastfeeding for two or more days due to the belief that colostrum is “dirty,” “old,” or “not real milk.” ³

These assertions can be eye‐opening and help us realize that different belief systems impact a mother’s perspective. However, I noticed all of these assertions are about cultures other than my own. I have a culture, too, and it is not represented in the items above. So, I’ll add the following:

• Women in Western industrialized countries tend to value individuality and independence, and they may be strongly encouraged to make their infants as independent as possible as quickly as possible. For example, some mothers are advised to “train” babies to sleep on a schedule by gradually responding less to their cries.

• In the United States, the female breast is especially sexualized, so breastfeeding in public or breastfeeding an older infant may therefore be considered indecent.

Breastfeeding, meet culture

Does this mean you have to become an expert in every world culture in order to support a woman from a different background? This misleading idea of “cultural competence” can cause a lot of fear and anxiety. You may worry that you have to study for 40 years to become “competent” before you can talk to a family from another culture. No, not true! Learning about cultures other than our own (and reflecting on our own culture) is never ending, and none of us will ever know everything about every culture.

Even if we could, we would still not know what an individual’s culture is. Let me explain.

Reading those last items in the list above, I can recognize that, yes, women in my culture are pressured to impose a schedule on a baby. But at the same time, that is not representative of me. I think, “You can’t just assume that because I’m American, I let my baby cry it out!” Precisely! We cannot conclude that a woman’s racial, religious, national, or linguistic identity is a reliable predictor of attitudes about breastfeeding. In other words, when supporting a mother from a different background from her own, a Leader appreciates that each individual within a culture takes what works for her and leaves the rest. However, even if a mother doesn’t buy into a particular expectation, the pressure is still there. To take an example from within my own culture: I won’t assume that every mother I help is “watching the clock.” However, you can bet I will ask her open‐ended questions about how often she nurses and listen carefully for hints about her prevalent cultural attitudes.

The goal, then, is to work with a cultural lens, not cultural blinders.

Cultural lens, meet relationship

When in doubt,

respond with empathy.

When rapport is lost,

all is lost.

from USA Communication Skills “Listening from Your Heart” Session One handout.

It is very important to establish a relationship with the breastfeeding mother, so that you are viewed as a helper, not as someone who “just doesn’t get me.” We can get to know a mother and her unique cultural understanding of breastfeeding, by doing what Leaders already do all the time: listen, ask questions, show empathy, and empower.⁴  By applying a cultural lens to this practice, we might also listen for and ask: Are there any rituals, special values, or taboos around infant feeding in her culture? Which ones does she agree with? Which ones does she struggle with?

If a Mexican family believes that atole (a cornmeal drink) helps a breastfeeding mother produce milk, then by all means you can acknowledge it. If a Mexican mother believes that colostrum should be discarded, then you can discuss the potential impact on her breastfeeding goals and then, as always, let that information support and empower the mother to make her own decision. All of this takes place in a context of mutual respect.

Keep working with empathy, remain thoughtful, aware, and respectful, and you will be doing much more good than harm.

Mouth, meet foot

It can be scary to reach out to someone different from ourselves, because we just don’t want to make a blunder. We don’t want to offend anyone. We don’t want to look insensitive. The truth is: you will make mistakes. We all make mistakes. You might get called out or you might notice nonverbal cues. You will be embarrassed.

What can you do when this happens? Use your reflective listening skills! Contact a Communication Skills Instructor (CSI) for support.

Here’s the good news: it is actually important to make mistakes on these levels to truly get to the heart of a helping relationship. If a mistake is made within the context of a relationship, it can be met with humor and understanding. The best person to learn from is the person you are hoping to learn about! The learning process starts anew with the next mother you help, and the process is lifelong. Don’t fear mistakes, but be prepared to make them, and then learn from them. Keep working with empathy, remain thoughtful, aware, and respectful, and you will be doing much more good than harm. And then come back and share the experience with other Leaders so we can all do better.

Helping without giving advice

Vicky Tanco, a Leader from Sao Paulo, Brazil, developed a method she calls “LACE” for helping without giving advice. This was in the article, Avoiding the Advice Trap, LLLI, Leaven, August-September 2001.

1. Listen. Wait for the question. Allow the mother to give you an insight into herself—her feelings, attitudes, and relationship with her baby. It takes time to get to know someone. A phone call may not be enough. However, by listening actively, letting the mother use us as a sounding board, we can better help her go on to the next step.
2. Ask questions. Ask specific questions. Use How and What. (“What is your baby’s feeding pattern?” “Can you describe to me how his diapers look.”), rather than questions answerable by yes or no. Also ask a mother about her thoughts, such as “How do you feel about that?” and “What feels right to you?” or “What would you like to see happen?”
3. Give choices. Impart enough information to allow the mother to make an informed decision. Avoid telling her what to do. Use phrases like “Many mothers have found” or “Let me read to you what I have on the subject.” Her choice will stem from her own discernment of the situation and the responsibility will rest on her.
4. Let information and support empower her. It is the mother’s responsibility to decide what’s best for her family. She is the expert in her baby’s care. Information and support are seeds that will help her confidence grow in her mothering. An important point to remember is that the Leader is not responsible for persuading the mother to choose one way or the other. You do not need to feel that you have somehow failed if the mother makes a choice different from one you yourself would have made, or one that runs counter to LLL philosophy. That new mother who perhaps chooses to wean early with her first baby will probably come to LLL for help and support with successive babies if she goes away with a positive feeling about her relationship with you. She may pass the word along to her family and friends who have babies. And who knows, someday she may become a Leader herself.

References 

1. Pickett, E. A Closer Look at Cultural Issues Surrounding Breastfeeding, 30 October 2012, (accessed 11 April 2014).

2. Weibert, S. Cultural diversity and breastfeeding. Breastfeeding Update 2002; 2(3):1, 3.

3. Morse, JM, Jehle, C, Gamble, D. Initiating breastfeeding: a world survey of the timing of postpartum breastfeeding, 1990,  (accessed 23 January 2015).

4. Whelan, J. Avoiding the advice trap. Leaven August‐September 2001; 37(4):84 (adapted from Leaders’ Line, the Area Leader’s Letter of LLL of Indiana, USA, Spring 2000).

Bolton, R. People Skills: How to Assert Yourself, Listen to Others, and Resolve Conflicts. New York, New York: Touchstone, 1979; 22

Leader’s Handbook. Schaumburg, Illinois: La Leche League International, 1998; 23.

Carrie Richardson has a master’s degree in linguistically and culturally diverse education. She was accredited in 2012 as a La Leche League Leader in Denver, Colorado, USA, where she lives with her husband, their son Benjamin (4), and two dogs. Carrie is currently the editor of LLL of Colorado/Wyoming’s Rocky Mountain Leader and administrator of the Area’s Facebook page, www.facebook.com/LLLCOWY