Research Communications

Child Support: Students explore how to enhance breastfeeding education in Appalachia 

By Jessica Salerno

(Editor's note: Holly Strickland will be one of more than 650 presenters at the 2013 Student Research and Creative Activity Expo on April 11.)

Holly Strickland recalls that she was surprised to learn that Appalachian Ohio has the lowest breastfeeding rates in the state, as the region is low-income and breastfeeding is an inexpensive infant feeding option. In a recent research project that she and psychology doctoral student Amy Borchardt helped conduct with the Voinovich School of Leadership and Public Affairs, the senior psychology major learned why there's such a big disconnect.

The Ohio Department of Health contracted with the school to examine the barriers and facilitators to breastfeeding initiation and duration, as well as opportunities for improving breastfeeding education and support. The study was held in 19 Appalachian counties with low breastfeeding rates, and feedback was gathered from women through focus groups.  

The students, working with Voinovich School Assistant Professor Holly Raffle, co-facilitated 10 of those groups and then transcribed and analyzed responses from the female participants.

The 176 women interviewed were receiving Women, Infant, and Children (WIC) benefits, which is a federally funded nutrition assistance program for low-income women who are pregnant, breastfeeding an infant, or have had an infant within the past six months, and children from birth up to age five.

"We were just interested in getting perceptions and beliefs across the board," Strickland says.

The researchers considered generational poverty and Appalachian culture when reviewing the focus group findings. 

Holly Strickland (left) and Amy Borchardt (right) at the 2012 Student Research and Creative Activity Expo (Photo credit: Holly Craycraft, Voinovich School of Leadership and Public Affairs)

One characteristic of generational poverty is that most women are more focused on getting through the day than planning ahead for the future, Strickland explains. That has implications for breastfeeding, as women need to schedule various times throughout the day to pump milk and must keep track of the necessary supplies.

Family also is a big Appalachian value, and so if a woman's mother or mother-in-law didn't breastfeed or looks down upon those who breastfeed, the woman was more likely to be influenced by that opinion.

Another issue, Raffle adds, is that Appalachian women may prefer to communicate through stories. If their health care providers made them feel rushed or ignored their communication style, it affected the amount of effort the women wanted to make towards breastfeeding.

Women must be taught how to breastfeed, as it's not an action that comes naturally, Raffle notes. It's a new process that requires mothers to interact closely with their doctors, nurses, and lactation consultants.

"How (health care providers) interact with women plays a big part in (women's) health decisions," Strickland says.

Borchardt, who shared a first-place prize with Strickland for their research at the university's Student Research and Creative Activity Expo in 2012, agrees that strong interpersonal skills are crucial for making an impact.  

"The key to helping increase breastfeeding rates in the area is to make sure there are lactation consultants and health care providers willing to take the time to make a connection with the mother so she feels comfortable asking for help when she needs it," Borchardt says.

It's important for health care providers to understand cultural issues, Raffle says, so that they can improve their interactions with patients.

"What we have to focus on is changing those interactions ever so slightly to help support those women from Appalachia who are living in poverty," she says.

Although each woman must make a choice about how to feed her infant, Strickland says that studies have suggested numerous benefits of breastfeeding, such as improved infant health and stronger mother-child bonding.
This article will appear in the Spring/Summer 2013 issue of Ohio University's Perspectives magazine.