Sample characteristics
A total of 14 mothers were interviewed. They were between 24 and 54 years old (mean age: 34 years) and had been living in Ireland from three to 18 years (mean duration: nine years) at time of the study. Most mothers (n=8, 57%) were primiparous; while 43% (n=6) had two children (one had twins). Ten participants had achieved third-level education (71%); while four (29%) obtained education from secondary or training schools. Over half (n=8) of the participants were housewives or had part-time non-professional jobs; while six were self-employed or had professional jobs. The majority (n=11) of the participants had an annual family income over 30,000 euro (before tax); while three had an annual family income of 15,000-30,000 euro. All participants held positive attitudes towards exclusive breastfeeding because they believed that exclusive breastfeeding for four to six months would benefit babies, mothers and society.
Mothers’ personal opinions on exclusive breastfeeding promotion
Results generated from thematic analyses were summarized in Table 1. Three themes were identified, including 1) recommendation for mothers; 2) recommendation for family members, employers and colleagues, and health care professionals; and 3) recommendation for the government.
Theme 1. Recommendation for mothers
- Maintaining maternal intention and improving self-efficacy
All participants emphasized that immigrants should maintain intention, appreciation, and confidence towards exclusive breastfeeding, and ignore negative comments received when they breastfeed in public. “You can complain, but do not give up.” (P5). For this, mothers need to have a high degree of self-efficacy and confidence. “My advice is not to rely on others. Otherwise, you will feel it (maintaining breastfeeding) to be hard.” (P6)
1.2 Creating suitable condition for exclusive breastfeeding
Some participants suggested immigrants should prepare enough free time and have sufficient finance security, as well as ensure that they have an Irish visa or citizenship for the duration of the lactation period before delivery. “Some people have to work, making it difficult to breastfeed exclusively.” (P5). For renters, sharing the accommodation with those who also have babies was also considered to be helpful. “As they were experienced, they could understand your difficulties, tolerance the noise from the baby, and provide timely help when necessary.” (P14)
1.3 Obtaining breastfeeding knowledge
Participants suggested mothers compare breastfeeding information objectively and rationally as there were some conflicting information. For example, a mother reflected that treatments of breast milk jaundice given by Chinese doctors and Irish doctors were completely different. “My baby had jaundice due to breastfeeding. Chinese doctors advised to stop breastfeeding for one or two weeks. But Irish medical staff advised to increase breastfeeding frequency to promote infant digesting and wetting nappy.” (P6)
Chinese mothers were advised to ask questions proactively in hospitals, not to exclude regular home visits, and to form or join a breastfeeding group (regardless of nationality). A mother compared what she saw in China with her own experience in Ireland, and then she said: “Don’t exclude home visits because you can’t speak English well… In Ireland, people pay less attention to breastfeeding (than in China). Thus, you need to ask questions proactively.” (P14)
Theme 2. Recommendation for family members, employers and colleagues, and health care professionals
2.1 Family members’ sufficient support
Sufficient family’s support given to the mothers while breastfeeding was strongly recommended. Some participants suggested that family members of Chinese mothers could come to Ireland for baby care. Some participants who focused on the important role of husbands suggested husbands adjust their working hours to adhere with the mothers’ schedule. “Family support is indispensable.” (P7)
2.2 Employers’ support and colleagues’ respect
Some working mothers suggested employers prolong the maternity leave, provide facilities to store breast milk, and set up nurseries within or near the workplace. “The nurseries near my workplace were convenient for me to breastfeed.” (P13)
They also hoped work colleagues, especially male colleagues, respect and support their breastfeeding decision, by avoiding giving negative comments on breastfeeding. “I managed to continue breastfeeding exclusively after returning to work because my colleagues understood my situation well.” (P3)
2.3 Health care professionals’ support
2.3.1 Encouragement and advocacy
It was suggested that health care professionals in Irish hospitals and health centers should be stronger advocates for breastfeeding and should provide more support to mothers. “Breastfeeding was seldom mentioned in medical advice. Doctors should encourage mothers to breastfeed.” (P1)
2.3.2 Multilingual specialization
Most participants suggested to train language-specific health care professionals to provide support and prenatal education for language-specific mothers, as many mothers experienced the pain of language barrier, especially difficulties in understanding the professional terminologies. “In fact, there was still a language barrier. When I communicated with a health care professional, there were many professional terminologies which troubled me. So, I think maybe more Chinese nurses and midwives would be better.” (P6). Some suggested health care professionals provide breastfeeding support and consultation more initiatively and patiently. The health care professionals should provide mothers with the solutions to their problems correctly and in sufficient detail. “I felt that Irish nurses or midwives were deficient in experience and specialty…which made new mothers anxious.” (P14)
2.3.3 Appropriate breastfeeding education combined with practice
Some participants suggested that health care professionals should teach breastfeeding knowledge appropriately to immigrant mothers. Separation of breastfeeding theory and practice was reported by many of them. They suggested to combine breastfeeding knowledge with practice in prenatal education classes. “Primipara were taught breastfeeding knowledge, but it’s difficult for them to operate in practice… Practice is needed to assist the understanding of theoretical knowledge.” (P14)
Theme 3. Recommendation for the government
3.1 Setting up well-equipped breastfeeding facilities in public places
The majority of participants felt that the Irish governmental agencies should set up more breastfeeding rooms in public places (such as shopping malls), and equip these rooms with seats, water and breast milk heaters. “There were many places for nappy changing, but breastfeeding facilities were not enough.” (P5). In addition, special groups for mothers to share experiences was also recommended.
3.2 Providing social welfare policies
Some participants suggested the Irish governmental agencies amend the laws and regulations to provide policy guarantees for maternity leave and financial subsidies. “The government could give appropriate subsidies for breastfeeding, such as dozens of Euros a month.” (P11). Irish governmental agencies were suggested to consider the following new security policies for the Chinese. First, narrow down the gap of social welfare between native residents and immigrants. “As there is a big gap of social welfare between immigrants and Irish, I do hope that Ireland could provide special social welfare policy for immigrants.” (P14). Second, provide longer-term Irish visas for the Chinese mothers migrating for education-related reasons to ensure that they could breastfeed six months in Ireland after birth. A newly arrived mother said, “I attained language class in the second month after delivery for student visa which caused difficulties in exclusive breastfeeding.” (P14)
3.3 Publicity
3.3.1 Increasing intensity of publicity
Enhancement of publicity for breastfeeding in clinics, communities and television advertisements was also suggested. “The government still need to increase the publicity to let more mothers know that breast milk is better than bottles.” (P9)
3.3.2 Enriching contents of publicity
Improvement in the content of the publicity was suggested. Suggestions from participants were as follows. First, publicize that breastfeeding is natural, necessary and worthwhile, rather than as an alternative feeding method. Second, promote the education on benefits of breastfeeding, correct the misconceptions, and deliver the breastfeeding message via the community. Third, provide solutions to breastfeeding problems, such as mothers’ taking medication. “I think you can compare breast milk with formula, and present in a table.” (P9)
3.3.3 Publicizing by various means
Many participants suggested that breastfeeding should be publicized in multiple languages and in various venues. “Add some Chinese information on breastfeeding.” (P12). “Publicity can be made through newspapers and television.” (P5). “Publicizing breastfeeding to Chinese immigrants by brochures may be better, because they don’t like to join clubs.” (P6)