This is the first study exploring Chinese immigrant mothers’ suggestions on the promotion of exclusive breastfeeding in Ireland.This paper complements an earlier paper from our group which identified facilitators and barriers to breastfeeding among this ethnic group . The findingsof the current study provide breastfeeding promotion suggestionsfor Chinese immigrant mothers, employers, health care professionals and Irish governmental agencies.These suggestionsmight inspire other countries with low breastfeeding rates, as few studies had explored immigrants’ opinions on improving exclusive breastfeeding rates in host countries.
Suggestions for New Immigrant Mothers
The important role of maternal attitudes towards breastfeeding has been reported in a number of studies [31-34]. Consistently, our findings implied that Chinese mothers’ strong willpowerto exclusively breastfeed wasimportant to the success of optimal feeding practices.Maternal attitudes might especially be true for the first generation of Chinese immigrant mothers because of traditional beliefs that mothers are strong, persistent and should do whatever is best for their off-spring’s well-being. For new mothers, reinforcing traditional positive attitudes and their ability to breastfeed along with increasing self-efficacy, appears to be crucial to increasing breastfeeding rates among new mothers.
In addition to maternal attitudes, previous studies have identified family support as an important factor in supportingexclusively breastfeeding [35-37]. The findings ofthis study alsosuggested that new mothers turn to their family members for support during lactation. Notably, besides parents, the encouragement and cooperationof husbands during lactation were crucial to the success of exclusively breastfeeding.It was reported that most Chinese-Irish families were nuclear families(a family group consisting of two parents and their children) where the husband was the main source of financial support [23, 37]. The husband’s busy working schedule may have contributed to a lack of involvement or support of exclusively breastfeeding.Indeed, a previous studyconfirmed that increasing fathers’ involvement during an infants’ first year of life may improve breastfeeding duration up to six months of age . Other studies have also reported that husbands’ positive attitudes and support are associated with longer breastfeeding duration [39, 40].Toaddress these issuesand promote breastfeeding in Ireland, relevant policies have been developed in Ireland. As of November 2019, under the new employment legislation, both new mothers and fathers are entitled to two weeks extra parental leave on top of current maternity/paternity leave entitlements. This policy may help fathers to get more involved and to better support breastfeeding.
Suggestions for Employers
Chinese immigrant mothers in this study considered a supportive working environmenta key factor for the success of exclusive breastfeeding, especially the need to establish relevant policies on extending maternity leave. Previous studies in other countries have shown that immigrant women are more likely to return to work earlier for financial reasons, despite their intention to breastfeed for six months or longer [42, 43]. Therefore, as suggested by our study participants, ensuring a sufficient period of paid maternity leave may help improve the duration ofbreastfeeding among immigrant mothers.To date, some relevant policies,such as the Maternity Protection (Amendment) Act (2004), have been released to ensure the rights of breastfeeding mothers in Ireland.These policies allow breastfeeding mothers maternity leave of no less than 18 consecutive working weeks and to breastfeed during working hours withoutloss of pay [44, 45]. However, our study participants rarely mentioned these policies, possibly due to their unawareness of this entitlement. It should be noted that these policies were updated as the Parent’s Leave and Benefit Act 2019, which allowed for a total of 26 weeks paid maternity leave. Employers need to provide and explain these updated policies in detailto ensure that immigrant mothers are aware of their breastfeeding rights in the work place.
Further, previous studieshave shown an unfavorable workplace environment may be significantly associated with the cessation of breastfeeding [28, 46].The findings from our studyalsosuggestthe importance of a breastfeeding-friendly workplace (e.g., nurseries, breastfeeding rooms) and further suggest thatemployers set up a private space andasafe and clean facility for breast milk storage. It should also be noted that under Irish law, employers are not obliged to provide breastfeeding facilities in the workplace if the provision of such facilities involves considerable costs.Consequently, there is a need to explore ways to reduce the cost of providing workplace breastfeeding facilities/spaces and/or incentives for employers to adopt such policies.
Suggestions for Health Care Professionals
Breastfeeding counseling provided by health care professionals is also a useful source for obtaining breastfeeding knowledge[43, 47]. Previous research has established the importance of health care professionals’ attitudes and advice on exclusive breastfeeding rates among Chinese immigrants [12, 43]. Participants in our study felt that health care professionals didnot sufficiently stress the importance of breastfeeding in the hospital setting, and needed to talk more explicitly about the practice with immigrant mothers.
It should be noted that the interviews for this study were collected 10 years ago and changes have been made to the Irish health care system over the past decade. According to 2015 Breastfeeding Policy for Primary Care Teams and Community Health Care Settings developed by Irish Health Service Executive (HSE), all staff involved in the care of pregnant women, infants and young children should support and enable mothers to breastfeed exclusively for 6 months. This policy indicates training should be provided for all health workers on the knowledge and skills necessary to implement the breastfeeding policy; and all health workers should discuss with pregnant women and their families the importance and management of breastfeeding. In 2020, Sullivan et al published a paper examining breastfeeding beliefs among Polish-born mothers in Irelandwhich suggested that health professionals were very “pushing” about breastfeeding. This outcome may be the result of the efforts made to improve breastfeeding training train among health care professionals. Additionally, the National Standards for Antenatal Education in Ireland was published in 2020. This document provides information on the content, mode of delivery and training resources for the development of a high-quality antenatal education program. It also set up the standards for such programs in Ireland. However, no specific section or reference to immigrant mothers was found.
Despite the promising results from training health care professionals in Ireland, limited improvementshavebeenshown to address the language and cultural differences encountered by immigrant mothers. Our study suggested thatthe language barrier was a great impedance to obtain breastfeeding relevant information by Chinese immigrant mothers. This finding is consistent with many other studies among immigrant populations[18, 23, 43]. A translation service might be used to overcome this barrier. However, according to another study among immigrant women in Ireland, the lack of access to trained interpreters continued to be a problem and was often limited in the hospitals due to cost. Therefore, the recruitment of multilingual staff is needed in the health care system. Besides language problems, multilingual health care professionals may come from the same or similar culture and have a better understanding of the cultural differences encountered by immigrant mothers. Consequently, they might be able to clarify specific misconceptions or conflicted information received by immigrant mothers. Currently, no data have been published on whether the recruitment of multilingual staff has been increased since the time of this study. Future research should address this gap and collect informationon how the Irish health care system deals with language problems in the hospitals.
Suggestions for Government Agencies
Nearly half of our participants reflected that governmentagenciesshouldinitiatemore societalchanges to promote breastfeeding amongimmigrantsin Ireland.Such moves should include increasing publicity on breastfeeding and making breastfeeding messages more visibleviabrochures, books or television. To the author’s best knowledge, information in Chineselanguages on the Irish government websiteremainslimited with, so far,only one flyer called “Feeding cues” is available in Chinese on the HSE website.More language-specific material on topics proposed by our study participantssuch as comparisons between breastfeeding and formula feeding, the benefits of breastfeeding, breastfeeding misconceptions and solutions to breastfeeding problems, should be developed and made available to immigrant mothers.
Although not mentioned by the participants, a hotline might be another effective way to increase breastfeeding publicity among immigrant populations, as indicated by one study conducted in Chinese-Canadian population.In Ireland,no hotline has been established, but an email service called “ask the expert on-line lactation consultant service” is available on HSE websites and has been providing support for breastfeeding mothers who have questions or need to join a local breastfeeding support group. However, it is unclear whether this email service has multilingual agents to respond to the immigrant population from non-English speaking countries. Further exploration on the effectiveness of this email service in improving the breastfeeding rates in Ireland immigrant population is needed.
Other suggestionsproposed by our study participants includedsetting up better equipped, specific breastfeeding rooms in public places, especially shopping malls.Although the Equal Status Act (2000) prevents discrimination and harassment of breastfeeding in public , mothers may still feel embarrassed and the need some privacy when it comes to breastfeeding. Certain policies should be put in place to help create a safe place in public for breastfeeding moms. Additionally, the participants suggested several otherpolicy changes, including developing new social security policies for Chinese immigrants, narrowing the gap of social welfare benefits between Irish and immigrant residents, and providing a longer-term Irish visa for breastfeeding moms. These issues havenot been previouslydocumented and currently there are no such policies in place. Such policies could be of future consideration for the Irish Immigrant Council of Ireland.
Severallimitations should be kept in mind when interpreting the results of this study. First, the interviews were collected 10 years ago, and suggestions from the findings may not be relevant today. However, to the best of the author’s knowledge following a thorough search online, little has been done to address suggestions such as recruiting multilingual health care professionals or establishing policies to support breastfeeding among immigrant population. Further research should also be conducted to explore the efficacyof any legislative changes in support of breastfeeding and their impact on the experiences of immigrant mothers. Additionally, the generalizability of the findings is limited given this studyinvolved only a small sample of Chinese immigrant mothers. Consequently, it is possible that our results may not be reflect the experiences of the general population of Chinese immigrant mothers. Additionally, our results may not be fully comprehensive, as we only included mothers who exclusively breastfed for at least four months.The rationale for this restriction was to documentthe opinions of mothers whose exclusive breastfeeding experience was successful and positive. Nonetheless, constructive opinions from immigrants’ families and husbands and motherswho breastfed for less than four months are warranted in further studies.