Breastfeeding rates remain low, especially among low-income minority women. The objective
of this qualitative study was to assess barriers to breastfeeding and reasons for combination
feeding among low-income Latina women and their families. Meetings were held with
key informants to inform the sampling plan and develop questions for focus groups. Data
were collected from eight qualitative focus groups with primiparous mothers postpartum,
mothers breastfeeding at 4 to 6 months, mothers formula feeding at 4 to 6 months, grandmothers
and fathers, and 29 individual interviews with formula- and combination-feeding
mothers. Transcripts of focus groups and interviews were content coded and analyzed for thematic
domains and then compared for concurrence and differences. Four main domains with
15 categories were identified: (a) Best of both: Mothers desire to ensure their babies get both
the healthy aspects of breast milk and "vitamins" in formula. (b) Breastfeeding can be a struggle:
Breastfeeding is natural but can be painful, embarrassing, and associated with breast
changes and diet restrictions. (c) Not in Mother's Control: Mothers want to breastfeed, but
things happen that cause them to discontinue breastfeeding. (d) Family and cultural beliefs:
Relatives give messages about supplementation for babies who are crying or not chubby. Negative
emotions are to be avoided so as to not affect mother's milk.
Those counseling Latina mothers about infant feeding should discourage and/or limit early
supplementation with formula, discuss the myth of "best of both," understand the fatalism
involved in problem-solving breastfeeding issues, and enlist the altruism embedded in the
family unit for support of the mother–infant pair.
