The purpose of this study was to explore the ways in which cascading disasters (i.e., disruptions to the environment that generate unexpected secondary events of strong impact) shape perceptions of perinatal wellbeing and breastfeeding/formula-feeding practices in south Alabama. Ethnographic research was conducted with perinatal healthcare providers (n = 10) and birth parents (n = 10) in south Alabama during the COVID-19 pandemic and in the aftermath of multiple hurricanes in 2020. Results reveal that concerns related to cascading disasters were exacerbated or eclipsed by system-level challenges that shaped breastfeeding and formula-feeding practices. Specifically, the absence of paid parental leave and community-based breastfeeding support was perceived as profoundly stressful for participants. Birth parents often had to negotiate between breastfeeding/formula-feeding decisions and their own needs. We argue that robust federal and state-level support systems are needed if birth parents and perinatal healthcare providers are to follow guidelines for breastfeeding before, during, and after cascading disasters.
Institute for Economics & Peace. Ecological Threat Report: Analysing Ecological Threats, Resilience & Peace. http://visionofhumanity.org/resources (2022, accessed 10 January 2025).
3.
CutterSL. Compound, cascading, or complex disasters: What’s in a name?Environ: Sci Policy Sustain Dev2018; 60: 16-25.
4.
ChungR. Justice and health inequalities in humanitarian crises: Structured health vulnerabilities and natural disasters. In: LenardPTStraehleC (eds) Health inequalities and global justice. Edinburgh University Press, 2012, pp.197-212. DOI:10.1515/9780748646937-014.
5.
PescaroliGAlexanderD. Critical infrastructure, panarchies and the vulnerability paths of cascading disasters. Nat Hazards2016; 82: 175-192.
6.
ThomasDSKJangSScandlynJ. The CHASMS conceptual model of cascading disasters and social vulnerability: The COVID-19 case example. Int J Disaster Risk Reduct2020; 51: 101828.
7.
SmithGSAnjumE, et al.Climate change, environmental disasters, and health inequities: The underlying role of structural inequalities. Curr Envir Health Rpt2022; 9: 80-89.
8.
HausmanEMBlackSRBrometE, et al.Reciprocal effects of maternal and child internalizing symptoms before and after a natural disaster. J Fam Psychol2020; 34: 836-845.
9.
HarvilleEWBeitschL, et al.Assessing the effects of disasters and their aftermath on pregnancy and infant outcomes: A conceptual model. Int J Disaster Risk Reduct2021; 62: 102415.
10.
ArnaoutiMKCCahillGBairdMD, et al.Medical disaster response: A critical analysis of the 2010 Haiti earthquake. Front Public Health2022; 10: 995595.
11.
DesRochesRComerioMEberhardM, et al.Overview of the 2010 Haiti earthquake. Earthquake Eng Res Inst2011; 27: S1-S21.
12.
BartelsSAFraulinG, et al.Cholera in the time of Minustah: Experiences of community members affected by cholera in Haiti. IJERPH2022; 19: 4974.
13.
DeYoungSSujiMSouthallHG. Maternal perceptions of infant feeding and health in the context of the 2015 Nepal earthquake. J Hum Lact2018; 34: 242-252.
14.
KhanalB. The impacts of the 2015 Gorkha earthquake on children’s health in Nepal. World Dev2022; 153: 105826.
15.
BrunsonJ. Maternal, newborn, and child health after the 2015 Nepal earthquakes: An investigation of the long-term gendered impacts of disasters. Matern Child Health J2017; 21: 2267-2273.
16.
HwangCHIellamoAVerversM. Barriers and challenges of infant feeding in disasters in middle-and high-income countries. Int Breastfeed J2021; 16: 62.
17.
WingateMSEpsteinAEBelloFO. Perinatal epidemiology. In: International encyclopedia of public health. Elsevier, pp. 442-448.
VictoraCGBahlRBarrosAJD, et al.Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effects. Lancet2016; 387: 475-490.
20.
SethSLewisAJGalballyM. Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: A systematic literature review. BMC Pregnancy Childbirth2016; 16: 124.
AnderssonNParedes-SolísS, et al.Breastfeeding in a complex emergency: Four linked cross-sectional studies during the Bosnian conflict. Public Health Nutr2010; 13: 2097-2104.
23.
HipgraveDBAssefaF, et al.Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java. Public Health Nutr2012; 15: 307-315.
24.
CreekTLKimALuL, et al.Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006. JAIDS2010; 53: 14-19.
25.
GribbleKDMcGrathM, et al.Supporting breastfeeding in emergencies: Protecting women’s reproductive rights and maternal and infant health. Disasters2011; 35: 720-738.
26.
Vilar-CompteMPérez-EscamillaRRuanoAL. Interventions and policy approaches to promote equity in breastfeeding. Int J Equity Health2022; 21: 63. s12939-022-01670.
27.
AugustoANevesDMHenriquesV. Breastfeeding experiences and women’s self-concept: Negotiations and dilemmas in the transition to motherhood. Front Sociol2023; 8: 1130808.
GuptaASuriS. The World Breastfeeding Trends Initiative: Has your nation done enough to bridge the GAPS? (2017, accessed 27 January 2025).
30.
AllanCCarrick-SenDMartinCR. What is perinatal well-being? A concept analysis and review of the literature. J Reprod Infant Psychol2013; 31: 381-398.
31.
SingerMBaerH. Critical Medical Anthropology. 2nd ed. New York: Routledge, 2018.
32.
LockMArgentieriMAShieldsAE. The contribution of ethnography to epigenomics research: Toward a new bio-ethnography for addressing health disparities. Epigenomics2021; 13: 1771-1786.
33.
World Meteorological Organization. WMO Atlas of Mortality and Economic Losses from Weather, Climate and Water Extremes (1970–2019). Geneva: WMO, 2021, https://library.wmo.int/idurl/4/57564.
34.
CangialosiJPBergR. National Hurricane Center Tropical Cyclone Report: Hurricane Delta (AL262020). National Hurricane Center.
Alabama Department of Public Health. Bureau of Family Health Services: Alabama maternal mortality review 2020 annual report. (2022, accessed 11 November 2024).
HoranHLockeEBradleyLJ. A community-informed maternal and infant health needs assessment in Alabama. Matern Child Health J2024; 28: 1833-1839.
43.
KnottERaoAH, et al.Interviews in the social sciences. Nat Rev Methods Primers2022; 2: 73.
44.
SanjekRSanjekR. Fieldnotes: the makings of anthropology. Ithaca: Cornell University Press, 2019.
45.
CharmazKThornbergR. The pursuit of quality in grounded theory. Qual Res Psycho2021; 18: 305-327.
46.
BinghamAJ. From data management to actionable findings: A five-phase process of qualitative data analysis. Int J Qual Methods2023: 22. DOI:10.1177/16094069231183620
47.
United States Census Bureau. Mobile County, Alabama—Census Bureau Profile. County Profile: Mobile County, Alabama, https://data.census.gov/profile/Mobile_County,_Alabama?g=050XX00US01097 (2020, accessed 29 August 2025).
48.
United States Census Bureau. Baldwin County, Alabama—Census Bureau Profile. County Profile: Baldwin County, Alabama, https://data.census.gov/profile/Baldwin_County,_Alabama?g=050XX00US01003 (2020, accessed 29 August 2025).
KerschbaumerLCrossettLHolausM, et al.COVID-19 and health inequalities: The impact of social determinants of health on individuals affected by poverty. Health Policy Technol2024; 13: 100803.
51.
RobinsonTMSinghS. Chronic Inequities: Environmental & Structural Racism during COVID-19 and Hurricane Laura Disaster Recovery, https://trace.tennessee.edu/cds/vol2/iss1/2 (accessed 29 August 2025).
52.
WhitleyMBanksA. Work as an understudied driver of racial inequities in breastfeeding. NEW SOLUTIONS: J Environ Occupa Health Policy2022; 32: 189-200.
53.
CheyneyM, et al.From policy to practice: Women’s experiences of breastfeeding-friendly worksites, part 1. Clin Lacta2019a; 10: 104-112.
54.
KhanMS. Paid family leave and children’s health outcomes in OECD countries. Child.4 Youth Serv Rev2020; 116: 105259.
55.
NiewöhnerJLockM. Situating local biologies: Anthropological perspectives on environment/human entanglements. BioSocieties2018; 13: 681-697.
56.
KnaakSJ. Contextualising risk, constructing choice: Breastfeeding and good mothering in risk society. Health Risk Soc2010; 12: 345-355.
57.
PerryMFBuiL, et al.Association between state-paid family and medical leave and breastfeeding, depression, and postpartum visits. Obstet Gynecol2023. DOI:10.1097/AOG.0000000000005428
58.
YourkavitchJHall SmithP. Women’s status, breastfeeding support, and breastfeeding practices in the United States. In: WashioY (eds) PLos ONE. 2022, 17, pp. e0275021.
Hoyt-AustinAEKairLRLarsonIA, et al.Academy of breastfeeding medicine clinical protocol #2: Guidelines for birth hospitalization discharge of breastfeeding dyads, revised 2022. Breastfeed Med2022; 17: 197-206.
61.
FlahermanVJBeilerJS, et al.Relationship of newborn weight loss to milk supply concern and anxiety: The impact on breastfeeding duration. Matern Child Nutr2016; 12: 463-472.
62.
PalmquistAEL, et al.Pandemic policies and breastfeeding: A cross-sectional study during the onset of COVID-19 in the United States. Front Sociol2022; 7: 958108.
63.
EvansEJ. The cost of a ‘beautiful bill’: Medicaid retrenchment and the moral crisis for social work. Health Soc Work2025; 50: 277-279.
64.
GaffneyAHimmelsteinDUWoolhandlerS. Projected effects of proposed cuts in federal medicaid expenditures on medicaid enrollment, uninsurance, health care, and health. Ann Intern Med2025; 178: 1334-1342.
AmissahEAKancherlaVKoY-A, et al.Validation study of maternal recall on breastfeeding duration 6 years after childbirth. J Hum Lact2017; 33: 390-400.
67.
LiRIngolTTSmithK, et al.Reliability of maternal recall of feeding at the breast and breast milk expression 6 years after delivery. Breastfeed Med2020; 15: 224-236.
68.
Van ZylZMaslinKDeanT, et al.The accuracy of dietary recall of infant feeding and food allergen data. J Human Nutrition Diet2016; 29: 777-785.
69.
NatlandSTAndersenLFNilsenTIL, et al.Maternal recall of breastfeeding duration twenty years after delivery. BMC Med Res Methodol2012; 12: 179.
