"Socio-Cultural Factors Influencing Breastfeeding Practices among Low-Income Women in Fortaleza, Ceará, Brazil: Using Leininger's Sunrise Model as a Tool for Sociological Field Observation"
Background: Overwhelming evidence supports the benefits associated with breastfeeding. Yet, a significant number of women in developing and developed countries either fail to breastfeed or terminate breastfeeding practice before the recommended length. Brazil is one country whose government has funded health education campaigns aimed at breastfeeding promotion; however, literature examining the effects of these interventions contains analyses mostly of southern regions of Brazil. Little is known about the breastfeeding practices in the northeastern region of the country, particularly in Fortaleza. My study was developed to understand the socio-cultural influences that determine the breastfeeding practices of low-income women in this specific region.
Methods: My research utilized Leininger's Culture Care Theory in order to identify essential factors to be observed in the chosen population. An observational data sheet was constructed and included the seven cultural factors defined in Leininger's Sunrise Model. My research team included two nursing students from Universidade Federal do Ceará (UFC.) We targeted Centro de Desenvolvimento Familiar (CEDEFAM), a clinic central to two neighborhoods included in the study, in order to identify and recruit potential subjects. All subjects were low-income women living in the favelas or poverty-stricken areas. Using the observational data sheet as a tool, we visited the homes of pregnant and breastfeeding women, observed their living conditions, and collected their demographic data. Observations included the researchers' interpretations of living conditions, surrounding physical and emotional environment, as well as the overall demeanor and verbal input of the women. Our observations were recorded on the data sheet and further evidenced by photographs taken at each household. In addition to observational efforts, we conducted literary reviews that explained current ongoing interventions in Brazil aimed at breastfeeding and past socio-cultural analysis.
Results: The factors that appeared to have the most influence on women's decisions regarding breastfeeding were kinship and social factors, and economic factors. The women who appeared most comfortable with the practice of breastfeeding were experienced mothers and also had the support of their family and friends in their decisions surrounding breastfeeding. While all women were classified as low-income, some had better living situations than others, which created less stress for the mother. Another significant factor that has been proven by past studies to be associated with breastfeeding success is education; unfortunately we did not have enough time to fully analyze and observe the educational system in Fortaleza. It is expected that the findings of both studies will help to make current interventions aimed at increasing breastfeeding initiation and duration more culturally appropriate and effective.