Objective To explore nativity differences and the role of attitudes, social norms, and behavioral control perceptions surrounding breastfeeding initiation and duration among middle-class African-American (AA) and African-born (AB) mothers in the US. Methods Semi-structured individual interviews were conducted with 20 middle-class AA and AB mothers in central Ohio from December 2012 to February 2013. Interview questions were developed based on the Theory of Planned Behavior (TPB). Interviews were analyzed for salient themes by TPB constructs. Differences in themes were examined by nativity status. Results All study participants had initiated breastfeeding or bottle-feeding with expressed breast milk, noting the benefits it conferred as well as the persuasive encouragement they received from others. Persistent encouragement was often cited as a factor for sustaining breastfeeding. More AA mothers had discontinued breastfeeding by the time of the interview, which was often attributed to health, lactation, and work challenges. Inconsistent support from health providers, dissuasive remarks from others, ambivalent breastfeeding attitudes, and diminished family support led some mothers to begin formula supplementation. Analysis of maternal narratives revealed nativity differences across sources of encouragement. Specifically, important sources of encouragement were health providers for AA mothers and family, friends, partners and culture for AB mothers. Only AB mothers expressed concerns about difficulty they encountered with breastfeeding due to the lack of proximal family support. Conclusions Findings reveal that both groups of mothers may be susceptible to unsupportive breastfeeding norms in the US and also highlight the need for intervention in health care settings and workplaces to improve AA women's breastfeeding rates.
Keywords: African American mothers; African-born mothers; Breastfeeding; Health disparities; Immigrant health; Theory of Planned Behavior.