Breastfeeding experiences and infant feeding decisions for women birthing Aboriginal children in Adelaide, South Australia: a qualitative study

Background: Increasing breastfeeding rates among Aboriginal and Torres Strait Islander (hereafter, respectfully Aboriginal) infants could improve health outcomes that disproportionately affect Aboriginal children into adulthood. This study was undertaken with mothers birthing Aboriginal children in Adelaide, Australia. The study sought to: understand their perceptions, motivations, influences and experiences around breastfeeding; explore factors affecting the ability to breastfeed; perceptions of alternative feeding options; and experiences of care to support breastfeeding. Methods: Semi-structured Research Yarning interviews were conducted between November 2020 and May 2022 with 30 mothers who birthed an Aboriginal baby within metropolitan Adelaide, Australia, within the previous 18 months. Women were invited to participate if they were enrolled in a larger cohort study known as the Aboriginal Families and Baby Bundles Study, or had antenatal care from the local Aboriginal community controlled health service, were aged 16 and over, and were involved in feeding the child since birth. Three female Aboriginal researchers undertook the Yarning interviews, which were transcribed and analysed thematically. Results: Participants demonstrated a strong desire to breastfeed and described a range of factors impacting on their ability to establish or maintain breastfeeding. The role of healthcare providers was key to breastfeeding success with participants reporting both positive and negative care experiences. Participants described supportive experiences as those where non-judgemental care was provided that was tailored to their needs, included Aboriginal staff, and provision of continuity of care. Mothers described negative effects of their experiences of racism and ageism (young mothers) from care providers. Conclusions: Aboriginal women expressed a range of challenges to sustaining breastfeeding that could be addressed by increased investment in provision of timely, non-judgemental postnatal care tailored to their social and cultural needs, including access to specialised lactation care in the hospital and including facilitated continuation of successful breastfeeding at home.