What lies beneath? A review of the literature on breastfeeding and African-American women from qualitative research studies

Background: African-Americans have the lowest breastfeeding rates in comparison to other racial/ethnic groups in the United States. Few studies have examined breastfeeding in African-Americans using qualitative methods, which are useful for in-depth examination of phenomena, such as breastfeeding, and describing people's personal experiences. Purpose: The purpose is to review findings from qualitative studies exploring decision-making and personal experiences related to breastfeeding in African-American women. Methods: The literature search was conducted in January 2013 using the CINAHL, MEDLINE and PsycINFO databases with the key words: ‘breastfeeding', ‘qualitative or interview or focus group' and ‘African-American or Black'. Studies relating to the research purpose of examining breastfeeding decision-making and personal experiences were included. The search was limited to published research studies employing qualitative methods with a study sample comprising of only African-American women, conducted in the United States in the past 20 years. Mixed-methods studies were also included. Those studies using quantitative methods were excluded from the review, as well as theses and dissertations. Of the initial search results, four articles met the inclusion criteria. The references of these articles were reviewed for other studies that met the inclusion criteria, which yielded another five articles. Findings: Nine published studies were included in the review, with a variety of qualitative research designs. (Three of these published different results of one large ethnography). Overarching themes that emerge from the studies will be presented. Implications: Despite low breastfeeding rates nationally, African-American women are breastfeeding. However most research focuses on breastfeeding intentions or decision-making rather than highlighting lessons learned from actual breastfeeding African-American women. Collaborative research methodologies, such as positive deviance, offer a unique approach to conducting breastfeeding research in the African American population by incorporating and mobilizing community members at each step of the research process.