The Influence of Sociocultural Perceptions in Breastfeeding Practices Among African American Women

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Olowoyo, Emily Ike Okpala, Perseverance N Moyo, Ayooluwa G Olowoyo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8756913/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Breastfeeding offers critical health benefits for infants and mothers, yet significant disparities persist among African American women in the United States, who exhibit the lowest initiation rates (74.5%) compared to other racial groups. This systematic review, adhering to PRISMA 2020 guidelines, examines sociocultural factors influencing breastfeeding practices within this population. Nine peer-reviewed studies (2019–2024) from PubMed, SCOPUS, and Google Scholar were analyzed, focusing on cultural norms, barriers, and facilitators. Key findings reveal that breastfeeding behaviors are shaped by social support networks (family, community), cultural perceptions (historical legacies of systemic racism, sexualization of breasts), and structural barriers (economic constraints, limited workplace accommodations). Healthcare provider engagement and access to resources, such as lactation support, emerged as pivotal yet inconsistent influences. While community normalization of breastfeeding and ethnic pride were motivators, misconceptions about dependency and inadequate postpartum support hindered sustained practices. The review underscores the necessity for culturally sensitive interventions addressing systemic inequities, enhancing healthcare collaboration with community organizations, and implementing policies supporting maternity leave and lactation accessibility. Multifaceted strategies integrating education, economic support, and dismantling cultural stigmas are essential to reducing disparities and promoting equitable breastfeeding outcomes. By centering African American women’s sociocultural contexts, public health initiatives can foster environments that empower maternal-infant health through sustained breastfeeding practices. Figures Figure 1 1. Introduction 1.1 Background and Significance Breastfeeding is a well-known and widely accepted practice for infant nutrition that offers numerous physical and emotional benefits for both mother and child [1]. It is crucial in reducing infant mortality [2] and contributes significantly to an infant's healthy development and growth. Additionally, studies have shown that breastfeeding serves as a protective factor against childhood obesity, as well as gastrointestinal and respiratory infections [1, 3]. Breastmilk is the ideal food for infants, providing all the necessary nutrients in the right proportions [4]. Breastfeeding also promotes a strong emotional bond between mother and child, which can have long-term positive effects on the child's emotional and psychological development [5]. Moreover, breastfeeding has been linked to better cognitive development and higher intelligence scores in children [5]. For mothers, breastfeeding can reduce the risk of certain cancers, such as breast and ovarian cancer, and may help with postpartum weight loss [1]. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life; exclusive breastfeeding will help both mother and child achieve the benefits explored earlier in this article. Continued breastfeeding and appropriate complementary foods up to two years of age or beyond ensure that infants receive the necessary nutrition to meet their evolving needs and maintain their health [6,7]. However, significant disparities in breastfeeding initiation and continuation exist across racial and ethnic groups in the United States, with African American women being disproportionately affected [8]. In a recent study, it was found that breastfeeding initiation rates in the United States vary significantly by race and ethnicity. African American women had the lowest initiation rate at 74.5%, compared to higher rates among other groups, such as Asian mothers at 90.1% [8]. For African American women, breastfeeding practices are often shaped by deep-rooted cultural perceptions, including generational attitudes, community norms, and the legacy of systemic inequities in healthcare [9, 10]. Understanding these cultural influences is critical to developing effective interventions that promote breastfeeding within this population. 1.2 The Research Problem Over the years, significant efforts have been made to understand breastfeeding practices among African Americans. Although these efforts have led to some progress, with data indicating a steady increase in initiation rates from 2019 to 2021, African American women still have the lowest initiation rates [4, 11]. This increase, while noteworthy, remains minimal. Cultural beliefs, historical contexts, and societal norms significantly influence breastfeeding behaviors, yet these factors remain underexplored, especially among marginalized populations. Understanding these cultural dynamics is important for addressing disparities and developing tailored interventions. Therefore, more work is needed from healthcare researchers to bridge this gap in understanding within the African American community, so there can be effective implementation of health programs, strategies, and policies is essential to address this issue. 1.3 The Purpose of the Review The purpose of this review is to examine the sociocultural facilitators/perceptions that influence breastfeeding practices among African American women. By shedding light on findings from existing literature, this study aims to highlight the unique sociocultural factors that shape breastfeeding behaviors within this population. The findings will contribute to informing culturally sensitive public health strategies and interventions that address breastfeeding disparities in African American communities. 2. Methods This review was conducted using the 2020 PRISMA guidelines [ 12 ]. The checklist provided was reviewed by the researchers and utilized to create an accurate systematic review. As this study constitutes a systematic review of existing literature, it did not involve direct interaction with human participants or primary data collection. Therefore, Institutional Review Board (IRB) approval was not required. All articles included in this review were peer-reviewed and publicly available, ensuring adherence to ethical research standards. PubMed, SCOPUS, and Google Scholar were used for the article search. Articles were first filtered by date, including only those published from 2019 to 2024. The reviewers conducted an in-depth search using Boolean operators and combinations of “OR” and “AND” with the following keywords: ((black) OR (African American)) AND (perceptions on breastfeeding) / (cultural/social norms breastfeeding) / (beliefs breastfeeding), “perceptions" OR "beliefs" OR "knowledge" AND “breastfeeding,” “cultural/social perceptions” AND “breastfeeding.” The selection process of the articles was further refined using inclusion and exclusion criteria established by the reviewers. 2.1. Inclusion Criteria 2.1.1. Geographical Location - United States 2.1.2. Racial Group – Black or African American 2.1.3. Articles published in the English language. 2.1.4. Articles published in the last 5 years. 2.1.5. Peer-reviewed articles 2.1.6. Articles that had participants who were mothers who breastfed. 2.1.7. Articles that explored the cultural beliefs of fathers in the African American community. 2.1.8. Studies that explored cultural attitudes, beliefs, and perceptions related to breastfeeding. 2.2. Exclusion criteria 2.2.1. Articles not written in English. 2.2.2. Meta-analysis, Systematic Review, and Scoping Review of previous studies. 2.2.3. Articles with no/closed access. Initially, a total of 1,075 articles were retrieved from all data sources used: 71 from PubMed, four from SCOPUS, and 1,000 from Google Scholar. These articles were screened, and after applying the inclusion criteria, 17 full-text articles were selected after the screening process and assessed for eligibility: 9 from PubMed, 3 from SCOPUS, and 5 from Google Scholar. 9 full-text articles were finally selected for this review. The articles were divided among the reviewers for accurate and effective screening and selection. Articles that a reviewer could not decide on were discussed as a group. Group discussions and consensus among the researchers were done to ensure that bias was avoided. 3. Results Figure 1 is a flow diagram showing the PRISMA methodology in selecting the final nine studies reviewed in this article. [13] Table 1 reflects the common themes noted on the influence of breastfeeding practices on African American women across the nine studies reviewed. Villalobos et al. [14] conducted a study to understand the gap in breastfeeding duration and exclusivity between African American mothers and their white counterparts, despite the overall rise in initiation rates. The researchers used Chung and Rimal’s revision of normative influences to understand different social norms (descriptive, injunctive, and subjective) and their connection to breastfeeding norms. The study had five focus groups with 30 African American mothers who had given birth between 2016 and 2019. Their findings indicated that immediate family (especially mothers and aunts), close friends, and the community had a significant influence on their decisions to breastfeed. The perception that breastfeeding was gradually being normalized in Black communities also encouraged these mothers to breastfeed, with variations in perceptions based on socioeconomic backgrounds; mothers of higher socioeconomic status (SES) reported more favorable views on breastfeeding based on community practices. Recent initiatives aimed at supporting breastfeeding, particularly through programs like Women, Infants, and Children (WIC), were acknowledged as factors that could positively influence perceptions among lower SES groups. The researchers concluded that the identity of being a mother was central to the participants' breastfeeding choices. Ethnic pride emerged as a recurring theme, with some mothers viewing breastfeeding as a means to combat health inequities affecting their communities. Deubel et al. [15] focused on perceptions and practices of infant feeding among low-income African American women and analyzed attitudes towards breastfeeding education and support received via the Baby-Friendly Hospital Initiative (BFHI) alongside factors influencing breastfeeding decisions. The study utilized qualitative interviews with 20 African American women receiving care at a low-income clinic. Participants were over 18 years old and less than 3 months postpartum. Interviews explored predisposing, enabling, and service-related factors affecting breastfeeding choices. The participants identified several predisposing factors regarding breastfeeding, including cultural beliefs that breastfeeding may spoil infants or foster dependency, as well as perceptions that infants showed a preference for formula over breast milk. The lack of breastfeeding role models further contributed to their hesitancy to initiate breastfeeding. Enabling factors included structural constraints, such as economic pressures that forced women to return to work quickly, impacting their breastfeeding ability. Additionally, the accessibility of resources was limited, particularly due to the unaffordability of electric breast pumps, with 95% of women planning to return to work shortly after childbirth. Furthermore, only one participant reported having paid maternity leave, which severely restricted breastfeeding opportunities. On the service-related front, participants expressed high satisfaction with the prenatal education provided by the clinic, highlighting its positive impact on their breastfeeding attitudes. At the same time, those who utilized doulas in the postpartum period reported greater breastfeeding success due to the extra support received. McClain [16] investigated prenatal breastfeeding intentions and perceptions among pregnant African American women eligible for Head Start. It specifically aimed to understand these women's attitudes, beliefs, and perceived barriers regarding breastfeeding. Grounded in Social Cognitive Theory (SCT), the research emphasized how personal, environmental, and behavioral factors influenced health behaviors, particularly focusing on self-efficacy and perceived behavioral control. Utilizing a qualitative design, the study involved focus group discussions with 13 pregnant women, where data were gathered through audio recordings and analyzed for themes related to breastfeeding. Key findings revealed three major themes: participants recognized breastfeeding as the best feeding option due to its nutritional benefits, identified significant barriers, including negative past experiences and societal pressures, and expressed intentions to begin breastfeeding immediately postpartum with plans to continue for an extended duration. Subthemes indicated that encouragement from family and peers played a significant role, while barriers such as fears about milk supply, embarrassment, and pain were also highlighted. Schindler-Ruwisch et al. [17] aimed to explore determinants of breastfeeding initiation and duration using social cognitive theory and social support frameworks in their study. The study involved 24 African American women who were recent WIC recipients. The study identified several barriers to breastfeeding that were influenced by community perceptions and norms. Interpersonal barriers emerged from limited support from healthcare providers, which impacted mothers' experiences. At an individual level, physical issues such as pain, latching difficulties, and concerns about milk supply also hindered breastfeeding efforts. Support from family and friends played a crucial role in helping mothers navigate breastfeeding challenges. While some mothers received support from loved ones, the assistance from healthcare providers remained insufficient, revealing a gap that needed to be addressed. Many respondents were aware of the breastfeeding resources provided by WIC, yet overall utilization was low. It was suggested that enhanced outreach and follow-up from WIC could lead to improved breastfeeding rates and duration among African American mothers. The study highlighted how women's breastfeeding intentions and practices were often swayed by community opinions, alongside their recognition of the health benefits of breastfeeding for both infants and mothers. Participants faced common obstacles, including pain, latching problems, and concerns about milk supply, that hindered their ability to continue breastfeeding, underlining the importance of emotional and informational support, which could significantly enhance their confidence and success in breastfeeding. Tran et al. [18] conducted a study that aimed to identify the perceived barriers and facilitators to exclusive breastfeeding among back mothers for at least three months. Six focus groups were conducted, including mothers who had successfully breastfed exclusively for three months and those who had not. Researchers utilized a modified Barrier Analysis approach guided by the Socioecological Model. Several barriers were identified in the study. Lactation support and supplies were often inaccessible, making it difficult for mothers to obtain timely and quality assistance, which significantly impacted their breastfeeding success. The cultural stigma surrounding the sexualization of breasts created discomfort and discouraged mothers from breastfeeding in public. Many participants were unaware of workplace policies that were breastfeeding-friendly, such as maternity leave and designated lactation spaces, which restricted their ability to continue breastfeeding after returning to work. Additionally, socioeconomic factors, including structural racism and discrimination, heightened stress levels, and obstructed breastfeeding efforts, leading to adverse health outcomes. Conversely, facilitators included strong support networks, prior knowledge of breastfeeding benefits, and financial incentives perceived by mothers as motivating factors. The findings illustrated that sociocultural norms significantly influenced breastfeeding choices, with formula feeding often viewed as the default in certain communities, emphasizing the need for cultural change. Hinson et al. [19] interviewed subject matter experts (SMEs) across various professional disciplines to gather insights on the barriers and facilitators of breastfeeding initiation amongst African American women. The SMEs highlighted the importance of understanding community perspectives in crafting effective breastfeeding promotion strategies. The themes that emerged included the recognition of breastfeeding's health benefits and the influences of historical factors, particularly the legacy of slavery and systemic racism, which shaped beliefs surrounding breastfeeding in the African American community. Additionally, the sexualization of breastfeeding was acknowledged. Social influences, such as support from family, partners, and religious communities, were found to significantly impact a mother's breastfeeding choices, alongside the crucial role of healthcare providers. Barriers identified included competing priorities like work and school obligations, childcare issues, public exposure discomfort, limited exposure and education about breastfeeding practices within the African American community, and restricted access to resources, particularly affecting low-income mothers. On the other hand, facilitators included supportive partners, previous positive experiences with breastfeeding, peer support networks, and institutional backing from initiatives like Baby-Friendly Hospitals. However, issues of equity and care quality were noted. Gyamfi et al. [20] conducted a study to investigate breastfeeding attitudes and subjective norms among African American Christians in New England and examine the influence of faith communities on breastfeeding practices. An online survey involved 101 participants from four Christian churches, aged 18-44 and primarily Catholic. The findings showed a high willingness to support six months of exclusive breastfeeding. They revealed two main attitudes: breastfeeding was seen as both beneficial and natural, and that community support was essential. The participants perceived breastfeeding as essential for infant health, maternal bonding, and overall family benefits. They also stated that emotional and practical support from community members, especially during church gatherings, was important. The thematic analysis highlighted the perceived biblical endorsement of breastfeeding and the importance of church leaders in promoting these practices while acknowledging gaps in awareness regarding scriptural references. The study suggested that healthcare providers should engage with churches to support breastfeeding initiatives and develop educational programs, emphasizing the importance of involving male partners and clergy in fostering a supportive environment for new mothers. Shipp et al. [21] investigated the factors influencing breastfeeding outcomes among African American women since they experienced notably lower rates of initiation and continuation compared to other racial groups in the United States. Thirteen women were selected to participate in this semi-structured qualitative interview, and the analysis was thematic. The findings were split into two sections: challenges faced and the facilitators for success. Many participants reported a loss of confidence in their ability to breastfeed due to various issues, such as milk supply and work-related constraints. Specific breastfeeding challenges, including latching problems and discomfort with public breastfeeding, led to discouragement and, in some cases, the decision to discontinue breastfeeding. On the opposite side, participants discussed how understanding the health advantages of breastfeeding reinforced their commitment. They also stated that they gained confidence as positive outcomes and health milestones were noticed in their infants. Emotional and informational support from partners, family, and community resources was noted as a significant contributor to sustaining breastfeeding efforts. Jefferson et al. [22] studied the decision-making processes of African American mothers who discontinued breastfeeding and switched to formula feeding. The study employed Bandura’s social cognitive theory to analyze how personal, behavioral, and environmental factors influenced breastfeeding decisions among African American mothers. A secondary analysis of qualitative interviews with 30 mothers aged 18 and above who had infants aged 1 to 6 months was conducted to identify barriers and support systems associated with breastfeeding. Through thematic analysis, four key themes emerged regarding the mothers' experiences that led to transitioning from breastfeeding to formula feeding. Many mothers viewed formula feeding as simpler and more convenient, with lifestyle factors such as returning to work and societal perceptions affecting their choices. Additionally, mothers experienced diverse levels of support from family and friends, where some promoted breastfeeding while others favored formula feeding, demonstrating the crucial role of emotional backing from partners. Participants also believed that early breastfeeding was sufficient for infant health, despite physical challenges discouraging ongoing breastfeeding efforts. Finally, although mothers received some initial support from healthcare providers, they faced a lack of ongoing resources, compounded by economic and transportation barriers, which diminished their ability to maintain breastfeeding and increased reliance on programs like WIC for formula assistance. 3.1. Themes The reviewed articles shared many common factors that contributed to low breastfeeding rates amongst African Americans. Themes Key Findings Example Studies Social Support Networks Family, partners, and community members significantly influence initiation and continuation. Lack of role models or conflicting advice discourages mothers. Villalobos et al. [14], Shipp et al. [20] Cultural Beliefs & Historical Context Historical trauma (e.g., slavery, systemic racism) and stigma (e.g., sexualization of breasts) shape perceptions. Formula feeding was often viewed as a "default." Hinson et al. [19], Tran et al. [18] Economic & Structural Barriers Workplace constraints (e.g., no paid leave), unaffordable lactation supplies, and systemic inequities disproportionately affect low-income mothers. Deubel et al. [15], Jefferson et al. [21] Healthcare System Engagement Prenatal education improves intentions, but inconsistent postpartum support reduces confidence. Distrust in providers due to racial bias impacts adherence. Schindler-Ruwisch et al. [17], McClain [16] Community Normalization & Ethnic Pride Breastfeeding normalization in communities increases confidence. Ethnic pride motivates breastfeeding as resistance to inequities. Gyamfi et al. [20], Villalobos et al. [14] Table 1: Common Themes Influencing Breastfeeding Practices Among African American Women 4. Discussion ​The studies highlighted several interconnected themes that significantly influenced breastfeeding practices among African American women.​ Social support emerged as a dominant factor, with the presence of family, friends, and community networks being identified as crucial in shaping mothers' breastfeeding decisions. This support was not just emotional but also included informational guidance, which helped mothers navigate the challenges associated with breastfeeding. Also, community perception played a considerable role in normalizing breastfeeding within African American communities, suggesting that collective attitudes could positively influence individual behaviors. Cultural beliefs also profoundly impacted breastfeeding practices, where historical contexts and prevailing norms significantly shaped mothers' attitudes. The legacy of slavery and systemic racism continued to influence perceptions, underscoring the need for culturally sensitive approaches that acknowledged and addressed these historical factors. Additionally, misconceptions such as breastfeeding fostering dependency further deterred initiation and continuation, indicating a pressing need for educational interventions to change these beliefs. Economic barriers, particularly those related to returning to work and accessing resources, posed significant challenges to breastfeeding. Many mothers faced structural constraints that hindered their ability to establish and maintain breastfeeding routines, emphasizing the need for improved support systems, such as better maternity leave policies and access to breastfeeding equipment like pumps. It was evident that socioeconomic status greatly influenced breastfeeding views and practices, denoting a gap that required bridging to achieve more equitable breastfeeding outcomes. Healthcare providers played an influential role in promoting breastfeeding practices. While parental education during prenatal care was beneficial, continuous support post-delivery was often lacking. This gap represented an opportunity for healthcare systems to enhance their involvement and ensure consistent information and assistance throughout the breastfeeding journey. Integrating healthcare services with community organizations could create a more supportive environment, empowering mothers to sustain breastfeeding efforts longer. Despite how in-depth the studies were, one significant limitation noted was the small sample sizes, which were often used in the studies that utilized qualitative research; this can lead to a possible inaccurate reflection of the broader population's views, leading to issues concerning the generalizability of the findings. 5. Conclusion This literature review emphasizes the multifaceted influences on breastfeeding practices among African American mothers, revealing critical areas for intervention. ​Social support, economic considerations, and cultural beliefs are pivotal in shaping breastfeeding experiences, stressing the importance of a holistic approach to improve rates and durations of breastfeeding in these communities.​ By fostering environments of encouragement and understanding, challenging cultural misconceptions, alleviating economic constraints, and enhancing healthcare accessibility, interventions can lead to improved maternal and infant health outcomes. Ultimately, culturally relevant strategies are essential to empowering mothers and promoting a supportive breastfeeding culture within African American communities. Declarations Availability of Data and Materials Consent to participate Not applicable Consent to publish Not applicable. This study does not contain any individual person’s data in any form. Ethics statement As this review utilized publicly available data from previously published studies, no ethical approval was required. Clinical Trial Number Not applicable Funding Declaration The authors declare that this research received no funding Declaration of Interest Statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethical Accordance This narrative review is based entirely on a wealth of existing, publicly available research, meaning that no new primary data or direct human involvement was collected. Consequently, official ethical approval was not required. Nonetheless, we approached this synthesis with a strong commitment to academic integrity, carefully adhering to the confidentiality guidelines and ethical considerations established by the original researchers. Although our study is fundamentally secondary, it aims to honor their contributions while maintaining a steadfast dedication to ethical scholarship. References Couto GR, Dias V, Oliveira IDJ. Benefits of exclusive breastfeeding: An integrative review. Nurs Pract Today. 2020. https://doi.org/10.18502/npt.v7i4.4034 . Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. https://doi.org/10.1016/S0140-6736(15)01024-7 . Frank NM, Lynch KF, Uusitalo U, Yang J, Lönnrot M, Virtanen SM, Hyöty H, Norris JM. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr. 2019;19(1). https://doi.org/10.1186/s12887-019-1693-2 . Muro-Valdez JC, Meza-Rios A, Aguilar-Uscanga BR, Lopez-Roa RI, Medina-Díaz E, Franco-Torres EM, Zepeda-Morales AS. Breastfeeding-Related Health Benefits in Children and Mothers: Vital Organs Perspective. Medicina. 2023;59(9):1535. https://doi.org/10.3390/medicina59091535 . American Academy of Pediatrics. Breastfeeding, Physical Growth, and Cognitive Development. Pediatrics. 2021;147(5):e2020008029. https://doi.org/10.1542/peds.2020-008029 . Kramer MS, Kakuma R. (2009). Optimal duration of exclusive breastfeeding. The Cochrane Database of Systematic Reviews, 2009(4), CD003517. https://doi.org/10.1002/14651858.CD003517.pub2 Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec,J., … Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms,and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7. Marks KJ. Disaggregation of breastfeeding initiation rates by race and ethnicity—United states, 2020–2021. Prev Chronic Dis. 2023;20. https://doi.org/10.5888/pcd20.230199 . Petit M, Smart DA, Sattler V, Wood NK. Examination of factors that contribute to breastfeeding disparities and inequities for black women in the us. J Nutr Educ Behav. 2021;53(11):977–86. https://doi.org/10.1016/j.jneb.2021.08.013 . Gyamfi A, O’Neill B, Henderson WA, Lucas R. Black/african american breastfeeding experience: Cultural, sociological, and health dimensions through an equity lens. Breastfeed Med. 2021;16(2):103–11. https://doi.org/10.1089/bfm.2020.0312 . Chiang KV. (2021). Racial and ethnic disparities in breastfeeding initiation united states, 2019. MMWR. Morbidity and Mortality Weekly Report, 70. https://doi.org/10.15585/mmwr.mm7021a1 Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D.,Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J.,Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson,E., McDonald, S., … McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration:Updated guidance and exemplars for reporting systematic reviews. BMJ, n160. https://doi.org/10.1136/bmj.n160. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230 Villalobos AVK, Davis C, Turner MM, Long S, Hull S, Lapinski MK. Breastfeeding in context: African american women’s normative referents, salient identities, and perceived social norms. Health Educ Behav. 2021;48(4):496–506. https://doi.org/10.1177/10901981211014445 . Deubel TF, Miller EM, Hernandez I, Boyer M, Louis-Jacques A. Perceptions and practices of infant feeding among african american women. Ecol Food Nutr. 2019;58(4):301–16. https://doi.org/10.1080/03670244.2019.1598977 . McClain JS. (2019). Pregnant African American Women Breastfeeding Intentions, Beliefs Attitudes and Perspectives (Order No. 13426812). Available from ProQuest Central; ProQuest Dissertations & Theses Global. (2205584401). https://go.openathens.net/redirector/liberty.edu?url=https://www.proquest.com/dissertations-theses/pregnant-african-american-women-breastfeeding/docview/2205584401/se-2 Schindler-Ruwisch J, Roess A, Robert RC, Napolitano M, Woody E, Thompson P, Ilakkuvan V. Determinants of breastfeeding initiation and duration among african american dc wic recipients: Perspectives of recent mothers. Women’s Health Issues. 2019;29(6):513–21. https://doi.org/10.1016/j.whi.2019.07.003 . Tran V, Reese Masterson A, Frieson T, Douglass F, Pérez-Escamilla R, O’Connor Duffany K. Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach. Matern Child Nutr. 2023;19(1):e13428. https://doi.org/10.1111/mcn.13428 . Hinson TD, Skinner AC, Spatz DL. Subject matter experts identify health equity concerns in breastfeeding for african american women. J Perinat Neonatal Nurs. 2021;35(2):160–8. https://doi.org/10.1097/JPN.0000000000000486 . Gyamfi A, Jefferson UT, O’Neill B, Lucas R, Spatz DL, Henderson WA. Breastfeeding attitudes and social support among christian african americans. Breastfeed Med. 2024;19(5):333–9. https://doi.org/10.1089/bfm.2023.0277 . Shipp GM, Weatherspoon LJ, Norman GS, Alexander GL, Kelleher D, Kerver JM. Understanding factors influencing breastfeeding outcomes in a sample of african american women. Matern Child Health J. 2022;26(4):853–62. https://doi.org/10.1007/s10995-021-03261-w . Jefferson UT, Reed AE, Rabbitte M. African american mothers’ decision to discontinue breastfeeding and switch to formula. West J Nurs Res. 2022;44(1):15–22. https://doi.org/10.1177/01939459211041164 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8756913","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":606414609,"identity":"d9872d2c-0c5b-4595-b22a-2a2073d86c87","order_by":0,"name":"Sharon A. Olowoyo","email":"","orcid":"","institution":"Liberty University","correspondingAuthor":false,"prefix":"","firstName":"Sharon","middleName":"A.","lastName":"Olowoyo","suffix":""},{"id":606414610,"identity":"c3efda22-d892-4b48-9f78-27cd27bc8c8d","order_by":1,"name":"Emily Ike Okpala","email":"","orcid":"","institution":"Liberty University","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"Ike","lastName":"Okpala","suffix":""},{"id":606414611,"identity":"bd69ac9d-cc9a-4c3c-95f7-97ad282688b5","order_by":2,"name":"Perseverance N Moyo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYPACGxk2CRj7AHFa0njAWg6QoOUwDwPRWsyluxMf81Sc5+GTbj72+WMbgxzfjQT8WiznnN1szHPmNg+bzLHkGQfbGIwlCWkxuJG7TZq3DahFIseYAaglcQORWs4BteR/BmmpJ1bLAZAtzCAtCQYE/TIjd7PhnDPJIL8YM5w5J2E488wD/FrMJXI3PnhTYScnP7v5MUNFmY0833FCDgNiJh4YjxGRBvBrYfwB5/4hrGMUjIJRMApGHgAAvfFD+4CjmpYAAAAASUVORK5CYII=","orcid":"","institution":"Liberty University","correspondingAuthor":true,"prefix":"","firstName":"Perseverance","middleName":"N","lastName":"Moyo","suffix":""},{"id":606414612,"identity":"c2cc71e7-d408-457c-9e07-8dd457f43529","order_by":3,"name":"Ayooluwa G Olowoyo","email":"","orcid":"","institution":"Liberty University","correspondingAuthor":false,"prefix":"","firstName":"Ayooluwa","middleName":"G","lastName":"Olowoyo","suffix":""},{"id":606414613,"identity":"410c6204-2f2a-45e9-967a-b75418947604","order_by":4,"name":"Oluwatosin M. Oduneye","email":"","orcid":"","institution":"Liberty University","correspondingAuthor":false,"prefix":"","firstName":"Oluwatosin","middleName":"M.","lastName":"Oduneye","suffix":""},{"id":606414614,"identity":"812a38e5-fbaa-4c73-b300-9be8d69eb924","order_by":5,"name":"Oyebolu A Akinkugbe","email":"","orcid":"","institution":"Liberty University","correspondingAuthor":false,"prefix":"","firstName":"Oyebolu","middleName":"A","lastName":"Akinkugbe","suffix":""}],"badges":[],"createdAt":"2026-02-01 14:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8756913/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8756913/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104708050,"identity":"ef583798-6e75-424a-b7e3-5e8e0b0ea288","added_by":"auto","created_at":"2026-03-16 09:45:13","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62546,"visible":true,"origin":"","legend":"\u003cp\u003eSystematic literature review using PRISMA methodology. [13]\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8756913/v1/39ddea8e086a27c0509c7ab8.jpeg"},{"id":105562603,"identity":"61f01233-43b6-47a6-ba43-37b0e1fba99f","added_by":"auto","created_at":"2026-03-27 12:43:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":836990,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8756913/v1/da9d5688-3fce-4ff1-bca3-d9665fcffd63.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Influence of Sociocultural Perceptions in Breastfeeding Practices Among African American Women","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e1.1\u0026nbsp;Background and Significance\u003c/p\u003e\n\u003cp\u003eBreastfeeding is a well-known and widely accepted practice for infant nutrition that offers numerous physical and emotional benefits for both mother and child [1]. It is crucial in reducing infant mortality [2] and contributes significantly to an infant\u0026apos;s healthy development and growth. Additionally, studies have shown that breastfeeding serves as a protective factor against childhood obesity, as well as gastrointestinal and respiratory infections [1, 3]. Breastmilk is the ideal food for infants, providing all the necessary nutrients in the right proportions [4]. Breastfeeding also promotes a strong emotional bond between mother and child, which can have long-term positive effects on the child\u0026apos;s emotional and psychological development [5]. Moreover, breastfeeding has been linked to better cognitive development and higher intelligence scores in children [5]. For mothers, breastfeeding can reduce the risk of certain cancers, such as breast and ovarian cancer, and may help with postpartum weight loss [1]. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life; exclusive breastfeeding will help both mother and child achieve the benefits explored earlier in this article. Continued breastfeeding and appropriate complementary foods up to two years of age or beyond ensure that infants receive the necessary nutrition to meet their evolving needs and maintain their health [6,7].\u003c/p\u003e\n\u003cp\u003eHowever, significant disparities in breastfeeding initiation and continuation exist across racial and ethnic groups in the United States, with African American women being disproportionately affected [8]. In a recent study, it was found that breastfeeding initiation rates in the United States vary significantly by race and ethnicity. African American women had the lowest initiation rate at 74.5%, compared to higher rates among other groups, such as Asian mothers at 90.1% [8]. For African American women, breastfeeding practices are often shaped by deep-rooted cultural perceptions, including generational attitudes, community norms, and the legacy of systemic inequities in healthcare [9, 10]. Understanding these cultural influences is critical to developing effective interventions that promote breastfeeding within this population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.2\u0026nbsp;The Research Problem\u003c/p\u003e\n\u003cp\u003eOver the years, significant efforts have been made to understand breastfeeding practices among African Americans. Although these efforts have led to some progress, with data indicating a steady increase in initiation rates from 2019 to 2021, African American women still have the lowest initiation rates [4, 11]. This increase, while noteworthy, remains minimal. Cultural beliefs, historical contexts, and societal norms significantly influence breastfeeding behaviors, yet these factors remain underexplored, especially among marginalized populations. Understanding these cultural dynamics is important for addressing disparities and developing tailored interventions. Therefore, more work is needed from healthcare researchers to bridge this gap in understanding within the African American community, so there can be effective implementation of health programs, strategies, and policies is essential to address this issue.\u003c/p\u003e\n\u003cp\u003e1.3\u0026nbsp;The Purpose of the Review\u003c/p\u003e\n\u003cp\u003eThe purpose of this review is to examine the sociocultural facilitators/perceptions that influence breastfeeding practices among African American women. By shedding light on findings from existing literature, this study aims to highlight the unique sociocultural factors that shape breastfeeding behaviors within this population. The findings will contribute to informing culturally sensitive public health strategies and interventions that address breastfeeding disparities in African American communities.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThis review was conducted using the 2020 PRISMA guidelines [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. The checklist provided was reviewed by the researchers and utilized to create an accurate systematic review. As this study constitutes a systematic review of existing literature, it did not involve direct interaction with human participants or primary data collection. Therefore, Institutional Review Board (IRB) approval was not required. All articles included in this review were peer-reviewed and publicly available, ensuring adherence to ethical research standards.\u003c/p\u003e\n \u003cp\u003ePubMed, SCOPUS, and Google Scholar were used for the article search. Articles were first filtered by date, including only those published from 2019 to 2024. The reviewers conducted an in-depth search using Boolean operators and combinations of \u0026ldquo;OR\u0026rdquo; and \u0026ldquo;AND\u0026rdquo; with the following keywords: ((black) OR (African American)) AND (perceptions on breastfeeding) / (cultural/social norms breastfeeding) / (beliefs breastfeeding), \u0026ldquo;perceptions\u0026quot; OR \u0026quot;beliefs\u0026quot; OR \u0026quot;knowledge\u0026quot; AND \u0026ldquo;breastfeeding,\u0026rdquo; \u0026ldquo;cultural/social perceptions\u0026rdquo; AND \u0026ldquo;breastfeeding.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eThe selection process of the articles was further refined using inclusion and exclusion criteria established by the reviewers.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Inclusion Criteria\u003c/h2\u003e\n \u003cdiv id=\"Sec3\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.1. Geographical Location - United States\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.2. Racial Group \u0026ndash; Black or African American\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.3. Articles published in the English language.\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.4. Articles published in the last 5 years.\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.5. Peer-reviewed articles\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.6. Articles that had participants who were mothers who breastfed.\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.7. Articles that explored the cultural beliefs of fathers in the African American community.\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e2.1.8. Studies that explored cultural attitudes, beliefs, and perceptions related to breastfeeding.\u003c/h2\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Exclusion criteria\u003c/h2\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.1. Articles not written in English.\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.2. Meta-analysis, Systematic Review, and Scoping Review of previous studies.\u003c/h2\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.3. Articles with no/closed access.\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eInitially, a total of 1,075 articles were retrieved from all data sources used: 71 from PubMed, four from SCOPUS, and 1,000 from Google Scholar. These articles were screened, and after applying the inclusion criteria, 17 full-text articles were selected after the screening process and assessed for eligibility: 9 from PubMed, 3 from SCOPUS, and 5 from Google Scholar. 9 full-text articles were finally selected for this review. The articles were divided among the reviewers for accurate and effective screening and selection. Articles that a reviewer could not decide on were discussed as a group. Group discussions and consensus among the researchers were done to ensure that bias was avoided.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e is a flow diagram showing the PRISMA methodology in selecting the final nine studies reviewed in this article. [13] \u003cstrong\u003eTable 1\u003c/strong\u003e reflects the common themes noted on the influence of breastfeeding practices on African American women across the nine studies reviewed.\u003c/p\u003e\n\u003cp\u003eVillalobos et al. [14] conducted a study to understand the gap in breastfeeding duration and exclusivity between African American mothers and their white counterparts, despite the overall rise in initiation rates. The researchers used Chung and Rimal\u0026rsquo;s revision of normative influences to understand different social norms (descriptive, injunctive, and subjective) and their connection to breastfeeding norms. The study had five focus groups with 30 African American mothers who had given birth between 2016 and 2019. Their findings indicated that immediate family (especially mothers and aunts), close friends, and the community had a significant influence on their decisions to breastfeed. The perception that breastfeeding was gradually being normalized in Black communities also encouraged these mothers to breastfeed, with variations in perceptions based on socioeconomic backgrounds; mothers of higher socioeconomic status (SES) reported more favorable views on breastfeeding based on community practices.\u003c/p\u003e\n\u003cp\u003eRecent initiatives aimed at supporting breastfeeding, particularly through programs like Women, Infants, and Children (WIC), were acknowledged as factors that could positively influence perceptions among lower SES groups. The researchers concluded that the identity of being a mother was central to the participants\u0026apos; breastfeeding choices. Ethnic pride emerged as a recurring theme, with some mothers viewing breastfeeding as a means to combat health inequities affecting their communities.\u003c/p\u003e\n\u003cp\u003eDeubel et al. [15] focused on perceptions and practices of infant feeding among low-income African American women and analyzed attitudes towards breastfeeding education and support received via the Baby-Friendly Hospital Initiative (BFHI) alongside factors influencing breastfeeding decisions. The study utilized qualitative interviews with 20 African American women receiving care at a low-income clinic. Participants were over 18 years old and less than 3 months postpartum. Interviews explored predisposing, enabling, and service-related factors affecting breastfeeding choices. The participants identified several predisposing factors regarding breastfeeding, including cultural beliefs that breastfeeding may spoil infants or foster dependency, as well as perceptions that infants showed a preference for formula over breast milk. The lack of breastfeeding role models further contributed to their hesitancy to initiate breastfeeding. Enabling factors included structural constraints, such as economic pressures that forced women to return to work quickly, impacting their breastfeeding ability. Additionally, the accessibility of resources was limited, particularly due to the unaffordability of electric breast pumps, with 95% of women planning to return to work shortly after childbirth. Furthermore, only one participant reported having paid maternity leave, which severely restricted breastfeeding opportunities. On the service-related front, participants expressed high satisfaction with the prenatal education provided by the clinic, highlighting its positive impact on their breastfeeding attitudes. At the same time, those who utilized doulas in the postpartum period reported greater breastfeeding success due to the extra support received.\u003c/p\u003e\n\u003cp\u003eMcClain [16] investigated prenatal breastfeeding intentions and perceptions among pregnant African American women eligible for Head Start. It specifically aimed to understand these women\u0026apos;s attitudes, beliefs, and perceived barriers regarding breastfeeding. Grounded in Social Cognitive Theory (SCT), the research emphasized how personal, environmental, and behavioral factors influenced health behaviors, particularly focusing on self-efficacy and perceived behavioral control. Utilizing a qualitative design, the study involved focus group discussions with 13 pregnant women, where data were gathered through audio recordings and analyzed for themes related to breastfeeding. Key findings revealed three major themes: participants recognized breastfeeding as the best feeding option due to its nutritional benefits, identified significant barriers, including negative past experiences and societal pressures, and expressed intentions to begin breastfeeding immediately postpartum with plans to continue for an extended duration. Subthemes indicated that encouragement from family and peers played a significant role, while barriers such as fears about milk supply, embarrassment, and pain were also highlighted.\u003c/p\u003e\n\u003cp\u003eSchindler-Ruwisch et al. [17] aimed to explore determinants of breastfeeding initiation and duration using social cognitive theory and social support frameworks in their study. The study involved 24 African American women who were recent WIC recipients. The study identified several barriers to breastfeeding that were influenced by community perceptions and norms. \u0026nbsp;Interpersonal barriers emerged from limited support from healthcare providers, which impacted mothers\u0026apos; experiences. At an individual level, physical issues such as pain, latching difficulties, and concerns about milk supply also hindered breastfeeding efforts. Support from family and friends played a crucial role in helping mothers navigate breastfeeding challenges. While some mothers received support from loved ones, the assistance from healthcare providers remained insufficient, revealing a gap that needed to be addressed. Many respondents were aware of the breastfeeding resources provided by WIC, yet overall utilization was low. It was suggested that enhanced outreach and follow-up from WIC could lead to improved breastfeeding rates and duration among African American mothers. The study highlighted how women\u0026apos;s breastfeeding intentions and practices were often swayed by community opinions, alongside their recognition of the health benefits of breastfeeding for both infants and mothers. Participants faced common obstacles, including pain, latching problems, and concerns about milk supply, that hindered their ability to continue breastfeeding, underlining the importance of emotional and informational support, which could significantly enhance their confidence and success in breastfeeding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTran et al. [18] conducted a study that aimed to identify the perceived barriers and facilitators to exclusive breastfeeding among back mothers for at least three months. Six focus groups were conducted, including mothers who had successfully breastfed exclusively for three months and those who had not. Researchers utilized a modified Barrier Analysis approach guided by the Socioecological Model. Several barriers were identified in the study. Lactation support and supplies were often inaccessible, making it difficult for mothers to obtain timely and quality assistance, which significantly impacted their breastfeeding success. The cultural stigma surrounding the sexualization of breasts created discomfort and discouraged mothers from breastfeeding in public. Many participants were unaware of workplace policies that were breastfeeding-friendly, such as maternity leave and designated lactation spaces, which restricted their ability to continue breastfeeding after returning to work. Additionally, socioeconomic factors, including structural racism and discrimination, heightened stress levels, and obstructed breastfeeding efforts, leading to adverse health outcomes. Conversely, facilitators included strong support networks, prior knowledge of breastfeeding benefits, and financial incentives perceived by mothers as motivating factors. The findings illustrated that sociocultural norms significantly influenced breastfeeding choices, with formula feeding often viewed as the default in certain communities, emphasizing the need for cultural change.\u003c/p\u003e\n\u003cp\u003eHinson et al. [19] interviewed subject matter experts (SMEs) across various professional disciplines to gather insights on the barriers and facilitators of breastfeeding initiation amongst African American women. The SMEs highlighted the importance of understanding community perspectives in crafting effective breastfeeding promotion strategies. The themes that emerged included the recognition of breastfeeding\u0026apos;s health benefits and the influences of historical factors, particularly the legacy of slavery and systemic racism, which shaped beliefs surrounding breastfeeding in the African American community. Additionally, the sexualization of breastfeeding was acknowledged. Social influences, such as support from family, partners, and religious communities, were found to significantly impact a mother\u0026apos;s breastfeeding choices, alongside the crucial role of healthcare providers. Barriers identified included competing priorities like work and school obligations, childcare issues, public exposure discomfort, limited exposure and education about breastfeeding practices within the African American community, and restricted access to resources, particularly affecting low-income mothers. On the other hand, facilitators included supportive partners, previous positive experiences with breastfeeding, peer support networks, and institutional backing from initiatives like Baby-Friendly Hospitals. However, issues of equity and care quality were noted.\u003c/p\u003e\n\u003cp\u003eGyamfi et al. [20] conducted a study to investigate breastfeeding attitudes and subjective norms among African American Christians in New England and examine the influence of faith communities on breastfeeding practices. An online survey involved 101 participants from four Christian churches, aged 18-44 and primarily Catholic. The findings showed a high willingness to support six months of exclusive breastfeeding. They revealed two main attitudes: breastfeeding was seen as both beneficial and natural, and that community support was essential. The participants perceived breastfeeding as essential for infant health, maternal bonding, and overall family benefits. They also stated that emotional and practical support from community members, especially during church gatherings, was important. The thematic analysis highlighted the perceived biblical endorsement of breastfeeding and the importance of church leaders in promoting these practices while acknowledging gaps in awareness regarding scriptural references. The study suggested that healthcare providers should engage with churches to support breastfeeding initiatives and develop educational programs, emphasizing the importance of involving male partners and clergy in fostering a supportive environment for new mothers.\u003c/p\u003e\n\u003cp\u003eShipp et al. [21] investigated the factors influencing breastfeeding outcomes among African American women since they experienced notably lower rates of initiation and continuation compared to other racial groups in the United States. Thirteen women were selected to participate in this semi-structured qualitative interview, and the analysis was thematic. The findings were split into two sections: challenges faced and the facilitators for success. Many participants reported a loss of confidence in their ability to breastfeed due to various issues, such as milk supply and work-related constraints. Specific breastfeeding challenges, including latching problems and discomfort with public breastfeeding, led to discouragement and, in some cases, the decision to discontinue breastfeeding. On the opposite side, participants discussed how understanding the health advantages of breastfeeding reinforced their commitment. They also stated that they gained confidence as positive outcomes and health milestones were noticed in their infants. Emotional and informational support from partners, family, and community resources was noted as a significant contributor to sustaining breastfeeding efforts.\u003c/p\u003e\n\u003cp\u003eJefferson et al. [22] studied the decision-making processes of African American mothers who discontinued breastfeeding and switched to formula feeding. The study employed Bandura\u0026rsquo;s social cognitive theory to analyze how personal, behavioral, and environmental factors influenced breastfeeding decisions among African American mothers. A secondary analysis of qualitative interviews with 30 mothers aged 18 and above who had infants aged 1 to 6 months was conducted to identify barriers and support systems associated with breastfeeding. Through thematic analysis, four key themes emerged regarding the mothers\u0026apos; experiences that led to transitioning from breastfeeding to formula feeding. Many mothers viewed formula feeding as simpler and more convenient, with lifestyle factors such as returning to work and societal perceptions affecting their choices. Additionally, mothers experienced diverse levels of support from family and friends, where some promoted breastfeeding while others favored formula feeding, demonstrating the crucial role of emotional backing from partners. Participants also believed that early breastfeeding was sufficient for infant health, despite physical challenges discouraging ongoing breastfeeding efforts. Finally, although mothers received some initial support from healthcare providers, they faced a lack of ongoing resources, compounded by economic and transportation barriers, which diminished their ability to maintain breastfeeding and increased reliance on programs like WIC for formula assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.\u0026nbsp;Themes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reviewed articles shared many common factors that contributed to low breastfeeding rates amongst African Americans.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKey Findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eExample Studies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Support Networks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily, partners, and community members significantly influence initiation and continuation. Lack of role models or conflicting advice discourages mothers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVillalobos et al. [14], Shipp et al. [20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCultural Beliefs \u0026amp; Historical Context\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHistorical trauma (e.g., slavery, systemic racism) and stigma (e.g., sexualization of breasts) shape perceptions. Formula feeding was often viewed as a \u0026quot;default.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHinson et al. [19], Tran et al. [18]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEconomic \u0026amp; Structural Barriers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWorkplace constraints (e.g., no paid leave), unaffordable lactation supplies, and systemic inequities disproportionately affect low-income mothers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDeubel et al. [15], Jefferson et al.\u0026nbsp;[21]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare System Engagement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrenatal education improves intentions, but inconsistent postpartum support reduces confidence. Distrust in providers due to racial bias impacts adherence.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSchindler-Ruwisch et al. [17], McClain [16]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity Normalization \u0026amp; Ethnic Pride\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBreastfeeding normalization in communities increases confidence. Ethnic pride motivates breastfeeding as resistance to inequities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGyamfi et al. [20], Villalobos et al. [14]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Common Themes Influencing Breastfeeding Practices Among African American Women\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e​The studies highlighted several interconnected themes that significantly influenced breastfeeding practices among African American women.​ Social support emerged as a dominant factor, with the presence of family, friends, and community networks being identified as crucial in shaping mothers' breastfeeding decisions. This support was not just emotional but also included informational guidance, which helped mothers navigate the challenges associated with breastfeeding. Also, community perception played a considerable role in normalizing breastfeeding within African American communities, suggesting that collective attitudes could positively influence individual behaviors. Cultural beliefs also profoundly impacted breastfeeding practices, where historical contexts and prevailing norms significantly shaped mothers' attitudes. The legacy of slavery and systemic racism continued to influence perceptions, underscoring the need for culturally sensitive approaches that acknowledged and addressed these historical factors. Additionally, misconceptions such as breastfeeding fostering dependency further deterred initiation and continuation, indicating a pressing need for educational interventions to change these beliefs.\u003c/p\u003e \u003cp\u003eEconomic barriers, particularly those related to returning to work and accessing resources, posed significant challenges to breastfeeding. Many mothers faced structural constraints that hindered their ability to establish and maintain breastfeeding routines, emphasizing the need for improved support systems, such as better maternity leave policies and access to breastfeeding equipment like pumps. It was evident that socioeconomic status greatly influenced breastfeeding views and practices, denoting a gap that required bridging to achieve more equitable breastfeeding outcomes. Healthcare providers played an influential role in promoting breastfeeding practices. While parental education during prenatal care was beneficial, continuous support post-delivery was often lacking. This gap represented an opportunity for healthcare systems to enhance their involvement and ensure consistent information and assistance throughout the breastfeeding journey. Integrating healthcare services with community organizations could create a more supportive environment, empowering mothers to sustain breastfeeding efforts longer.\u003c/p\u003e \u003cp\u003eDespite how in-depth the studies were, one significant limitation noted was the small sample sizes, which were often used in the studies that utilized qualitative research; this can lead to a possible inaccurate reflection of the broader population's views, leading to issues concerning the generalizability of the findings.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis literature review emphasizes the multifaceted influences on breastfeeding practices among African American mothers, revealing critical areas for intervention. ​Social support, economic considerations, and cultural beliefs are pivotal in shaping breastfeeding experiences, stressing the importance of a holistic approach to improve rates and durations of breastfeeding in these communities.​ By fostering environments of encouragement and understanding, challenging cultural misconceptions, alleviating economic constraints, and enhancing healthcare accessibility, interventions can lead to improved maternal and infant health outcomes. Ultimately, culturally relevant strategies are essential to empowering mothers and promoting a supportive breastfeeding culture within African American communities.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study does not contain any individual person\u0026rsquo;s data in any form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this review utilized publicly available data from previously published studies, no ethical approval was required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that this research received no funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Accordance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis narrative review is based entirely on a wealth of existing, publicly available research, meaning that no new primary data or direct human involvement was collected. Consequently, official ethical approval was not required. Nonetheless, we approached this synthesis with a strong commitment to academic integrity, carefully adhering to the confidentiality guidelines and ethical considerations established by the original researchers. Although our study is fundamentally secondary, it aims to honor their contributions while maintaining a steadfast dedication to ethical scholarship.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCouto GR, Dias V, Oliveira IDJ. Benefits of exclusive breastfeeding: An integrative review. Nurs Pract Today. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18502/npt.v7i4.4034\u003c/span\u003e\u003cspan address=\"10.18502/npt.v7i4.4034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVictora CG, Bahl R, Barros AJD, Fran\u0026ccedil;a GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(15)01024-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(15)01024-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrank NM, Lynch KF, Uusitalo U, Yang J, L\u0026ouml;nnrot M, Virtanen SM, Hy\u0026ouml;ty H, Norris JM. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr. 2019;19(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12887-019-1693-2\u003c/span\u003e\u003cspan address=\"10.1186/s12887-019-1693-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuro-Valdez JC, Meza-Rios A, Aguilar-Uscanga BR, Lopez-Roa RI, Medina-D\u0026iacute;az E, Franco-Torres EM, Zepeda-Morales AS. Breastfeeding-Related Health Benefits in Children and Mothers: Vital Organs Perspective. Medicina. 2023;59(9):1535. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina59091535\u003c/span\u003e\u003cspan address=\"10.3390/medicina59091535\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Pediatrics. Breastfeeding, Physical Growth, and Cognitive Development. Pediatrics. 2021;147(5):e2020008029. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2020-008029\u003c/span\u003e\u003cspan address=\"10.1542/peds.2020-008029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKramer MS, Kakuma R. (2009). Optimal duration of exclusive breastfeeding. The Cochrane Database of Systematic Reviews, 2009(4), CD003517. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD003517.pub2\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD003517.pub2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVictora, C. G., Bahl, R., Barros, A. J. D., Fran\u0026ccedil;a, G. V. A., Horton, S., Krasevec,J., \u0026hellip; Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms,and lifelong effect. The Lancet, 387(10017), 475\u0026ndash;490. https://doi.org/10.1016/S0140-6736(15)01024-7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarks KJ. Disaggregation of breastfeeding initiation rates by race and ethnicity\u0026mdash;United states, 2020\u0026ndash;2021. Prev Chronic Dis. 2023;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5888/pcd20.230199\u003c/span\u003e\u003cspan address=\"10.5888/pcd20.230199\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetit M, Smart DA, Sattler V, Wood NK. Examination of factors that contribute to breastfeeding disparities and inequities for black women in the us. J Nutr Educ Behav. 2021;53(11):977\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jneb.2021.08.013\u003c/span\u003e\u003cspan address=\"10.1016/j.jneb.2021.08.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGyamfi A, O\u0026rsquo;Neill B, Henderson WA, Lucas R. Black/african american breastfeeding experience: Cultural, sociological, and health dimensions through an equity lens. Breastfeed Med. 2021;16(2):103\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/bfm.2020.0312\u003c/span\u003e\u003cspan address=\"10.1089/bfm.2020.0312\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiang KV. (2021). Racial and ethnic disparities in breastfeeding initiation united states, 2019. MMWR. Morbidity and Mortality Weekly Report, 70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.15585/mmwr.mm7021a1\u003c/span\u003e\u003cspan address=\"10.15585/mmwr.mm7021a1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D.,Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J.,Grimshaw, J. M., Hr\u0026oacute;bjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson,E., McDonald, S., \u0026hellip; McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration:Updated guidance and exemplars for reporting systematic reviews. BMJ, n160. https://doi.org/10.1136/bmj.n160.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddaway NR, Page MJ, Pritchard CC, McGuinness LA. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews, 18, e1230. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/cl2.1230\u003c/span\u003e\u003cspan address=\"10.1002/cl2.1230\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVillalobos AVK, Davis C, Turner MM, Long S, Hull S, Lapinski MK. Breastfeeding in context: African american women\u0026rsquo;s normative referents, salient identities, and perceived social norms. Health Educ Behav. 2021;48(4):496\u0026ndash;506. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/10901981211014445\u003c/span\u003e\u003cspan address=\"10.1177/10901981211014445\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeubel TF, Miller EM, Hernandez I, Boyer M, Louis-Jacques A. Perceptions and practices of infant feeding among african american women. Ecol Food Nutr. 2019;58(4):301\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/03670244.2019.1598977\u003c/span\u003e\u003cspan address=\"10.1080/03670244.2019.1598977\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcClain JS. (2019). Pregnant African American Women Breastfeeding Intentions, Beliefs Attitudes and Perspectives (Order No. 13426812). Available from ProQuest Central; ProQuest Dissertations \u0026amp; Theses Global. (2205584401). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://go.openathens.net/redirector/liberty.edu?url=https://www.proquest.com/dissertations-theses/pregnant-african-american-women-breastfeeding/docview/2205584401/se-2\u003c/span\u003e\u003cspan address=\"https://go.openathens.net/redirector/liberty.edu?url=https://www.proquest.com/dissertations-theses/pregnant-african-american-women-breastfeeding/docview/2205584401/se-2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchindler-Ruwisch J, Roess A, Robert RC, Napolitano M, Woody E, Thompson P, Ilakkuvan V. Determinants of breastfeeding initiation and duration among african american dc wic recipients: Perspectives of recent mothers. Women\u0026rsquo;s Health Issues. 2019;29(6):513\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.whi.2019.07.003\u003c/span\u003e\u003cspan address=\"10.1016/j.whi.2019.07.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTran V, Reese Masterson A, Frieson T, Douglass F, P\u0026eacute;rez-Escamilla R, O\u0026rsquo;Connor Duffany K. Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach. Matern Child Nutr. 2023;19(1):e13428. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/mcn.13428\u003c/span\u003e\u003cspan address=\"10.1111/mcn.13428\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHinson TD, Skinner AC, Spatz DL. Subject matter experts identify health equity concerns in breastfeeding for african american women. J Perinat Neonatal Nurs. 2021;35(2):160\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/JPN.0000000000000486\u003c/span\u003e\u003cspan address=\"10.1097/JPN.0000000000000486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGyamfi A, Jefferson UT, O\u0026rsquo;Neill B, Lucas R, Spatz DL, Henderson WA. Breastfeeding attitudes and social support among christian african americans. Breastfeed Med. 2024;19(5):333\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/bfm.2023.0277\u003c/span\u003e\u003cspan address=\"10.1089/bfm.2023.0277\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShipp GM, Weatherspoon LJ, Norman GS, Alexander GL, Kelleher D, Kerver JM. Understanding factors influencing breastfeeding outcomes in a sample of african american women. Matern Child Health J. 2022;26(4):853\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10995-021-03261-w\u003c/span\u003e\u003cspan address=\"10.1007/s10995-021-03261-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJefferson UT, Reed AE, Rabbitte M. African american mothers\u0026rsquo; decision to discontinue breastfeeding and switch to formula. West J Nurs Res. 2022;44(1):15\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/01939459211041164\u003c/span\u003e\u003cspan address=\"10.1177/01939459211041164\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8756913/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8756913/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBreastfeeding offers critical health benefits for infants and mothers, yet significant disparities persist among African American women in the United States, who exhibit the lowest initiation rates (74.5%) compared to other racial groups. This systematic review, adhering to PRISMA 2020 guidelines, examines sociocultural factors influencing breastfeeding practices within this population. Nine peer-reviewed studies (2019–2024) from PubMed, SCOPUS, and Google Scholar were analyzed, focusing on cultural norms, barriers, and facilitators. Key findings reveal that breastfeeding behaviors are shaped by social support networks (family, community), cultural perceptions (historical legacies of systemic racism, sexualization of breasts), and structural barriers (economic constraints, limited workplace accommodations). Healthcare provider engagement and access to resources, such as lactation support, emerged as pivotal yet inconsistent influences. While community normalization of breastfeeding and ethnic pride were motivators, misconceptions about dependency and inadequate postpartum support hindered sustained practices. The review underscores the necessity for culturally sensitive interventions addressing systemic inequities, enhancing healthcare collaboration with community organizations, and implementing policies supporting maternity leave and lactation accessibility. Multifaceted strategies integrating education, economic support, and dismantling cultural stigmas are essential to reducing disparities and promoting equitable breastfeeding outcomes. By centering African American women’s sociocultural contexts, public health initiatives can foster environments that empower maternal-infant health through sustained breastfeeding practices.\u003c/p\u003e","manuscriptTitle":"The Influence of Sociocultural Perceptions in Breastfeeding Practices Among African American Women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-16 09:45:03","doi":"10.21203/rs.3.rs-8756913/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-24T13:57:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T18:39:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T14:47:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T09:59:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T19:11:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63845636635021412152903226208231075617","date":"2026-03-19T18:29:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18156769999540103122687919426744811663","date":"2026-03-16T16:36:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78979138881310385486859573881157916155","date":"2026-03-16T13:55:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318749649663318332704868077550661657739","date":"2026-03-15T17:30:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206581381772758030544013682238530590586","date":"2026-03-15T15:57:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123768630622662147249555709702949823419","date":"2026-03-15T14:56:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273267656680097576230549095926300764692","date":"2026-03-13T16:46:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-13T14:21:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T15:49:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T05:35:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-10T18:41:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-02-10T18:34:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"68ead0fd-9569-4504-8933-5c99c37d4192","owner":[],"postedDate":"March 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T09:23:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-16 09:45:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8756913","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8756913","identity":"rs-8756913","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}