Yalbilinya miya (learn together): Privileging the voices of Aboriginal mothers and Elders to develop a community-led breastfeeding program

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Breastfeeding is an important practice for culture, nutrition and wellbeing for Aboriginal mothers and children in Australia, particularly in the context of historical and ongoing forced separations of Aboriginal mothers and their children. This study aims to highlight the breastfeeding perspectives and experiences of Aboriginal mothers and Elders; and identify the supports Aboriginal mothers desire to empower them to initiate and reach their breastfeeding goals. This information will inform the design and implementation of a holistic breastfeeding program in regional Australia in an Aboriginal community-controlled health service, Riverina Medical & Dental Aboriginal Corporation (RivMed). Methods This study used the Indigenous qualitative method of Yarning and was based on Wiradjuri Country (Wagga Wagga). Two participant types were included in this study: Aboriginal mothers who had given birth within the last five years and were patients of Riverina Medical and Dental Aboriginal Corporation (RivMed); and female Aboriginal Elders who had personal breastfeeding experience and had supported other Aboriginal women in their breastfeeding journey. Participants were invited by the RivMed Aboriginal research coordinator to participate in one-on-one Yarning or a Yarning circle conducted by female Aboriginal researchers. Results Overall, 20 Aboriginal women participated, 15 mothers of children aged under five years, and five Elders. Four themes emerged: 1) Intergenerational knowledge transfer; 2) influences of partner, family, community and workplace on breastfeeding; 3) challenges with initiating or continuing breastfeeding; and 4) the need for culturally responsive, community-led supports. Conclusion This study highlights the need for culturally responsive and community-led resources and programs to support Aboriginal women to initiate and continue to breastfeed their babies. The role of Aboriginal Elders was important in the intergenerational transfer of knowledge and cultural support, especially for first time mothers, or those who did not have breastfeeding role models in their own families. Breastfeeding qualitative community-led Aboriginal and Torres Strait Islander Background Aboriginal and Torres Strait Islander women have been breastfeeding their children as an important cultural practice for 65,000 years [ 1 , 2 ], often for four years and beyond. Breastfeeding is recognised as the ideal source of nutrition for newborns and infants, and reduces the risk of childhood conditions such as sudden infant death syndrome, gastrointestinal infections, respiratory infections, ear infections, obesity and type 1 diabetes [ 3 , 4 ]. Breastfeeding also provides long-term health benefits for children who received breastmilk, such as a reduced risk of type 2 diabetes, leukemia and cardiovascular diseases [ 5 , 6 ]. For mothers breastfeeding has health benefits such as reduced postpartum bleeding, reduced risk of postnatal depression, lower risk of type 2 diabetes and reduced risk of breast and ovarian cancer [ 5 – 7 ]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months, and then breastfeeding with solid foods for at least two years [ 8 ], and has set a target of 50% of women exclusively breastfeeding for six months [ 9 ]. In Australia, the National Breastfeeding Strategy has adopted strength-based approaches to achieve improvements in breastfeeding to these targets[ 9 ]. Although a deficit approach is often used to describe Aboriginal and Torres Strait Islander breastfeeding rates, national data shows that 83.4% of First Nations infants aged 0–3 years have ever received breastmilk [ 10 ]. However, there is a steep decline in breastfeeding rates among Aboriginal and Torres Strait Islander children with only 26.9% of infants being exclusively breastfed for at least 6 months. In a 2022/2023 report New South Wales (NSW) had the lowest rates of exclusive breastfeeding with only 22.1% of Aboriginal and Torres Strait Islander infants receiving breastmilk exclusively for at least 6 months [ 10 ]. Breastfeeding practices among many Aboriginal and Torres Strait Islander women have been disrupted by colonisation, including the Stolen Generations, continuing high rates of child removals, intergenerational trauma, racism, disruption of family structures, and other socioeconomic injustices [ 11 – 13 ]. These injustices have resulted in a reduction of initiation and duration of breastfeeding which has contributed to the gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia [ 14 – 16 ]. Aboriginal and Torres Strait Islander people have unique and holistic views of health and wellbeing differing from the dominant western medical model [ 17 ]. A significant part of this has been cultural breastfeeding practices that have been passed down between generations for thousands of years [ 17 ]. Health encompasses environmental and spiritual health, social and emotional wellbeing, connection to Country, community, and culture; all are equally as important and intrinsically connected [ 18 – 20 ]. Availability of culturally safe and responsive maternal care for Aboriginal and Torres Strait Islander women and their families increases the likelihood of Aboriginal and Torres Strait Islander women continuing to breastfeed [ 21 ]. Programs that enable Aboriginal and Torres Strait Islander women to engage in cultural practices such as smoking ceremonies after birth with ongoing cultural support through access to culturally safe spaces, while guiding and supporting breastfeeding, contribute to better breastfeeding outcomes [ 22 ]. Early breastfeeding support and education that is culturally responsive, including programs for smoking cessation and fostering positive breastfeeding support from their partners and family, enable Aboriginal and Torres Strait Islander women [ 23 – 25 ]. The important role of Elders in providing health and wellbeing support and education has been acknowledged [ 26 , 27 ]. Aboriginal and Torres Strait Islander women who live in regional or remote compared with urban areas have higher rates of breastfeeding initiation and duration. Higher rates of initiation and duration of breast feeding are associated with higher maternal education and being 25 years or older [ 25 ]. Focusing on Aboriginal and Torres Strait Islander women’s perspectives, lived experiences and factors influencing infant feeding decisions may provide a clearer understanding on the social determinants that impact breastfeeding initiation. Intentions to initiate and continue breastfeeding are complex. There is a strong need for policy and strategy implementation that focuses on guidance and education for mothers within their social network to enable them to feel safe and supported [ 16 , 28 ]. There is limited evidence on the barriers and facilitators of breastfeeding practices among Aboriginal and Torres Strait Islander women living in regional areas in New South Wales (NSW), Australia [ 16 ]. Further, there is little research regarding culturally safe and responsive supports available which encourage exclusive breastfeeding among Aboriginal and Torres Strait Islander women [ 13 ]. At the same time, there is a need for evidence-based culturally responsive breastfeeding support programs for Aboriginal and Torres Strait Islander women and families [ 11 , 14 ]. To fill this gap in knowledge we collaborated with a local Aboriginal Community-Controlled Health Service (ACCHS) on Wiradjuri Country (regional NSW) to gather breastfeeding knowledge and experiences among local Aboriginal and Torres Strait Islander women to inform a community-led pilot breastfeeding program aiming to use resources and supports that Aboriginal women want, to empower women to reclaim breastfeeding practices to ensure this knowledge is passed onto our future generations and to give Aboriginal and Torres Strait Islander babies the best start to life. Methods Indigenous theoretical approach The project protocol and methods have been published previously [ 29 ]. This study used an Indigenous qualitative method of Yarning to provide a respectful platform for Aboriginal and Torres Strait Islander ways of knowing, being and doing to be privileged [ 30 ]. Using an ‘Indigenist’ lens by Rigney, all aspects of this research were led by Aboriginal and Torres Strait Islander peoples with responsibility to their communities and “privileging Indigenous voices in Indigenist research”. This ensured the lived experiences and unique perspectives of Aboriginal and Torres Strait Islander women on breastfeeding were prioritised within an academic space [ 31 ]. Additionally, we used Indigenist theory to centre self-determination and “supports the right of Indigenous peoples to govern themselves and make decisions about their own lives and communities”[ 31 ]. Setting The research was conducted on unceded Wiradjuri Country in Wagga Wagga, a large regional area which is situated in NSW. The study was based at the Riverina Medical and Dental Aboriginal Corporation (RivMed) which is the local Aboriginal Community Controlled Health Service (ACCHS), governed by a board of community elected local Aboriginal people. ACCHSs provide culturally safe holistic services and programs to the local communities. These include cultural, spiritual, emotional, psychological, and physical wellbeing into their practices, in addition to the Western biomedical view of health. ACCHSs are run by Aboriginal and Torres Strait Islander peoples and were established to overcome the barriers Aboriginal and Torres Strait Islander peoples face when accessing mainstream health services. Positionality of the Research team The positioning of Aboriginal women with firsthand experience of breastfeeding who also live and work in the study location has been incorporated into the study design through co-constructed knowledge [ 32 , 33 ]. This relationality is vital to Aboriginal and Torres Strait Islander ways of knowing, being and doing, specifically for this project, and ensured strong and trusted relationships and high engagement with the project. The first author is a mother with personal breastfeeding experiences and has worked in Aboriginal health for over 10 years with ACCHSs. The last author is a Wotjobaluk Aboriginal woman, researcher and mother with personal breastfeeding experiences. The project team included Aboriginal women with personal breastfeeding knowledge and experiences (SS, KW, HH, AH, SMF NS, JN, MD, GS), an Aboriginal male public health researcher (SG), two Aboriginal researchers studying medicine or public health (CR, BW), non-Aboriginal researchers and clinicians with maternal and child health, lactation, medical, nursing and midwifery, public health, and nutrition qualifications, and qualitative methods experience (DK, SN, PL, RF, M-ER, AB). Most of the project team are based on Wiradjuri Country (Wagga Wagga) (SS, HH, KW, AH, PL, NS, M-ER, RF) working in or with the ACCHS. Participant selection and recruitment Participants were recruited through RivMed by the Aboriginal research coordinator (HH) via phone or in person at the clinic and were invited for an individual Yarn or a Yarning Circle. Aboriginal mothers were eligible if they were patients of RivMed, had a baby in the last five years and provided written informed consent. Aboriginal women were purposively selected to ensure that there was a range of breastfeeding experiences and ages. Female Aboriginal Elders were also contacted via phone or in person at RivMed by the Aboriginal research coordinator (HH) to be invited in for a one-on-one yarn or a yarning circle. They were eligible if they had personal breastfeeding experience, had supported other Aboriginal women in their breastfeeding journey and had provided written informed consent. Data collection Qualitative research using Yarning methodology was conducted by four female researchers (SS, HH, JN, DK), three of whom were Aboriginal women (SS, HH, JN), between September and November 2023. Yarning sessions were conducted face-to-face at RivMed or at the participant’s home. To ensure a culturally safe and respectful environment for the Yarns, the community decided the sessions were women’s business, so all people present were female. All but one person present for the Yarning sessions were Aboriginal (DK). Yarning guides were developed to prompt Aboriginal mothers and Elders to reflect on their own perceptions, experiences, and any challenges that they faced during breastfeeding or supporting Aboriginal women with breastfeeding. Aboriginal mothers and Elders were also asked what breastfeeding supports they have accessed or have knowledge about in the community, and what other support would have been beneficial throughout their own or other women’s breastfeeding journey. Participation in the study was voluntary and informed written consent was obtained prior to the yarn being conducted. Participants also consented for yarns to be audio-recorded and transcribed verbatim. Data analysis Four authors (SS, DK, BW, AB) independently read all transcripts and coded the information using inductive reasoning. A thematic analysis was conducted by SS and DK based on grounded theory using NVivo 14.23.2 (46). The themes were reviewed and refined during workshops held with six of the authors (SS, HH, DK, BW, AB, JN). Results Participants Overall, 20 Aboriginal women participated; 15 mothers with a child/children aged under five years and five Elders. Five participants were aged less than 30 years, 10 were between 31–45 years and five were over 45 years of age. All participants had given birth to at least one child. 18 out of 20 (90%) participants had breastfeeding experience (see Table 1 ). Table 1 – Participant characteristics Participant characteristics (n = 20) n % Aboriginality Aboriginal 20 100 Torres Strait Islander 0 0 Participant type Mother 15 75 Elder 5 25 Age group 18–30 5 25 30–45 10 50 45+ 5 25 Pregnancies 1–2 10 50 3–4 6 30 5+ 4 20 Ever breastfed Yes 18 90 No 2 10 Themes arising from the Yarning were: 1) intergenerational knowledge transfer; 2) influences of partner, family, community and workplace on breastfeeding; 3) challenges with initiating or continuing breastfeeding; and 4) the need for culturally responsive, community-led supports. Theme 1: Intergenerational Knowledge Transfer Among our participants breastfeeding was considered an important health practice: “I know my son could have been way more sick than if I wasn’t breastfeeding. He was a healthy baby ”. Aboriginal mother. It’s good for bubs as well. Yeah, there's so many benefits that they can get from it. Aboriginal mother. Participants in our study viewed breastfeeding as fostering a strong bond and attachment between mother and baby and deeply rooted in Aboriginal culture. That made me connect with her because I had that bond with the breastfeeding, so it was connection and bonding . Aboriginal mother. Family members spoke of passing on breastfeeding knowledge and supporting each other to breastfeed as well as women breastfeeding each other’s babies, as described by one mother: “As a Wiradjuri woman we have been breastfeeding for thousands of years, it’s part of who we are. My Aunties would share stories of how their mothers and aunties would share the responsibility of breastfeeding and take care of each other’s children. This links in with us being culturally responsible for our nieces and nephews as if they were our own” Aboriginal mother It was noted that impacts of colonial policies, such as the Stolen Generations and the ongoing high rates of child removal have disrupted intergenerational knowledge sharing in Aboriginal families and communities, impacting the ability to pass on important breastfeeding practices for some women, making it more difficult for Aboriginal women to breastfeed. This has also meant that many Aboriginal women do not have breastfeeding mentors within their families to provide guidance, encouragement, and practical support. Without these mentors, it was reported that new mothers can feel isolated and unsure of how to navigate breastfeeding. “Well, yeah, see I didn't have a lot of support like with my mum and things like that either so I didn't really have anyone showing me how to do things properly.” Aboriginal Mother. Participants felt that Aboriginal Elders, as respected knowledge holders, should be recognised and prioritised within health settings as key figures in passing on breastfeeding expertise to new mothers. Their lived experiences and cultural wisdom were considered invaluable in supporting and empowering the next generation. The sharing of breastfeeding stories was considered a powerful way to reclaim cultural practices that are at risk of being lost. These narratives help to preserve traditional knowledge and instill confidence in young Aboriginal mothers. As one Aboriginal mother shared: “Our Elders are our knowledge holders and leaders; they hold so many stories and wisdom around breastfeeding and should be engaged in programs to support our women to breastfed.” Aboriginal mother. Theme 2: Influences of partner, family, community and workplace on breastfeeding The role of family The perceptions and attitudes of partners and family members were reported to play a critical role in shaping a mother’s decision to breastfeed. When those closest to her are supportive and informed, mothers were thought to be more likely to initiate and continue breastfeeding. “My mum breastfed all of us. I think that’s also – I’ve seen it around all the women in my life, so it was just like no different. Breastfeeding was a thing in my family…I think I just knew no different.” Aboriginal mother Similarly, when there is limited breastfeeding knowledge in the family, it is difficult to support new mums in their breastfeeding journey. “You don’t know what you’re doing until you are put in the situation, and then it's good to have somebody that understands what's going on with your body and your baby, and to know – because you don’t know if – how their mouth is supposed to be when it's latching on.” Aboriginal Mother Partner influence Several participants told of how their partners and their families had knowledge of the benefits of breastfeeding and were actively supportive of breastfeeding: “My partner was very adamant, you're breastfeeding. It's best. Breast is best.” Aboriginal Mother. “My mother-in-law breastfed because all of my - me and my siblings were bottle fed so my mum didn't really know anything, but my mother-in-law breastfed all her kids till over two years old so she was a big help.” Aboriginal Mother. A clear need for increased education for partners and broader support networks about the benefits of breastfeeding and the practical ways they can assist mothers in their journey was highlighted. “ If your partner doesn’t understand the benefits of breastfeeding or want to support you that could make it hard to breastfeed as well. So they’ve got to be educated, if your breasts fill up too quick, like mastitis comes along and just little things like that. They only involved them when they go up for labour lessons. ” Aboriginal Elder. Normalising Breastfeeding in the Community Many women in the study expressed feelings of shame when breastfeeding in public due to societal stigma and the lack of private, comfortable spaces. “ People they may get a bit hostile sometimes and you have to cover yourself up when you pull out, you know, your boob to feed a bub in a restaurant, and whether the restaurant – some will allow it or cafes or whatever, some may allow it and some may not and you may have to [breastfeed] elsewhere and it’s very hard in that way. ” Aboriginal mother. “I have four kids as well… I was also a very young mum. I had my first when I was 17. I breastfed her for probably about a month and was shamed downtown so I stopped.” Aboriginal mother. Current facilities in the local area were considered inadequate, making it difficult for mothers to feed their babies with dignity and ease. “I don’t want to breastfeed my baby where they change the shitty nappies. So, I do bottles when I’m out and about.” Aboriginal mother. Some participants experienced judgement when breastfeeding into the toddler years: “One thing I didn’t like when people found out I was still breastfeeding, the judgement. It was like what? What do you mean? My mum did for like years. I just think why not?” Aboriginal Mother. One participant spoke of the need to make breastfeeding more visual in the community again to normalise it and empower our next generation to breastfeed: “If we start seeing it more in society, it’s just come a societal thing... I don’t want it to get to the point where no one’s breastfeeding”. Aboriginal Elder. Workplace and Public Policy Support Participants noted a significant gap in workplace policies that support breastfeeding mothers. Women returning to work often lacked access to paid time to travel to childcare to breastfeed or to express milk. “I'm like, well, am I able to get leave to go and feed my son and then come back? Because the daycare were happy with it. They had a room where you could go and breastfeed your child and then you could just leave. But yeah, it was the whole getting away from work.” Aboriginal Mother. Balancing the benefits of breastfeeding and the pressures of motherhood While the health and financial benefits of breastfeeding were recognised, many participants struggled to balance these with the demands of motherhood. The perception that breastfeeding is easy was thought to be undermining of the real challenges women face, leading to feelings of shame and failure when they cannot continue. “I guess it's other people’s opinion, and how they try and push that thing like, it's the healthiest way. It's the healthiest thing. I agree, it is the best thing, but some mothers can’t do it… and then you get, basically, shamed for not being able to – your body is not able to do what it's supposed to do. So, I think that’s a barrier and you feel like a failure.” Aboriginal Mother. “Breastfeeding is very hard. It’s not just a given thing. You have to work with your baby to get them on attached, knowing their signs and symptom as well – it is hard work.” Aboriginal Elder. Perceived convenience of bottle-feeding Several participants highlighted the perception that bottle-feeding was considered more convenient, particularly by the younger generation: “I sort of just was on my own and doing it on my own, so yeah, I just - it was just easier to just bottle feed. It was easier to pick it up and do it that way.” Aboriginal Mother. “But I think that this generation and society... like they’re young, so for them it’s like, well, the bottle’s convenient .” Aboriginal Elder. Others noted that the desire for partners or family members to help feed the baby was a driver of deciding to bottle-feed: “I think that needs to be done more with the younger ones ... because they’re still growing up, they want to go out, they want to party. Most times out of 10, they’re still home with their mum, so that family will support them in the way that [bottle-feeding] – but it’d be nice if they did [breastfeed], even if it was expressing and then giving it through the bottle.” Aboriginal Mother. Theme 3: Challenges with initiating or continuing breastfeeding Several women shared feelings of frustration and failure when they struggled to breastfeed, noting the need for culturally responsive support in the initial stages post-birth. As the participants reflected: “Breastfeeding is meant to be this natural, easy thing of just pop bub on the tit and go, but this isn’t the reality for many of our women.” Aboriginal Elder. “They kind of just chucked the baby on and it’s up to you to figure it out... It’s all very rushed over there [at the hospital]. It feels like no one gives you the time. It’s just like we’re a number in the hospital. But if a woman wants to breastfeed, that’s like – you teach her, you know?” Aboriginal Mother. “A lot of women beat themselves up, because they’re like, I want to breastfeed, but I don’t know how.” Aboriginal Mother. The need for support to initiate breastfeeding in the early stages was particularly evident for young mothers: “I didn't breastfeed. I have four children. I had my first one very young so I felt like maybe they didn't support a lot. They sort of just tried on me for maybe five minutes and then that was it, and I just switched off and I was like no, I'm just going to bottle feed. Then so having more kids, it was easier to just bottle feed but I think I probably would have liked the experience to breastfeed one of them, but I struggled a lot with latching and things like that .” Aboriginal Mother. However, mothers who had previously given birth also noted the need for support: “The nurse was like oh, you have three kids already, you'll be fine…But we have six years [between children], so it's like all brand new. I feel like I'm starting again and I felt like we were just rushed out because I have other kids. It's like, you're fine, you can go on your way and I was like, I'm really struggling because I don't have family out here. It's just me and my partner, so yeah, I felt very isolated I suppose at that time.” Aboriginal Mother. Additional challenges that were highlighted included tandem feeding, and concerns about low milk supply, often influenced by clinical monitoring of baby weight, contributed to anxiety in a number of participants. “With her she didn't gain. She lost a lot of her weight and then didn't gain any because we were having struggles with feeding and the nurse booked another appointment and was coming back the next week but still didn't support around breastfeeding because she wasn't gaining weight therefore something was wrong.” Aboriginal Mother. Women with mental health concerns often felt that breastfeeding was not a viable option, fearing it would negatively impact their social and emotional wellbeing and ability to breastfeed. “I was really scared of mastitis too but I – because I got mental health problems, I’ve got anxiety. I was like, ah, I don’t know if I can do it [breastfeeding]” Aboriginal Mother. Similarly, women using alcohol or other drugs believed they could not breastfeed at all and were unaware of the supports available to help them do so safely. “I still felt bad about smoking because I'm like, baby's getting it through the breast milk. It's like, alcohol would go through you, so I assume nicotine would. That's what I just assumed. I felt bad.” Aboriginal Mother. Health complications during and after birth exacerbating challenges It was highlighted that mothers and babies who experience health complications during pregnancy or birth face additional challenges in establishing breastfeeding, often due to being separated from their baby, limiting opportunities for feeding and bonding. Some participants shared stories where complications during and after birth resulted in them being separated from their baby and receiving minimal opportunity and support to breastfeed. “We had a lot of latching problems at the start when she - she was born too quick so I didn't get that first couple of hours with her because she was in NICU and we had latching problems for the next two days so we didn't really get that connection.” Aboriginal Mother. “Because I had certain anaesthesia I couldn't breastfeed and then they wouldn't let the baby come down so it was a bit…for four days we were separated and I wasn't allowed to pump.” Aboriginal Mother. “Even positioning him, because I had a C-section, it was like, how do I do this where I'm not hurting me, and he’s comfortable and I'm comfortable?” Aboriginal Mother. It was considered essential to empower new mothers with choices and provide support for expressing milk if they are separated from their baby. It was also suggested that hospital staff require more training on how to support breastfeeding in these circumstances, including when babies are in neonatal intensive care units (NICUs). The importance of appropriate breastfeeding support services It was reported by some participants that the Western clinical model of birthing often does not support breastfeeding. “[Breastfeeding] It used to be much more sacred. It takes away from the spiritual side of pregnancy and birth and it’s all medical. It shouldn’t be like that... that’s when all the interventions come in”. Aboriginal Elder. Due to chronic understaffing, women often felt rushed and unsupported, with little time to establish breastfeeding before discharge. “I didn't really use the hospital. I feel like they kicked me out after I gave birth… [baby] wasn't even 24 hours old and I'm sitting in the waiting room waiting to be picked up because they needed my bed.” Aboriginal Mother. “I was a first-time mum, I knew nothing, but they never ever came around to ask, are you breastfeeding? They never ever talked about breastfeeding.” Aboriginal Mother. “I thought I was doing it right, when I wasn’t. But I had no guidance because the nurse wasn’t there, and all the other nurses were too busy, and they had no idea.” Aboriginal Mother. Further, many women reported feeling judged, unsafe, or had experienced racism from mainstream nurses and midwives during hospital care and home visits. One mother noted regarding the midwife home visits: “I totally felt judged. I would clean the house up and try and hide all the mess… I feel like maybe if they were Aboriginal workers or something, if they were Aboriginal, I wouldn't have felt as judged. I was like, I don't really like this .” Aboriginal Mother. These experiences, coupled with fears of child removal by the Department of Community and Justice (DCJ), added significant stress during the postpartum period, but also made new mothers less willing to ask for assistance with issues such as breastfeeding. “I said to her straight out, in front of all the medical practitioners and that, DCJs and what - why are you favouring my daughter for and why do I gotta book to see my daughter… you’re going to do a Stolen Generation again? I said, it ain’t happening… Soon as I got her to 2.2 [kg] she was out of there. I got DCJ to help me to get her out. I was not leaving her in there.” Aboriginal Mother. Participants highlighted that breastfeeding is a mutual learning process between mother and baby, and this journey must be given the time and space it deserves. Some mothers reported receiving good support and advice in hospital, which had resulted in them being able to successfully breastfeed. “When I'd come back from the surgery and stuff with [baby], they were like, okay, we're going to try and breastfeed him. I'm like, there's nothing in there. They're like, no, just let him and he'll get it going. Yeah, he did it…I don't know if it was a midwife or a nurse that came round and was helping with it to make sure that he was latched properly. That's why I was like, it hurts. She's like, well, he's not latched properly… I ended up getting chapped nipples and stuff, so when the nurse came over, she gave me some creams to get - she gave me some samples and then I went and got the cream from the chemist. She was helpful in that way.” Aboriginal Mother. It was noted that breastfeeding challenges can arise at any time, yet culturally safe support is often unavailable outside of standard business hours. Many women in the study did not feel comfortable accessing mainstream services such as the Australian Breastfeeding Association phoneline. Another mother shared her experience: “After trying to teach myself how to breastfeed my newborn son, I was left with cracked and bleeding nipples and the feeling of failure. I was in pain, I was crying, and I had nowhere to go.” Aboriginal mother. Theme 4: The need for culturally responsive, community-led education and supports A holistic, community-led approach to breastfeeding support was desired, which moves away from Western clinical models and centres around Aboriginal ways of knowing and being. Participants considered the following education and supports to be beneficial in assisting new mothers on their breastfeeding journeys. “It’d be good to have something there specifically for the Indigenous women - like a one-on-one that follows them through.” Aboriginal Mother. Education and information Participants expressed a pressing need for more community-led education programs that commence prior to birth that highlight the benefits of breastfeeding, noting that much of the existing ante-natal education focussed on the delivery of the baby: “But I also think too, looking back, when I went to antenatal classes... they never ever really talked about breastfeeding, it was all about getting you prepared for labour.” Aboriginal Mother I definitely think the education, like through the pregnancy, more of a talk around it and the processes and the stages. Aboriginal Mother The participants suggested that the education needs to address what to expect during the breastfeeding journey and how to manage common challenges: “I think that that’s what we need to do with these women too, is get them to put their feet in the water, have a yarn to other women that have breastfed, have a look at the complications as well as the – the pros as well as the cons.” Aboriginal Mother. “Maybe they're just not aware, because I didn't know that if you latch the baby on, then the milk starts producing and stuff. That's why I just thought, maybe I'm not breastfeeding because they're empty. I don't know, maybe more information around it.” Aboriginal Mother. Participants also specifically highlighted a need for health promotion materials such as videos and posters to support new mums to breastfeed: “It’d be nice to create a video of just taking away the stigma of it and the shame factor and just promoting that breast is best.” Aboriginal Elder “Maybe doing – when you do a video or a poster, show them the different forms that you can feed a baby because if you only give them one option and that option’s not working, it’s like, oh …” Aboriginal Mother. Participants felt there was a need for more education around alternative breastfeeding methods, such as pumping, as many mothers are required to return to work, or needed to care for other children. “Even when I did go back to work, I went back to work and your body adapts, your milk supply adapts … so reassuring the mums that it does get easier and your milk supply goes to the demand of the baby. That’s also never explained, you know what I mean, simple things like that .” Aboriginal Mother. “ So yeah, I feel like there could have been a bit more support definitely. I know it's hard if a baby is not going to latch but still, they could have told me about pumping and helped me around - like oh well at least pump so that your breasts are getting that movement.” Aboriginal Mother. “They gave me – this is what annoyed me too, is they gave me a breast pump and just expected me to know what the hell I was meant to do with it. Like this is my first child, and you just giving me a breast pump. I don’t know how am I meant to learn... Then, it sucked too, because the nurses, every time you tried to do it, get that little bit of privacy to do that, the nurses were in and out, in and out. It's like you are in and out, but you are not here to help me.” Aboriginal Mother. Some participants noted the need to start education prior to pregnancy: “ I’d like to see the young ones become involved with dolls or whatever, you get those type, and how to hold them and breastfeed the and this is the correct way, so it would encourage, one day when they do have their own children, this is the best way and improve slowly about breastfeeding ”. Aboriginal Elder. Ongoing breastfeeding support The need for culturally safe, responsive, hands-on breastfeeding support to Aboriginal women to assist them in their breastfeeding journey was considered crucial to ensure women receive comprehensive breastfeeding support: “There’s got to be that connection because our mums are struggling out there.” Aboriginal Mother “Having that Indigenous person for our women that follow them through maybe could make a change… just stay involved with them until they’re completely comfortable and know that they’re doing the right thing.” Aboriginal mother “[Regarding mainstream breastfeeding phone lines] I don’t think our women are going to access it, which is why I think it’d be so important to have the information that could be someone that’s on-call or there is someone Monday to Friday from these times that can come out and do check-ups.” Aboriginal mother Peer support groups Community-led breastfeeding groups were suggested as a much needed a safe space for Aboriginal women to connect, share their experiences, and support one another, potentially supporting good mental health. “You hear about youth groups and women’s group and mums and bubs and that, but there’s none about pregnancy or breastfeeding or education around that.” Aboriginal Elder. “I guess it’s creating those safe groups… a breastfeeding, a society or group where you can come and talk about the issues that you’re facing or the things that worked for you.” Aboriginal Mother. “I think that would great for women, especially after you’ve had a baby you feel so isolated, and especially for new mums how they go through that transition of becoming a mum, and where they don’t get to see their friends, or their friends don’t come around. I went through that with my first, and then I mean, I don’t know how I got through it, but I got through it. But I see other women that have just had babies and they’re struggling, and they feel really isolated and forgotten about.” Aboriginal Mother. Better access to lactation consultants Participants in the study expressed a need for more access to publicly funded lactation consultants to be based in the hospital and Aboriginal Community Controlled Health Services (ACCHSs) along with greater access to Aboriginal midwives and health workers. “ I think also having the option there so when you’re at pregnancy care and you’re booking in, everyone has to book in, having that conversation and if they say yes, booking in a consult with the lactation nurse or whatever they want to call them.” Aboriginal Mother. “I looked at it with [baby] to have a lactation consultant because it was really painful and I wanted to give it a really good crack, but there was no one available for weeks and then it costs.” Aboriginal Mother. “I think just having somebody that’s there – just when you don’t know, and when they're not, they're pretty much saying, I'm here for you, I can support you, I'm not going to be letting you go and rush off to another patient.” Aboriginal Mother. “If I would’ve got the support from the beginning from when I first had him, and I didn’t understand why there wasn’t a nurse during the weekend and especially in Sydney in a busy hospital, like why do they not have multiple nurses that are educated in this? I reckon I would’ve continued to breast feed him if I was able to get that help from the get go, I reckon he would’ve latched on perfectly. But because I had to wait…” Aboriginal Mother. Equipment and other resources The option of breast pumps to support ongoing breastfeeding with the help of family was discussed, however the high cost of breast pumps and limited knowledge about their use created barriers. It was suggested that breast pumps could be included as part of a breastfeeding support program: “A lot of women probably can’t afford breast pumps to give them a break, so it could be that if they come on as a client, that they can either rent or get a breast pump so that when mum’s tired, I guess she can pump it, then dad can also feed. It’s not just on mum. So, maybe having some supplies.” Aboriginal Mother. The theme of feeling shame when feeding in public was mentioned by many participants, as was the lack of private and hygienic places to breastfeed when out in public. Given this it was suggested that a breastfeeding cover with Indigenous artwork on it could be provided as part of the breastfeeding program. “There’s t-shirts you can get and you open the zip…Is there something we could do in a cultural way, like even just a shirt that tucks back under…something like that so that we can show the girls that they can still be fashionable. For the ones that don’t want to be exposed, that’s just a little bit more of a comfort thing for them.” Aboriginal Mother. Discussion This study highlights the perspectives of Aboriginal women about the importance of breastfeeding and the challenges they experience through their breastfeeding journeys. Access to culturally safe and responsive lactation support was limited, and a need for local community-led programs was highlighted to fill these gaps in resources and support structures for Aboriginal mothers. In this study, Aboriginal women spoke about the importance of intergenerational knowledge transfer between pregnant women and Elders. Participants in this study noted the disruption of breastfeeding practices due to colonisation, which has also been reported in other work [ 34 , 35 ]. Despite this, intergenerational knowledge transfer remains important, a finding which was also highlighted in a study among Indigenous peoples in Canada, where grandmothers cultural breastfeeding teachings continue to pass on knowledge about the health and cultural benefits of breastfeeding to the next generation of Indigenous parents [ 35 ]. Similarly, a study in Australia found that Aboriginal grandmothers had a direct and positive influence on breastfeeding, in comparison to non-Indigenous grandmothers which did not result in a positive effect of breastfeeding [ 36 ]. This highlights the important influence that Aboriginal grandmothers and Elders have on initiation and continuing breastfeeding of Aboriginal women. In this study, there was a clear influence on breastfeeding practices from partners, family, community and workplaces. Women spoke about the influence male partners can have on both initiation and continuation of breastfeeding. This included when a male partner’s family had strong breastfeeding experience and knowledge, and provided a positive influence through passing on that knowledge to the mother, which is consistent with other studies in Aboriginal populations [ 37 ]. These findings highlight the need to include partners and other family members when designing a program to support breastfeeding program, particularly around education. The issue of supporting mothers to continue breastfeeding when they return to work was highlighted in this study. A review reported key factors that enabled breastfeeding in the workplace for mothers. These included: changes in workplace culture, manager support, co-worker support and physical environments, and provision of time. This highlights that for mothers that return to work, workplace policies and context can increase their likelihood of continuing breastfeeding [ 38 ]. While in Australia legislation and policies exist at both the national and state level to support breastfeeding in the workplace [ 39 ], including breaks and areas to breastfeed, this study and other work conducted suggests there is a lack of implementation, and that employees are unaware of their breastfeeding rights [ 40 , 41 ]. Consistent with other studies, while community facilities exist in the local area to allow breastfeeding whilst out in public, participants in this study found them to be unhygienic, particularly given nappy change and toilet facilities were co-located in the same spaces, suggesting the need for a re-think of how the spaces are designed [ 42 ]. One option is lactation pods, which provide privacy without being co-located with toilets [ 43 ]. Findings from this study also suggest that further health promotion work is required to decrease stigma among the general population towards women breastfeeding in public, an issue that has been highlighted in other studies [ 44 , 45 ]. In this study, Aboriginal women spoke about challenges with initiating or continuing to breastfeed [ 46 ]. Consistent with other studies, this was especially the case where either the mother or child experienced other health challenges in pregnancy, during or soon after birth, including gestational diabetes and pre-term birth [ 47 ]. Many participants noted the lack of support whilst in the hospital due to understaffing and the need for beds to be freed up, a finding that has been reported in other studies in Australia [ 48 , 49 ]. Where breastfeeding support was provided participants were often able to initiate breastfeeding. This highlights the importance of both professional and non-professional support and after birth to increase breastfeeding initiation, particularly for those with additional health concerns. A need for more lactation specialists was highlighted in this study. Training pathways and programs can play an important role in equipping Aboriginal Health Workers, Aboriginal Health Practitioners and Midwives with the skills to provide culturally responsive lactation support and will be the focus of future research. There are currently no Aboriginal and Torres Strait Islander-specific lactation training courses available in Australia. Additionally, Aboriginal mothers in this study had experiences of racism and judgement in the hospital at birth and afterwards, highlighting the need for mainstream maternity ward staff to undergo further education and expanded resources to better support breastfeeding to Aboriginal mothers in a culturally safe and responsive way. As prefaced earlier, findings from this study will be used to inform the design and implementation of a holistic breastfeeding program in an Aboriginal community-controlled health service in regional Australia. Participants noted the need for the program to include breastfeeding support once home from the hospital and felt this would be ideally provided by an ACCHS to ensure that the care is culturally responsive. Based on the current lack of culturally responsive breastfeeding support available, ongoing support by a breastfeeding specialist will be a key component of the program being designed and implemented at RivMed. There are already a few examples of culturally responsive maternity care models, such as Birthing on Country, which have resulted in high initiation of breastfeeding [ 21 , 50 ], suggesting that this model has a high likelihood of success. Other important components of a breastfeeding program for Aboriginal women, based on the finding of this study include breastfeeding education to be offered antenatally to post-birth, the facilitation of mother’s groups to support each other through the breastfeeding journey, as well as resources such as breast pumps and covers for discreet breastfeeding. This education has the potential to counter reported perceptions of bottle feeding being easier and more convenient, a finding that has been highlighted here and elsewhere [ 45 ]. Being community-led, this program will align with national guidance from Aboriginal and Torres Strait Islander organisations such as the Lowitja Institute, whose 2025 co-design policy details the importance of genuine co-design in enabling meaningful participation in program development [ 51 ]. Strengths and limitations A strength of the study was that it was led by an Aboriginal Community Controlled Health Service (RivMed), all aspects of the research were led by Aboriginal women with firsthand breastfeeding experiences and living in the same community as the participants. This relationality is vital in Aboriginal and Torres Strait Islander research and supported trusting and open engagement with participants. The interviews were conducted by Aboriginal women which provided a more comfortable interaction between the interviewer and interviewee, and a higher level of cultural understanding between them. A limitation is that this study was conducted in one regional Aboriginal community and may not be generalisable to other communities especially those in remote or urban areas. There is also potential for recall bias for mothers yarning about their breastfeeding practices with one or more babies born five or more years ago. Recommendations Breastfeeding is not on the national agenda, even though the evidence is clear on the short and long-term health and wellbeing benefits it has for mother and baby, therefore, it should be prioritised and incorporated into government-funded projects within Close the Gap initiatives for improved outcomes, as well as into the National Aboriginal and Torres Strait Islander Health Plan [ 52 , 53 ]. It is a human right that all women have access to culturally responsive and safe lactation care. However, this is not the case in Australia where there are currently no Aboriginal and Torres Strait Islander lactation training pathways. Urgent action and investment are required to develop lactation training pathways that are grounded in Aboriginal and Torres Strait Islander ways of knowing, being and doing. This is foundational to develop an Aboriginal and Torres Strait Islander lactation workforce and to support the upskilling of Aboriginal Health Practitioners/Workers, Midwives and General Practitioners in ACCHSs, community health care and hospital settings. Conclusion This study highlights the perspectives and experiences of Aboriginal women living on Wiradjuri Country about their breastfeeding journeys and support programs required. Although breastfeeding is a natural biological process, it is a two-way learning for mother and baby and requires support and the right people to provide the teachings on how to breastfeed. Aboriginal women shared that they wanted to breastfeed their babies but often lacked the support to do so. Yalbilinya Miya highlights a community-led research project and the importance of breastfeeding programs that are responsive to the needs of Aboriginal and Torres Strait Islander women. RivMed will use these results to design, implement and evaluate a holistic breastfeeding program to support local Aboriginal women to initiate breastfeeding and achieve their goals. Through the development of culturally grounded supports the program will empower Aboriginal women to reclaim breastfeeding practices for the next generations. Abbreviations ACCHS Aboriginal Community Controlled Health Service NACCHO National Aboriginal Community Controlled Health Organisation NICUs Neonatal Intensive Care Units NSW New South Wales RivMed Riverina Medical and Dental Aboriginal Corporation Declarations Ethics approval and consent to participate Approval was provided by the Aboriginal Health & Medical Research Council NSW Human Research Ethics Committee (2132/23). Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was funded by a Lowitja Institute Major Grant (2023–2025). Author Contribution SS, KW, NS conceived the study. SS, KW, NS, HH, AH, RF designed the study materials, SS, HH, JN and DK conducted the data collection, SS, DK, BW and AB coded the data, and SS, HH, DK, BW, AB, JN developed the themes from the coded data. DK, SS, SG, CR, FM, BW and AB collectively wrote manuscript, all authors contributed to manuscript revisions. The author(s) read and approved the final manuscript. Acknowledgements Yalbilinya miya in the title of this paper is in Wiradjuri language and means ‘learn together’. We would like to acknowledge the Traditional Custodians ‘the Wiradjuri peoples’ of the lands in which this research was conducted and pay our respects to their Elders past and present. We would also like to thank all of the community members and stakeholders who participated in this project, without whom this research would not have been possible. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Adams K, Faulkhead S, Standfield R, Atkinson P. Challenging the colonisation of birth: Koori women's birthing knowledge and practice. Women Birth. 2018;31(2):81–8. Gracey M. Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children. Am J Clin Nutr. 2000;72(5 Suppl):S1361–7. Khan J, Vesel L, Bahl R, Martines JC. Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity–a systematic review and meta-analysis. Matern Child Health J. 2015;19(3):468–79. WHO, Breastfeeding. World Health Organisation; 2018 [Available from: https://www.who.int/news-room/facts-in-pictures/detail/breastfeeding Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007(153):1–186. Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016;28(1):7–14. Masi AC, Stewart CJ. Role of breastfeeding in disease prevention. Microb Biotechnol. 2024;17(7):e14520. COAG Health Council. Australian National Breastfeeding Strategy: 2019 and beyond. 2019. WHO. Global Targets. 2025: To improve maternal, infant and young child nutrition. 2014. AIHW. Australia's mothers and babies: Breastfeeding. 2024. NATIHS. Breastfeeding practices: National Aboriginal and Torres Strait Islander Health Survey. 2019 [Available from: https://www.indigenoushpf.gov.au/measures/2-20-breastfeeding-practices#references Ryan F, Kanyininpa (Holding), editors. A Way of Nurturing Children in Aboriginal Australia. Australian Social Work. 2011;64(2):183 – 97. Springall TL, McLachlan HL, Forster DA, Browne J, Chamberlain C. Breastfeeding rates of Aboriginal and Torres Strait Islander women in Australia: a systematic review and narrative analysis. Women Birth. 2022;35(6):e624–38. ABS, Breastfeeding Canberra. Australian Bureau of Statistics; 2022 [Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/breastfeeding/latest-release Aboriginal ABS. and Torres Strait Islander life expectancy: Australian Bureau of Statistics; 2023 [Available from: https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/aboriginal-and-torres-strait-islander-life-expectancy/latest-release Mitchell F, Walker T, Hill K, Browne J. Factors influencing infant feeding for Aboriginal and Torres Strait Islander women and their families: a systematic review of qualitative evidence. BMC Public Health. 2023;23(1):297. Salmon M, Doery K, Dance P, Chapman J, Gilbert R, Williams R, Lovett R. Defining the indefinable: Descriptors of Aboriginal and Torres Strait Islander Peoples’ cultures and their links to health and wellbeing. 2018. Clarkson C, Jacobs Z, Marwick B, Fullagar R, Wallis L, Smith M, et al. Human occupation of northern Australia by 65,000 years ago. Nature. 2017;547(7663):306–10. Trzepacz D, Guerin B, Thomas J. Indigenous Country as a context for mental and physical health: Yarning with the Nukunu Community. Australian Community Psychol. 2014;26(2):38–53. Watkin Lui F. My island home: re-presenting identities for Torres Strait Islanders living outside the Torres Strait. J Australian Stud. 2012;36(2):141–53. Kildea S, Gao Y, Hickey S, Nelson C, Kruske S, Carson A, et al. Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial. Lancet Global Health. 2021;9(5):e651–9. Lowell A, Kildea S, Liddle M, Cox B, Paterson B. Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program. BMC Pregnancy Childbirth. 2015;15(1):19. Foley W, Schubert L, Denaro T. Breastfeeding experiences of Aboriginal and Torres Strait Islander mothers in an urban setting in Brisbane. Breastfeed Rev. 2013;21(3):53–61. Craig PL, Knight J, Comino E, Webster V, Pulver LJ, Harris E. Initiation and duration of breastfeeding in an aboriginal community in south western Sydney. J Hum Lactation. 2011;27(3):250–61. Zheng CX, Atchan M, Hartz D, Davis D, Kurz E. Factors influencing Aboriginal and Torres Strait Islander women’s breastfeeding practice: A scoping narrative review. Women Birth. 2022. Varcoe C, Bottorff JL, Carey J, Sullivan D, Williams W. Wisdom and influence of elders: possibilities for health promotion and decreasing tobacco exposure in First Nations communities. Can J Public Health. 2010;101(2):154–8. Busija L, Cinelli R, Toombs MR, Easton C, Hampton R, Holdsworth K, et al. The Role of Elders in the Wellbeing of a Contemporary Australian Indigenous Community. Gerontologist. 2018;60(3):513–24. Matriano MG, Ivers R, Meedya S. Factors that influence women’s decision on infant feeding: an integrative review. Women Birth. 2022;35(5):430–9. Rowley C, Kalucy D, Honeysett H, Brown T, Elliott-Rudder M, Finlay SM, et al. Yalbilinya Miya (learn together): community-led program to support Aboriginal and Torres Strait Islander women through their breastfeeding journey-a protocol. BMJ Open. 2025;15(5):e096288. Bessarab D, Ng'Andu B. Yarning about yarning as a legitimate method in Indigenous research. Int J Crit Indigenous Stud. 2010;3(1):37–50. Moreton-Robinson A, Relationality. A Key Presupposition of an Indigenous Social Research Paradigm. Sources and Methods in Indigenous Studies. United Kingdom: Routledge. 2017:69–77. Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide 149. Med Teach. 2023;45(3):241–51. Wilson S. Research is ceremony: Indigenous research methods. Black Point. NS, Canada: Fernwood Publishing; 2008. p. 144. Helps C, Barclay L. Aboriginal women in rural Australia; a small study of infant feeding behaviour. Women Birth. 2015;28(2):129–36. Taylor G. Healthy Pregnancies and Beyond: Exploring the Experience and Teachings of Indigenous Grandmothers to Promote the Health of Future Generations of Indigenous people in Alberta. University of Alberta; 2023. Karthigesu SP. The perceived influence of grandparents’ beliefs and attitudes on parents’ breastfeeding behaviour and paediatric vaccination decisions. Edith Cowan University; 2020. Springall TL, McLachlan HL, Forster DA, Browne J, Chamberlain C. Factors associated with breastfeeding initiation and maintenance for Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis. Women birth: J Australian Coll Midwives. 2023;36(2):224–34. Litwan K, Tran V, Nyhan K, Perez-Escamilla R. How do breastfeeding workplace interventions work? a realist review. Int J Equity Health. 2021;20(1):148. Australian Breastfeeding Association. Breastfeeding and Work: Your rights at work. 2022. Australian Breastfeeding Association. Submission from the Australian Breastfeeding Association to the Senate Select Committee on Work and Care. 2022. Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, et al. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promotion J Australia. 2022;33(1):151–61. Hauck YL, Kuliukas L, Gallagher L, Brady V, Dykes C, Rubertsson C. Helpful and challenging aspects of breastfeeding in public for women living in Australia, Ireland and Sweden: a cross-sectional study. Int Breastfeed J. 2020;15(1):38. Fredrickson ME, Boyle J, Cober MP, King CA. A Call to Action for Lactation Support at Colleges of Pharmacy. Am J Pharm Educ. 2022;86(8):ajpe8693. Eni R, Phillips-Beck W, Mehta P. At the Edges of Embodiment: Determinants of Breastfeeding for First Nations Women. Breastfeed Med. 2014;9(4):203–14. Helps C. Exploring Infant Feeding Choices in the Northern NSW Aboriginal Community. 2014. Cohen SS, Alexander DD, Krebs NF, Young BE, Cabana MD, Erdmann P, et al. Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis. J Pediatr. 2018;203:190–6. e21. Chamberlain CR, Wilson AN, Amir LH, O'Dea K, Campbell S, Leonard D, et al. Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia. Aust N Z J Public Health. 2017;41(2):144–50. Gleeson D, Flowers K, Fenwick J. Midwives’ Time and Presence: A Key Factor in Facilitating Breastfeeding Support for New Mothers. Int J Childbirth. (4):219–27. James L, Sweet L, Donnellan-Fernandez R. Breastfeeding initiation and support: A literature review of what women value and the impact of early discharge. Women Birth. 2017;30(2):87–99. Springall T, Forster DA, McLachlan HL, McCalman P, Shafiei T. Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study. BMJ Open. 2023;13(1):e066978. Butler T, Anderson K, Black O, Ball A, Ngampromwomgse K, Murray R, et al. Co-design versus faux-design of Aboriginal and Torres Strait Islander health policy: a critical review. Lowtija institute; 2025. Australian Government. National Aboriginal and Torres Strait Islander Health Plan 2013–2023. Commonwealth of Australia 2013. Coalition of the Peaks. National Agreement on Closing the Gap. Australian Government; 2020. Additional Declarations No competing interests reported. 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05:27:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1133773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7540878/v1/832cac8a-08d8-4772-8f35-8f9aeef7897d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Yalbilinya miya (learn together): Privileging the voices of Aboriginal mothers and Elders to develop a community-led breastfeeding program","fulltext":[{"header":"Background","content":"\u003cp\u003eAboriginal and Torres Strait Islander women have been breastfeeding their children as an important cultural practice for 65,000 years [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], often for four years and beyond. Breastfeeding is recognised as the ideal source of nutrition for newborns and infants, and reduces the risk of childhood conditions such as sudden infant death syndrome, gastrointestinal infections, respiratory infections, ear infections, obesity and type 1 diabetes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Breastfeeding also provides long-term health benefits for children who received breastmilk, such as a reduced risk of type 2 diabetes, leukemia and cardiovascular diseases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. For mothers breastfeeding has health benefits such as reduced postpartum bleeding, reduced risk of postnatal depression, lower risk of type 2 diabetes and reduced risk of breast and ovarian cancer [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months, and then breastfeeding with solid foods for at least two years [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and has set a target of 50% of women exclusively breastfeeding for six months [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In Australia, the National Breastfeeding Strategy has adopted strength-based approaches to achieve improvements in breastfeeding to these targets[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although a deficit approach is often used to describe Aboriginal and Torres Strait Islander breastfeeding rates, national data shows that 83.4% of First Nations infants aged 0\u0026ndash;3 years have ever received breastmilk [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, there is a steep decline in breastfeeding rates among Aboriginal and Torres Strait Islander children with only 26.9% of infants being exclusively breastfed for at least 6 months. In a 2022/2023 report New South Wales (NSW) had the lowest rates of exclusive breastfeeding with only 22.1% of Aboriginal and Torres Strait Islander infants receiving breastmilk exclusively for at least 6 months [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBreastfeeding practices among many Aboriginal and Torres Strait Islander women have been disrupted by colonisation, including the Stolen Generations, continuing high rates of child removals, intergenerational trauma, racism, disruption of family structures, and other socioeconomic injustices [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These injustices have resulted in a reduction of initiation and duration of breastfeeding which has contributed to the gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Aboriginal and Torres Strait Islander people have unique and holistic views of health and wellbeing differing from the dominant western medical model [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A significant part of this has been cultural breastfeeding practices that have been passed down between generations for thousands of years [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Health encompasses environmental and spiritual health, social and emotional wellbeing, connection to Country, community, and culture; all are equally as important and intrinsically connected [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Availability of culturally safe and responsive maternal care for Aboriginal and Torres Strait Islander women and their families increases the likelihood of Aboriginal and Torres Strait Islander women continuing to breastfeed [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrograms that enable Aboriginal and Torres Strait Islander women to engage in cultural practices such as smoking ceremonies after birth with ongoing cultural support through access to culturally safe spaces, while guiding and supporting breastfeeding, contribute to better breastfeeding outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Early breastfeeding support and education that is culturally responsive, including programs for smoking cessation and fostering positive breastfeeding support from their partners and family, enable Aboriginal and Torres Strait Islander women [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The important role of Elders in providing health and wellbeing support and education has been acknowledged [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Aboriginal and Torres Strait Islander women who live in regional or remote compared with urban areas have higher rates of breastfeeding initiation and duration. Higher rates of initiation and duration of breast feeding are associated with higher maternal education and being 25 years or older [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Focusing on Aboriginal and Torres Strait Islander women\u0026rsquo;s perspectives, lived experiences and factors influencing infant feeding decisions may provide a clearer understanding on the social determinants that impact breastfeeding initiation.\u003c/p\u003e\u003cp\u003eIntentions to initiate and continue breastfeeding are complex. There is a strong need for policy and strategy implementation that focuses on guidance and education for mothers within their social network to enable them to feel safe and supported [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. There is limited evidence on the barriers and facilitators of breastfeeding practices among Aboriginal and Torres Strait Islander women living in regional areas in New South Wales (NSW), Australia [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Further, there is little research regarding culturally safe and responsive supports available which encourage exclusive breastfeeding among Aboriginal and Torres Strait Islander women [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. At the same time, there is a need for evidence-based culturally responsive breastfeeding support programs for Aboriginal and Torres Strait Islander women and families [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. To fill this gap in knowledge we collaborated with a local Aboriginal Community-Controlled Health Service (ACCHS) on Wiradjuri Country (regional NSW) to gather breastfeeding knowledge and experiences among local Aboriginal and Torres Strait Islander women to inform a community-led pilot breastfeeding program aiming to use resources and supports that Aboriginal women want, to empower women to reclaim breastfeeding practices to ensure this knowledge is passed onto our future generations and to give Aboriginal and Torres Strait Islander babies the best start to life.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eIndigenous theoretical approach\u003c/h2\u003e\u003cp\u003eThe project protocol and methods have been published previously [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This study used an Indigenous qualitative method of Yarning to provide a respectful platform for Aboriginal and Torres Strait Islander ways of knowing, being and doing to be privileged [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Using an \u0026lsquo;Indigenist\u0026rsquo; lens by Rigney, all aspects of this research were led by Aboriginal and Torres Strait Islander peoples with responsibility to their communities and \u0026ldquo;privileging Indigenous voices in Indigenist research\u0026rdquo;. This ensured the lived experiences and unique perspectives of Aboriginal and Torres Strait Islander women on breastfeeding were prioritised within an academic space [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Additionally, we used Indigenist theory to centre self-determination and \u0026ldquo;supports the right of Indigenous peoples to govern themselves and make decisions about their own lives and communities\u0026rdquo;[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThe research was conducted on unceded Wiradjuri Country in Wagga Wagga, a large regional area which is situated in NSW. The study was based at the Riverina Medical and Dental Aboriginal Corporation (RivMed) which is the local Aboriginal Community Controlled Health Service (ACCHS), governed by a board of community elected local Aboriginal people. ACCHSs provide culturally safe holistic services and programs to the local communities. These include cultural, spiritual, emotional, psychological, and physical wellbeing into their practices, in addition to the Western biomedical view of health. ACCHSs are run by Aboriginal and Torres Strait Islander peoples and were established to overcome the barriers Aboriginal and Torres Strait Islander peoples face when accessing mainstream health services.\u003c/p\u003e\n\u003ch3\u003ePositionality of the Research team\u003c/h3\u003e\n\u003cp\u003eThe positioning of Aboriginal women with firsthand experience of breastfeeding who also live and work in the study location has been incorporated into the study design through co-constructed knowledge [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This relationality is vital to Aboriginal and Torres Strait Islander ways of knowing, being and doing, specifically for this project, and ensured strong and trusted relationships and high engagement with the project. The first author is a mother with personal breastfeeding experiences and has worked in Aboriginal health for over 10 years with ACCHSs. The last author is a Wotjobaluk Aboriginal woman, researcher and mother with personal breastfeeding experiences. The project team included Aboriginal women with personal breastfeeding knowledge and experiences (SS, KW, HH, AH, SMF NS, JN, MD, GS), an Aboriginal male public health researcher (SG), two Aboriginal researchers studying medicine or public health (CR, BW), non-Aboriginal researchers and clinicians with maternal and child health, lactation, medical, nursing and midwifery, public health, and nutrition qualifications, and qualitative methods experience (DK, SN, PL, RF, M-ER, AB). Most of the project team are based on Wiradjuri Country (Wagga Wagga) (SS, HH, KW, AH, PL, NS, M-ER, RF) working in or with the ACCHS.\u003c/p\u003e\n\u003ch3\u003eParticipant selection and recruitment\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited through RivMed by the Aboriginal research coordinator (HH) via phone or in person at the clinic and were invited for an individual Yarn or a Yarning Circle. Aboriginal mothers were eligible if they were patients of RivMed, had a baby in the last five years and provided written informed consent. Aboriginal women were purposively selected to ensure that there was a range of breastfeeding experiences and ages. Female Aboriginal Elders were also contacted via phone or in person at RivMed by the Aboriginal research coordinator (HH) to be invited in for a one-on-one yarn or a yarning circle. They were eligible if they had personal breastfeeding experience, had supported other Aboriginal women in their breastfeeding journey and had provided written informed consent.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eQualitative research using Yarning methodology was conducted by four female researchers (SS, HH, JN, DK), three of whom were Aboriginal women (SS, HH, JN), between September and November 2023. Yarning sessions were conducted face-to-face at RivMed or at the participant\u0026rsquo;s home. To ensure a culturally safe and respectful environment for the Yarns, the community decided the sessions were women\u0026rsquo;s business, so all people present were female. All but one person present for the Yarning sessions were Aboriginal (DK). Yarning guides were developed to prompt Aboriginal mothers and Elders to reflect on their own perceptions, experiences, and any challenges that they faced during breastfeeding or supporting Aboriginal women with breastfeeding. Aboriginal mothers and Elders were also asked what breastfeeding supports they have accessed or have knowledge about in the community, and what other support would have been beneficial throughout their own or other women\u0026rsquo;s breastfeeding journey. Participation in the study was voluntary and informed written consent was obtained prior to the yarn being conducted. Participants also consented for yarns to be audio-recorded and transcribed verbatim.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eFour authors (SS, DK, BW, AB) independently read all transcripts and coded the information using inductive reasoning. A thematic analysis was conducted by SS and DK based on grounded theory using NVivo 14.23.2 (46). The themes were reviewed and refined during workshops held with six of the authors (SS, HH, DK, BW, AB, JN).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eOverall, 20 Aboriginal women participated; 15 mothers with a child/children aged under five years and five Elders. Five participants were aged less than 30 years, 10 were between 31\u0026ndash;45 years and five were over 45 years of age. All participants had given birth to at least one child. 18 out of 20 (90%) participants had breastfeeding experience (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Participant characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant characteristics (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAboriginality\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAboriginal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTorres Strait Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eParticipant type\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAge group\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePregnancies\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEver breastfed\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThemes arising from the Yarning were: 1) intergenerational knowledge transfer; 2) influences of partner, family, community and workplace on breastfeeding; 3) challenges with initiating or continuing breastfeeding; and 4) the need for culturally responsive, community-led supports.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eTheme 1: Intergenerational Knowledge Transfer\u003c/h2\u003e\u003cp\u003eAmong our participants breastfeeding was considered an important health practice:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I know my son could have been way more sick than if I wasn\u0026rsquo;t breastfeeding. He was a healthy baby\u003c/em\u003e\u0026rdquo;. Aboriginal mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003eIt\u0026rsquo;s good for bubs as well. Yeah, there's so many benefits that they can get from it.\u003c/em\u003e Aboriginal mother.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eParticipants in our study viewed breastfeeding as fostering a strong bond and attachment between mother and baby and deeply rooted in Aboriginal culture.\u003c/p\u003e\u003cp\u003e\u003cem\u003eThat made me connect with her because I had that bond with the breastfeeding, so it was connection and bonding\u003c/em\u003e. Aboriginal mother.\u003c/p\u003e\u003cp\u003eFamily members spoke of passing on breastfeeding knowledge and supporting each other to breastfeed as well as women breastfeeding each other\u0026rsquo;s babies, as described by one mother:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;As a Wiradjuri woman we have been breastfeeding for thousands of years, it\u0026rsquo;s part of who we are. My Aunties would share stories of how their mothers and aunties would share the responsibility of breastfeeding and take care of each other\u0026rsquo;s children. This links in with us being culturally responsible for our nieces and nephews as if they were our own\u0026rdquo; Aboriginal mother\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIt was noted that impacts of colonial policies, such as the Stolen Generations and the ongoing high rates of child removal have disrupted intergenerational knowledge sharing in Aboriginal families and communities, impacting the ability to pass on important breastfeeding practices for some women, making it more difficult for Aboriginal women to breastfeed. This has also meant that many Aboriginal women do not have breastfeeding mentors within their families to provide guidance, encouragement, and practical support. Without these mentors, it was reported that new mothers can feel isolated and unsure of how to navigate breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Well, yeah, see I didn't have a lot of support like with my mum and things like that either so I didn't really have anyone showing me how to do things properly.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eParticipants felt that Aboriginal Elders, as respected knowledge holders, should be recognised and prioritised within health settings as key figures in passing on breastfeeding expertise to new mothers. Their lived experiences and cultural wisdom were considered invaluable in supporting and empowering the next generation. The sharing of breastfeeding stories was considered a powerful way to reclaim cultural practices that are at risk of being lost. These narratives help to preserve traditional knowledge and instill confidence in young Aboriginal mothers. As one Aboriginal mother shared:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Our Elders are our knowledge holders and leaders; they hold so many stories and wisdom around breastfeeding and should be engaged in programs to support our women to breastfed.\u0026rdquo;\u003c/em\u003e Aboriginal mother.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2: Influences of partner, family, community and workplace on breastfeeding\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003eThe role of family\u003c/h2\u003e\u003cp\u003eThe perceptions and attitudes of partners and family members were reported to play a critical role in shaping a mother\u0026rsquo;s decision to breastfeed. When those closest to her are supportive and informed, mothers were thought to be more likely to initiate and continue breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My mum breastfed all of us. I think that\u0026rsquo;s also \u0026ndash; I\u0026rsquo;ve seen it around all the women in my life, so it was just like no different. Breastfeeding was a thing in my family\u0026hellip;I think I just knew no different.\u0026rdquo;\u003c/em\u003e Aboriginal mother\u003c/p\u003e\u003cp\u003eSimilarly, when there is limited breastfeeding knowledge in the family, it is difficult to support new mums in their breastfeeding journey.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;You don\u0026rsquo;t know what you\u0026rsquo;re doing until you are put in the situation, and then it's good to have somebody that understands what's going on with your body and your baby, and to know \u0026ndash; because you don\u0026rsquo;t know if \u0026ndash; how their mouth is supposed to be when it's latching on.\u0026rdquo;\u003c/em\u003e Aboriginal Mother\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003ePartner influence\u003c/h2\u003e\u003cp\u003eSeveral participants told of how their partners and their families had knowledge of the benefits of breastfeeding and were actively supportive of breastfeeding:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My partner was very adamant, you're breastfeeding. It's best. Breast is best.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My mother-in-law breastfed because all of my - me and my siblings were bottle fed so my mum didn't really know anything, but my mother-in-law breastfed all her kids till over two years old so she was a big help.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eA clear need for increased education for partners and broader support networks about the benefits of breastfeeding and the practical ways they can assist mothers in their journey was highlighted.\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eIf your partner doesn\u0026rsquo;t understand the benefits of breastfeeding or want to support you that could make it hard to breastfeed as well. So they\u0026rsquo;ve got to be educated, if your breasts fill up too quick, like mastitis comes along and just little things like that. They only involved them when they go up for labour lessons.\u003c/em\u003e\u0026rdquo; Aboriginal Elder.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eNormalising Breastfeeding in the Community\u003c/h2\u003e\u003cp\u003eMany women in the study expressed feelings of shame when breastfeeding in public due to societal stigma and the lack of private, comfortable spaces.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003ePeople they may get a bit hostile sometimes and you have to cover yourself up when you pull out, you know, your boob to feed a bub in a restaurant, and whether the restaurant \u0026ndash; some will allow it or cafes or whatever, some may allow it and some may not and you may have to [breastfeed] elsewhere and it\u0026rsquo;s very hard in that way.\u003c/em\u003e\u0026rdquo; Aboriginal mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I have four kids as well\u0026hellip; I was also a very young mum. I had my first when I was 17. I breastfed her for probably about a month and was shamed downtown so I stopped.\u0026rdquo;\u003c/em\u003e Aboriginal mother.\u003c/p\u003e\u003cp\u003eCurrent facilities in the local area were considered inadequate, making it difficult for mothers to feed their babies with dignity and ease.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I don\u0026rsquo;t want to breastfeed my baby where they change the shitty nappies. So, I do bottles when I\u0026rsquo;m out and about.\u0026rdquo;\u003c/em\u003e Aboriginal mother.\u003c/p\u003e\u003cp\u003eSome participants experienced judgement when breastfeeding into the toddler years:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;One thing I didn\u0026rsquo;t like when people found out I was still breastfeeding, the judgement. It was like what? What do you mean? My mum did for like years. I just think why not?\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eOne participant spoke of the need to make breastfeeding more visual in the community again to normalise it and empower our next generation to breastfeed:\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If we start seeing it more in society, it\u0026rsquo;s just come a societal thing... I don\u0026rsquo;t want it to get to the point where no one\u0026rsquo;s breastfeeding\u0026rdquo;.\u003c/em\u003e Aboriginal Elder.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eWorkplace and Public Policy Support\u003c/h2\u003e\u003cp\u003eParticipants noted a significant gap in workplace policies that support breastfeeding mothers. Women returning to work often lacked access to paid time to travel to childcare to breastfeed or to express milk.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I'm like, well, am I able to get leave to go and feed my son and then come back? Because the daycare were happy with it. They had a room where you could go and breastfeed your child and then you could just leave. But yeah, it was the whole getting away from work.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eBalancing the benefits of breastfeeding and the pressures of motherhood\u003c/h2\u003e\u003cp\u003eWhile the health and financial benefits of breastfeeding were recognised, many participants struggled to balance these with the demands of motherhood. The perception that breastfeeding is easy was thought to be undermining of the real challenges women face, leading to feelings of shame and failure when they cannot continue.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I guess it's other people\u0026rsquo;s opinion, and how they try and push that thing like, it's the healthiest way. It's the healthiest thing. I agree, it is the best thing, but some mothers can\u0026rsquo;t do it\u0026hellip; and then you get, basically, shamed for not being able to \u0026ndash; your body is not able to do what it's supposed to do. So, I think that\u0026rsquo;s a barrier and you feel like a failure.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Breastfeeding is very hard. It\u0026rsquo;s not just a given thing. You have to work with your baby to get them on attached, knowing their signs and symptom as well \u0026ndash; it is hard work.\u0026rdquo;\u003c/em\u003e Aboriginal Elder.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003ePerceived convenience of bottle-feeding\u003c/h2\u003e\u003cp\u003eSeveral participants highlighted the perception that bottle-feeding was considered more convenient, particularly by the younger generation:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I sort of just was on my own and doing it on my own, so yeah, I just - it was just easier to just bottle feed. It was easier to pick it up and do it that way.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;But I think that this generation and society... like they\u0026rsquo;re young, so for them it\u0026rsquo;s like, well, the bottle\u0026rsquo;s convenient\u003c/em\u003e.\u0026rdquo; Aboriginal Elder.\u003c/p\u003e\u003cp\u003eOthers noted that the desire for partners or family members to help feed the baby was a driver of deciding to bottle-feed:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think that needs to be done more with the younger ones ... because they\u0026rsquo;re still growing up, they want to go out, they want to party. Most times out of 10, they\u0026rsquo;re still home with their mum, so that family will support them in the way that [bottle-feeding] \u0026ndash; but it\u0026rsquo;d be nice if they did [breastfeed], even if it was expressing and then giving it through the bottle.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3: Challenges with initiating or continuing breastfeeding\u003c/h2\u003e\u003cp\u003eSeveral women shared feelings of frustration and failure when they struggled to breastfeed, noting the need for culturally responsive support in the initial stages post-birth. As the participants reflected:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Breastfeeding is meant to be this natural, easy thing of just pop bub on the tit and go, but this isn\u0026rsquo;t the reality for many of our women.\u0026rdquo;\u003c/em\u003e Aboriginal Elder.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;They kind of just chucked the baby on and it\u0026rsquo;s up to you to figure it out... It\u0026rsquo;s all very rushed over there [at the hospital]. It feels like no one gives you the time. It\u0026rsquo;s just like we\u0026rsquo;re a number in the hospital. But if a woman wants to breastfeed, that\u0026rsquo;s like \u0026ndash; you teach her, you know?\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;A lot of women beat themselves up, because they\u0026rsquo;re like, I want to breastfeed, but I don\u0026rsquo;t know how.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eThe need for support to initiate breastfeeding in the early stages was particularly evident for young mothers:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn't breastfeed. I have four children. I had my first one very young so I felt like maybe they didn't support a lot. They sort of just tried on me for maybe five minutes and then that was it, and I just switched off and I was like no, I'm just going to bottle feed. Then so having more kids, it was easier to just bottle feed but I think I probably would have liked the experience to breastfeed one of them, but I struggled a lot with latching and things like that\u003c/em\u003e.\u0026rdquo; Aboriginal Mother.\u003c/p\u003e\u003cp\u003eHowever, mothers who had previously given birth also noted the need for support:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The nurse was like oh, you have three kids already, you'll be fine\u0026hellip;But we have six years [between children], so it's like all brand new. I feel like I'm starting again and I felt like we were just rushed out because I have other kids. It's like, you're fine, you can go on your way and I was like, I'm really struggling because I don't have family out here. It's just me and my partner, so yeah, I felt very isolated I suppose at that time.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eAdditional challenges that were highlighted included tandem feeding, and concerns about low milk supply, often influenced by clinical monitoring of baby weight, contributed to anxiety in a number of participants.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;With her she didn't gain. She lost a lot of her weight and then didn't gain any because we were having struggles with feeding and the nurse booked another appointment and was coming back the next week but still didn't support around breastfeeding because she wasn't gaining weight therefore something was wrong.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eWomen with mental health concerns often felt that breastfeeding was not a viable option, fearing it would negatively impact their social and emotional wellbeing and ability to breastfeed.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I was really scared of mastitis too but I \u0026ndash; because I got mental health problems, I\u0026rsquo;ve got anxiety. I was like, ah, I don\u0026rsquo;t know if I can do it [breastfeeding]\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eSimilarly, women using alcohol or other drugs believed they could not breastfeed at all and were unaware of the supports available to help them do so safely.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I still felt bad about smoking because I'm like, baby's getting it through the breast milk. It's like, alcohol would go through you, so I assume nicotine would. That's what I just assumed. I felt bad.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eHealth complications during and after birth exacerbating challenges\u003c/h2\u003e\u003cp\u003eIt was highlighted that mothers and babies who experience health complications during pregnancy or birth face additional challenges in establishing breastfeeding, often due to being separated from their baby, limiting opportunities for feeding and bonding. Some participants shared stories where complications during and after birth resulted in them being separated from their baby and receiving minimal opportunity and support to breastfeed.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We had a lot of latching problems at the start when she - she was born too quick so I didn't get that first couple of hours with her because she was in NICU and we had latching problems for the next two days so we didn't really get that connection.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Because I had certain anaesthesia I couldn't breastfeed and then they wouldn't let the baby come down so it was a bit\u0026hellip;for four days we were separated and I wasn't allowed to pump.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Even positioning him, because I had a C-section, it was like, how do I do this where I'm not hurting me, and he\u0026rsquo;s comfortable and I'm comfortable?\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eIt was considered essential to empower new mothers with choices and provide support for expressing milk if they are separated from their baby. It was also suggested that hospital staff require more training on how to support breastfeeding in these circumstances, including when babies are in neonatal intensive care units (NICUs).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eThe importance of appropriate breastfeeding support services\u003c/h2\u003e\u003cp\u003eIt was reported by some participants that the Western clinical model of birthing often does not support breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[Breastfeeding] It used to be much more sacred. It takes away from the spiritual side of pregnancy and birth and it\u0026rsquo;s all medical. It shouldn\u0026rsquo;t be like that... that\u0026rsquo;s when all the interventions come in\u0026rdquo;.\u003c/em\u003e Aboriginal Elder.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDue to chronic understaffing, women often felt rushed and unsupported, with little time to establish breastfeeding before discharge.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn't really use the hospital. I feel like they kicked me out after I gave birth\u0026hellip; [baby] wasn't even 24 hours old and I'm sitting in the waiting room waiting to be picked up because they needed my bed.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I was a first-time mum, I knew nothing, but they never ever came around to ask, are you breastfeeding? They never ever talked about breastfeeding.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I thought I was doing it right, when I wasn\u0026rsquo;t. But I had no guidance because the nurse wasn\u0026rsquo;t there, and all the other nurses were too busy, and they had no idea.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFurther, many women reported feeling judged, unsafe, or had experienced racism from mainstream nurses and midwives during hospital care and home visits. One mother noted regarding the midwife home visits:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I totally felt judged. I would clean the house up and try and hide all the mess\u0026hellip; I feel like maybe if they were Aboriginal workers or something, if they were Aboriginal, I wouldn't have felt as judged. I was like, I don't really like this\u003c/em\u003e.\u0026rdquo; Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese experiences, coupled with fears of child removal by the Department of Community and Justice (DCJ), added significant stress during the postpartum period, but also made new mothers less willing to ask for assistance with issues such as breastfeeding.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I said to her straight out, in front of all the medical practitioners and that, DCJs and what - why are you favouring my daughter for and why do I gotta book to see my daughter\u0026hellip; you\u0026rsquo;re going to do a Stolen Generation again? I said, it ain\u0026rsquo;t happening\u0026hellip; Soon as I got her to 2.2 [kg] she was out of there. I got DCJ to help me to get her out. I was not leaving her in there.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eParticipants highlighted that breastfeeding is a mutual learning process between mother and baby, and this journey must be given the time and space it deserves. Some mothers reported receiving good support and advice in hospital, which had resulted in them being able to successfully breastfeed.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I'd come back from the surgery and stuff with [baby], they were like, okay, we're going to try and breastfeed him. I'm like, there's nothing in there. They're like, no, just let him and he'll get it going. Yeah, he did it\u0026hellip;I don't know if it was a midwife or a nurse that came round and was helping with it to make sure that he was latched properly. That's why I was like, it hurts. She's like, well, he's not latched properly\u0026hellip; I ended up getting chapped nipples and stuff, so when the nurse came over, she gave me some creams to get - she gave me some samples and then I went and got the cream from the chemist. She was helpful in that way.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eIt was noted that breastfeeding challenges can arise at any time, yet culturally safe support is often unavailable outside of standard business hours. Many women in the study did not feel comfortable accessing mainstream services such as the Australian Breastfeeding Association phoneline. Another mother shared her experience:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;After trying to teach myself how to breastfeed my newborn son, I was left with cracked and bleeding nipples and the feeling of failure. I was in pain, I was crying, and I had nowhere to go.\u0026rdquo;\u003c/em\u003e Aboriginal mother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4: The need for culturally responsive, community-led education and supports\u003c/h2\u003e\u003cp\u003eA holistic, community-led approach to breastfeeding support was desired, which moves away from Western clinical models and centres around Aboriginal ways of knowing and being. Participants considered the following education and supports to be beneficial in assisting new mothers on their breastfeeding journeys.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;d be good to have something there specifically for the Indigenous women - like a one-on-one that follows them through.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eEducation and information\u003c/h2\u003e\u003cp\u003eParticipants expressed a pressing need for more community-led education programs that commence prior to birth that highlight the benefits of breastfeeding, noting that much of the existing ante-natal education focussed on the delivery of the baby:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;But I also think too, looking back, when I went to antenatal classes... they never ever really talked about breastfeeding, it was all about getting you prepared for labour.\u0026rdquo;\u003c/em\u003e Aboriginal Mother\u003c/p\u003e\u003cp\u003e\u003cem\u003eI definitely think the education, like through the pregnancy, more of a talk around it and the processes and the stages.\u003c/em\u003e Aboriginal Mother\u003c/p\u003e\u003cp\u003eThe participants suggested that the education needs to address what to expect during the breastfeeding journey and how to manage common challenges:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think that that\u0026rsquo;s what we need to do with these women too, is get them to put their feet in the water, have a yarn to other women that have breastfed, have a look at the complications as well as the \u0026ndash; the pros as well as the cons.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Maybe they're just not aware, because I didn't know that if you latch the baby on, then the milk starts producing and stuff. That's why I just thought, maybe I'm not breastfeeding because they're empty. I don't know, maybe more information around it.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eParticipants also specifically highlighted a need for health promotion materials such as videos and posters to support new mums to breastfeed:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;d be nice to create a video of just taking away the stigma of it and the shame factor and just promoting that breast is best.\u0026rdquo; Aboriginal Elder\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Maybe doing \u0026ndash; when you do a video or a poster, show them the different forms that you can feed a baby because if you only give them one option and that option\u0026rsquo;s not working, it\u0026rsquo;s like, oh\u003c/em\u003e\u0026hellip;\u0026rdquo; Aboriginal Mother.\u003c/p\u003e\u003cp\u003eParticipants felt there was a need for more education around alternative breastfeeding methods, such as pumping, as many mothers are required to return to work, or needed to care for other children.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Even when I did go back to work, I went back to work and your body adapts, your milk supply adapts \u0026hellip; so reassuring the mums that it does get easier and your milk supply goes to the demand of the baby. That\u0026rsquo;s also never explained, you know what I mean, simple things like that\u003c/em\u003e.\u0026rdquo; Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSo yeah, I feel like there could have been a bit more support definitely. I know it's hard if a baby is not going to latch but still, they could have told me about pumping and helped me around - like oh well at least pump so that your breasts are getting that movement.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;They gave me \u0026ndash; this is what annoyed me too, is they gave me a breast pump and just expected me to know what the hell I was meant to do with it. Like this is my first child, and you just giving me a breast pump. I don\u0026rsquo;t know how am I meant to learn... Then, it sucked too, because the nurses, every time you tried to do it, get that little bit of privacy to do that, the nurses were in and out, in and out. It's like you are in and out, but you are not here to help me.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eSome participants noted the need to start education prior to pregnancy:\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI\u0026rsquo;d like to see the young ones become involved with dolls or whatever, you get those type, and how to hold them and breastfeed the and this is the correct way, so it would encourage, one day when they do have their own children, this is the best way and improve slowly about breastfeeding\u003c/em\u003e\u0026rdquo;. Aboriginal Elder.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eOngoing breastfeeding support\u003c/h2\u003e\u003cp\u003eThe need for culturally safe, responsive, hands-on breastfeeding support to Aboriginal women to assist them in their breastfeeding journey was considered crucial to ensure women receive comprehensive breastfeeding support:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;There\u0026rsquo;s got to be that connection because our mums are struggling out there.\u0026rdquo;\u003c/em\u003e Aboriginal Mother\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Having that Indigenous person for our women that follow them through maybe could make a change\u0026hellip; just stay involved with them until they\u0026rsquo;re completely comfortable and know that they\u0026rsquo;re doing the right thing.\u0026rdquo;\u003c/em\u003e Aboriginal mother\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[Regarding mainstream breastfeeding phone lines] I don\u0026rsquo;t think our women are going to access it, which is why I think it\u0026rsquo;d be so important to have the information that could be someone that\u0026rsquo;s on-call or there is someone Monday to Friday from these times that can come out and do check-ups.\u0026rdquo;\u003c/em\u003e Aboriginal mother\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003ePeer support groups\u003c/h2\u003e\u003cp\u003eCommunity-led breastfeeding groups were suggested as a much needed a safe space for Aboriginal women to connect, share their experiences, and support one another, potentially supporting good mental health.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;You hear about youth groups and women\u0026rsquo;s group and mums and bubs and that, but there\u0026rsquo;s none about pregnancy or breastfeeding or education around that.\u0026rdquo;\u003c/em\u003e Aboriginal Elder.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I guess it\u0026rsquo;s creating those safe groups\u0026hellip; a breastfeeding, a society or group where you can come and talk about the issues that you\u0026rsquo;re facing or the things that worked for you.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think that would great for women, especially after you\u0026rsquo;ve had a baby you feel so isolated, and especially for new mums how they go through that transition of becoming a mum, and where they don\u0026rsquo;t get to see their friends, or their friends don\u0026rsquo;t come around. I went through that with my first, and then I mean, I don\u0026rsquo;t know how I got through it, but I got through it. But I see other women that have just had babies and they\u0026rsquo;re struggling, and they feel really isolated and forgotten about.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eBetter access to lactation consultants\u003c/h2\u003e\u003cp\u003eParticipants in the study expressed a need for more access to publicly funded lactation consultants to be based in the hospital and Aboriginal Community Controlled Health Services (ACCHSs) along with greater access to Aboriginal midwives and health workers.\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI think also having the option there so when you\u0026rsquo;re at pregnancy care and you\u0026rsquo;re booking in, everyone has to book in, having that conversation and if they say yes, booking in a consult with the lactation nurse or whatever they want to call them.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I looked at it with [baby] to have a lactation consultant because it was really painful and I wanted to give it a really good crack, but there was no one available for weeks and then it costs.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think just having somebody that\u0026rsquo;s there \u0026ndash; just when you don\u0026rsquo;t know, and when they're not, they're pretty much saying, I'm here for you, I can support you, I'm not going to be letting you go and rush off to another patient.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If I would\u0026rsquo;ve got the support from the beginning from when I first had him, and I didn\u0026rsquo;t understand why there wasn\u0026rsquo;t a nurse during the weekend and especially in Sydney in a busy hospital, like why do they not have multiple nurses that are educated in this? I reckon I would\u0026rsquo;ve continued to breast feed him if I was able to get that help from the get go, I reckon he would\u0026rsquo;ve latched on perfectly. But because I had to wait\u0026hellip;\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eEquipment and other resources\u003c/h2\u003e\u003cp\u003eThe option of breast pumps to support ongoing breastfeeding with the help of family was discussed, however the high cost of breast pumps and limited knowledge about their use created barriers. It was suggested that breast pumps could be included as part of a breastfeeding support program:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;A lot of women probably can\u0026rsquo;t afford breast pumps to give them a break, so it could be that if they come on as a client, that they can either rent or get a breast pump so that when mum\u0026rsquo;s tired, I guess she can pump it, then dad can also feed. It\u0026rsquo;s not just on mum. So, maybe having some supplies.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003cp\u003eThe theme of feeling shame when feeding in public was mentioned by many participants, as was the lack of private and hygienic places to breastfeed when out in public. Given this it was suggested that a breastfeeding cover with Indigenous artwork on it could be provided as part of the breastfeeding program.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;There\u0026rsquo;s t-shirts you can get and you open the zip\u0026hellip;Is there something we could do in a cultural way, like even just a shirt that tucks back under\u0026hellip;something like that so that we can show the girls that they can still be fashionable. For the ones that don\u0026rsquo;t want to be exposed, that\u0026rsquo;s just a little bit more of a comfort thing for them.\u0026rdquo;\u003c/em\u003e Aboriginal Mother.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the perspectives of Aboriginal women about the importance of breastfeeding and the challenges they experience through their breastfeeding journeys. Access to culturally safe and responsive lactation support was limited, and a need for local community-led programs was highlighted to fill these gaps in resources and support structures for Aboriginal mothers.\u003c/p\u003e\u003cp\u003eIn this study, Aboriginal women spoke about the importance of intergenerational knowledge transfer between pregnant women and Elders. Participants in this study noted the disruption of breastfeeding practices due to colonisation, which has also been reported in other work [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Despite this, intergenerational knowledge transfer remains important, a finding which was also highlighted in a study among Indigenous peoples in Canada, where grandmothers cultural breastfeeding teachings continue to pass on knowledge about the health and cultural benefits of breastfeeding to the next generation of Indigenous parents [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Similarly, a study in Australia found that Aboriginal grandmothers had a direct and positive influence on breastfeeding, in comparison to non-Indigenous grandmothers which did not result in a positive effect of breastfeeding [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This highlights the important influence that Aboriginal grandmothers and Elders have on initiation and continuing breastfeeding of Aboriginal women.\u003c/p\u003e\u003cp\u003eIn this study, there was a clear influence on breastfeeding practices from partners, family, community and workplaces. Women spoke about the influence male partners can have on both initiation and continuation of breastfeeding. This included when a male partner\u0026rsquo;s family had strong breastfeeding experience and knowledge, and provided a positive influence through passing on that knowledge to the mother, which is consistent with other studies in Aboriginal populations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. These findings highlight the need to include partners and other family members when designing a program to support breastfeeding program, particularly around education.\u003c/p\u003e\u003cp\u003eThe issue of supporting mothers to continue breastfeeding when they return to work was highlighted in this study. A review reported key factors that enabled breastfeeding in the workplace for mothers. These included: changes in workplace culture, manager support, co-worker support and physical environments, and provision of time. This highlights that for mothers that return to work, workplace policies and context can increase their likelihood of continuing breastfeeding [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. While in Australia legislation and policies exist at both the national and state level to support breastfeeding in the workplace [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], including breaks and areas to breastfeed, this study and other work conducted suggests there is a lack of implementation, and that employees are unaware of their breastfeeding rights [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsistent with other studies, while community facilities exist in the local area to allow breastfeeding whilst out in public, participants in this study found them to be unhygienic, particularly given nappy change and toilet facilities were co-located in the same spaces, suggesting the need for a re-think of how the spaces are designed [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. One option is lactation pods, which provide privacy without being co-located with toilets [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Findings from this study also suggest that further health promotion work is required to decrease stigma among the general population towards women breastfeeding in public, an issue that has been highlighted in other studies [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, Aboriginal women spoke about challenges with initiating or continuing to breastfeed [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Consistent with other studies, this was especially the case where either the mother or child experienced other health challenges in pregnancy, during or soon after birth, including gestational diabetes and pre-term birth [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Many participants noted the lack of support whilst in the hospital due to understaffing and the need for beds to be freed up, a finding that has been reported in other studies in Australia [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Where breastfeeding support was provided participants were often able to initiate breastfeeding. This highlights the importance of both professional and non-professional support and after birth to increase breastfeeding initiation, particularly for those with additional health concerns.\u003c/p\u003e\u003cp\u003eA need for more lactation specialists was highlighted in this study. Training pathways and programs can play an important role in equipping Aboriginal Health Workers, Aboriginal Health Practitioners and Midwives with the skills to provide culturally responsive lactation support and will be the focus of future research. There are currently no Aboriginal and Torres Strait Islander-specific lactation training courses available in Australia. Additionally, Aboriginal mothers in this study had experiences of racism and judgement in the hospital at birth and afterwards, highlighting the need for mainstream maternity ward staff to undergo further education and expanded resources to better support breastfeeding to Aboriginal mothers in a culturally safe and responsive way.\u003c/p\u003e\u003cp\u003eAs prefaced earlier, findings from this study will be used to inform the design and implementation of a holistic breastfeeding program in an Aboriginal community-controlled health service in regional Australia. Participants noted the need for the program to include breastfeeding support once home from the hospital and felt this would be ideally provided by an ACCHS to ensure that the care is culturally responsive. Based on the current lack of culturally responsive breastfeeding support available, ongoing support by a breastfeeding specialist will be a key component of the program being designed and implemented at RivMed. There are already a few examples of culturally responsive maternity care models, such as Birthing on Country, which have resulted in high initiation of breastfeeding [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], suggesting that this model has a high likelihood of success.\u003c/p\u003e\u003cp\u003eOther important components of a breastfeeding program for Aboriginal women, based on the finding of this study include breastfeeding education to be offered antenatally to post-birth, the facilitation of mother\u0026rsquo;s groups to support each other through the breastfeeding journey, as well as resources such as breast pumps and covers for discreet breastfeeding. This education has the potential to counter reported perceptions of bottle feeding being easier and more convenient, a finding that has been highlighted here and elsewhere [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Being community-led, this program will align with national guidance from Aboriginal and Torres Strait Islander organisations such as the Lowitja Institute, whose 2025 co-design policy details the importance of genuine co-design in enabling meaningful participation in program development [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eA strength of the study was that it was led by an Aboriginal Community Controlled Health Service (RivMed), all aspects of the research were led by Aboriginal women with firsthand breastfeeding experiences and living in the same community as the participants. This relationality is vital in Aboriginal and Torres Strait Islander research and supported trusting and open engagement with participants. The interviews were conducted by Aboriginal women which provided a more comfortable interaction between the interviewer and interviewee, and a higher level of cultural understanding between them. A limitation is that this study was conducted in one regional Aboriginal community and may not be generalisable to other communities especially those in remote or urban areas. There is also potential for recall bias for mothers yarning about their breastfeeding practices with one or more babies born five or more years ago.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eBreastfeeding is not on the national agenda, even though the evidence is clear on the short and long-term health and wellbeing benefits it has for mother and baby, therefore, it should be prioritised and incorporated into government-funded projects within Close the Gap initiatives for improved outcomes, as well as into the National Aboriginal and Torres Strait Islander Health Plan [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is a human right that all women have access to culturally responsive and safe lactation care. However, this is not the case in Australia where there are currently no Aboriginal and Torres Strait Islander lactation training pathways. Urgent action and investment are required to develop lactation training pathways that are grounded in Aboriginal and Torres Strait Islander ways of knowing, being and doing. This is foundational to develop an Aboriginal and Torres Strait Islander lactation workforce and to support the upskilling of Aboriginal Health Practitioners/Workers, Midwives and General Practitioners in ACCHSs, community health care and hospital settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the perspectives and experiences of Aboriginal women living on Wiradjuri Country about their breastfeeding journeys and support programs required. Although breastfeeding is a natural biological process, it is a two-way learning for mother and baby and requires support and the right people to provide the teachings on how to breastfeed. Aboriginal women shared that they wanted to breastfeed their babies but often lacked the support to do so. Yalbilinya Miya highlights a community-led research project and the importance of breastfeeding programs that are responsive to the needs of Aboriginal and Torres Strait Islander women. RivMed will use these results to design, implement and evaluate a holistic breastfeeding program to support local Aboriginal women to initiate breastfeeding and achieve their goals. Through the development of culturally grounded supports the program will empower Aboriginal women to reclaim breastfeeding practices for the next generations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eACCHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAboriginal Community Controlled Health Service\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNACCHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Aboriginal Community Controlled Health Organisation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNICUs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNeonatal Intensive Care Units\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNSW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNew South Wales\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRivMed\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRiverina Medical and Dental Aboriginal Corporation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eApproval was provided by the Aboriginal Health \u0026amp; Medical Research Council NSW Human Research Ethics Committee (2132/23).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was funded by a Lowitja Institute Major Grant (2023\u0026ndash;2025).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSS, KW, NS conceived the study. SS, KW, NS, HH, AH, RF designed the study materials, SS, HH, JN and DK conducted the data collection, SS, DK, BW and AB coded the data, and SS, HH, DK, BW, AB, JN developed the themes from the coded data. DK, SS, SG, CR, FM, BW and AB collectively wrote manuscript, all authors contributed to manuscript revisions. The author(s) read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eYalbilinya miya in the title of this paper is in Wiradjuri language and means \u0026lsquo;learn together\u0026rsquo;. We would like to acknowledge the Traditional Custodians \u0026lsquo;the Wiradjuri peoples\u0026rsquo; of the lands in which this research was conducted and pay our respects to their Elders past and present. We would also like to thank all of the community members and stakeholders who participated in this project, without whom this research would not have been possible.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdams K, Faulkhead S, Standfield R, Atkinson P. Challenging the colonisation of birth: Koori women's birthing knowledge and practice. Women Birth. 2018;31(2):81\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGracey M. Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children. Am J Clin Nutr. 2000;72(5 Suppl):S1361\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhan J, Vesel L, Bahl R, Martines JC. Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity\u0026ndash;a systematic review and meta-analysis. Matern Child Health J. 2015;19(3):468\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO, Breastfeeding. World Health Organisation; 2018 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/facts-in-pictures/detail/breastfeeding\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/facts-in-pictures/detail/breastfeeding\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIp S, Chung M, Raman G, Chew P, Magula N, DeVine D et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007(153):1\u0026ndash;186.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBinns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016;28(1):7\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasi AC, Stewart CJ. Role of breastfeeding in disease prevention. Microb Biotechnol. 2024;17(7):e14520.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCOAG Health Council. Australian National Breastfeeding Strategy: 2019 and beyond. 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. Global Targets. 2025: To improve maternal, infant and young child nutrition. 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAIHW. Australia's mothers and babies: Breastfeeding. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNATIHS. Breastfeeding practices: National Aboriginal and Torres Strait Islander Health Survey. 2019 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.indigenoushpf.gov.au/measures/2-20-breastfeeding-practices#references\u003c/span\u003e\u003cspan address=\"https://www.indigenoushpf.gov.au/measures/2-20-breastfeeding-practices#references\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRyan F, Kanyininpa (Holding), editors. A Way of Nurturing Children in Aboriginal Australia. Australian Social Work. 2011;64(2):183\u0026thinsp;\u0026ndash;\u0026thinsp;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpringall TL, McLachlan HL, Forster DA, Browne J, Chamberlain C. Breastfeeding rates of Aboriginal and Torres Strait Islander women in Australia: a systematic review and narrative analysis. Women Birth. 2022;35(6):e624\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eABS, Breastfeeding Canberra. Australian Bureau of Statistics; 2022 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.abs.gov.au/statistics/health/health-conditions-and-risks/breastfeeding/latest-release\u003c/span\u003e\u003cspan address=\"https://www.abs.gov.au/statistics/health/health-conditions-and-risks/breastfeeding/latest-release\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAboriginal ABS. and Torres Strait Islander life expectancy: Australian Bureau of Statistics; 2023 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/aboriginal-and-torres-strait-islander-life-expectancy/latest-release\u003c/span\u003e\u003cspan address=\"https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/aboriginal-and-torres-strait-islander-life-expectancy/latest-release\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMitchell F, Walker T, Hill K, Browne J. Factors influencing infant feeding for Aboriginal and Torres Strait Islander women and their families: a systematic review of qualitative evidence. BMC Public Health. 2023;23(1):297.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalmon M, Doery K, Dance P, Chapman J, Gilbert R, Williams R, Lovett R. Defining the indefinable: Descriptors of Aboriginal and Torres Strait Islander Peoples\u0026rsquo; cultures and their links to health and wellbeing. 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClarkson C, Jacobs Z, Marwick B, Fullagar R, Wallis L, Smith M, et al. Human occupation of northern Australia by 65,000 years ago. Nature. 2017;547(7663):306\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTrzepacz D, Guerin B, Thomas J. Indigenous Country as a context for mental and physical health: Yarning with the Nukunu Community. Australian Community Psychol. 2014;26(2):38\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWatkin Lui F. My island home: re-presenting identities for Torres Strait Islanders living outside the Torres Strait. J Australian Stud. 2012;36(2):141\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKildea S, Gao Y, Hickey S, Nelson C, Kruske S, Carson A, et al. Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial. Lancet Global Health. 2021;9(5):e651\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLowell A, Kildea S, Liddle M, Cox B, Paterson B. Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program. BMC Pregnancy Childbirth. 2015;15(1):19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFoley W, Schubert L, Denaro T. Breastfeeding experiences of Aboriginal and Torres Strait Islander mothers in an urban setting in Brisbane. Breastfeed Rev. 2013;21(3):53\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCraig PL, Knight J, Comino E, Webster V, Pulver LJ, Harris E. Initiation and duration of breastfeeding in an aboriginal community in south western Sydney. J Hum Lactation. 2011;27(3):250\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZheng CX, Atchan M, Hartz D, Davis D, Kurz E. Factors influencing Aboriginal and Torres Strait Islander women\u0026rsquo;s breastfeeding practice: A scoping narrative review. Women Birth. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVarcoe C, Bottorff JL, Carey J, Sullivan D, Williams W. Wisdom and influence of elders: possibilities for health promotion and decreasing tobacco exposure in First Nations communities. Can J Public Health. 2010;101(2):154\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBusija L, Cinelli R, Toombs MR, Easton C, Hampton R, Holdsworth K, et al. The Role of Elders in the Wellbeing of a Contemporary Australian Indigenous Community. Gerontologist. 2018;60(3):513\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatriano MG, Ivers R, Meedya S. Factors that influence women\u0026rsquo;s decision on infant feeding: an integrative review. Women Birth. 2022;35(5):430\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRowley C, Kalucy D, Honeysett H, Brown T, Elliott-Rudder M, Finlay SM, et al. Yalbilinya Miya (learn together): community-led program to support Aboriginal and Torres Strait Islander women through their breastfeeding journey-a protocol. BMJ Open. 2025;15(5):e096288.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBessarab D, Ng'Andu B. Yarning about yarning as a legitimate method in Indigenous research. Int J Crit Indigenous Stud. 2010;3(1):37\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreton-Robinson A, Relationality. A Key Presupposition of an Indigenous Social Research Paradigm. Sources and Methods in Indigenous Studies. United Kingdom: Routledge. 2017:69\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide 149. Med Teach. 2023;45(3):241\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilson S. Research is ceremony: Indigenous research methods. Black Point. NS, Canada: Fernwood Publishing; 2008. p. 144.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHelps C, Barclay L. Aboriginal women in rural Australia; a small study of infant feeding behaviour. Women Birth. 2015;28(2):129\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaylor G. Healthy Pregnancies and Beyond: Exploring the Experience and Teachings of Indigenous Grandmothers to Promote the Health of Future Generations of Indigenous people in Alberta. University of Alberta; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarthigesu SP. The perceived influence of grandparents\u0026rsquo; beliefs and attitudes on parents\u0026rsquo; breastfeeding behaviour and paediatric vaccination decisions. Edith Cowan University; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpringall TL, McLachlan HL, Forster DA, Browne J, Chamberlain C. Factors associated with breastfeeding initiation and maintenance for Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis. Women birth: J Australian Coll Midwives. 2023;36(2):224\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLitwan K, Tran V, Nyhan K, Perez-Escamilla R. How do breastfeeding workplace interventions work? a realist review. Int J Equity Health. 2021;20(1):148.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustralian Breastfeeding Association. Breastfeeding and Work: Your rights at work. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustralian Breastfeeding Association. Submission from the Australian Breastfeeding Association to the Senate Select Committee on Work and Care. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, et al. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promotion J Australia. 2022;33(1):151\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHauck YL, Kuliukas L, Gallagher L, Brady V, Dykes C, Rubertsson C. Helpful and challenging aspects of breastfeeding in public for women living in Australia, Ireland and Sweden: a cross-sectional study. Int Breastfeed J. 2020;15(1):38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFredrickson ME, Boyle J, Cober MP, King CA. A Call to Action for Lactation Support at Colleges of Pharmacy. Am J Pharm Educ. 2022;86(8):ajpe8693.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEni R, Phillips-Beck W, Mehta P. At the Edges of Embodiment: Determinants of Breastfeeding for First Nations Women. Breastfeed Med. 2014;9(4):203\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHelps C. Exploring Infant Feeding Choices in the Northern NSW Aboriginal Community. 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen SS, Alexander DD, Krebs NF, Young BE, Cabana MD, Erdmann P, et al. Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis. J Pediatr. 2018;203:190\u0026ndash;6. e21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChamberlain CR, Wilson AN, Amir LH, O'Dea K, Campbell S, Leonard D, et al. Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia. Aust N Z J Public Health. 2017;41(2):144\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGleeson D, Flowers K, Fenwick J. Midwives\u0026rsquo; Time and Presence: A Key Factor in Facilitating Breastfeeding Support for New Mothers. Int J Childbirth. (4):219\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJames L, Sweet L, Donnellan-Fernandez R. Breastfeeding initiation and support: A literature review of what women value and the impact of early discharge. Women Birth. 2017;30(2):87\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpringall T, Forster DA, McLachlan HL, McCalman P, Shafiei T. Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study. BMJ Open. 2023;13(1):e066978.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eButler T, Anderson K, Black O, Ball A, Ngampromwomgse K, Murray R, et al. Co-design versus faux-design of Aboriginal and Torres Strait Islander health policy: a critical review. Lowtija institute; 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustralian Government. National Aboriginal and Torres Strait Islander Health Plan 2013\u0026ndash;2023. Commonwealth of Australia 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoalition of the Peaks. National Agreement on Closing the Gap. Australian Government; 2020.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding, qualitative, community-led, Aboriginal and Torres Strait Islander","lastPublishedDoi":"10.21203/rs.3.rs-7540878/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7540878/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBreastfeeding provides the best start to life; however, some women experience challenges with breastfeeding. Breastfeeding is an important practice for culture, nutrition and wellbeing for Aboriginal mothers and children in Australia, particularly in the context of historical and ongoing forced separations of Aboriginal mothers and their children. This study aims to highlight the breastfeeding perspectives and experiences of Aboriginal mothers and Elders; and identify the supports Aboriginal mothers desire to empower them to initiate and reach their breastfeeding goals. This information will inform the design and implementation of a holistic breastfeeding program in regional Australia in an Aboriginal community-controlled health service, Riverina Medical \u0026amp; Dental Aboriginal Corporation (RivMed).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study used the Indigenous qualitative method of Yarning and was based on Wiradjuri Country (Wagga Wagga). Two participant types were included in this study: Aboriginal mothers who had given birth within the last five years and were patients of Riverina Medical and Dental Aboriginal Corporation (RivMed); and female Aboriginal Elders who had personal breastfeeding experience and had supported other Aboriginal women in their breastfeeding journey. Participants were invited by the RivMed Aboriginal research coordinator to participate in one-on-one Yarning or a Yarning circle conducted by female Aboriginal researchers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOverall, 20 Aboriginal women participated, 15 mothers of children aged under five years, and five Elders. Four themes emerged: 1) Intergenerational knowledge transfer; 2) influences of partner, family, community and workplace on breastfeeding; 3) challenges with initiating or continuing breastfeeding; and 4) the need for culturally responsive, community-led supports.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study highlights the need for culturally responsive and community-led resources and programs to support Aboriginal women to initiate and continue to breastfeed their babies. The role of Aboriginal Elders was important in the intergenerational transfer of knowledge and cultural support, especially for first time mothers, or those who did not have breastfeeding role models in their own families.\u003c/p\u003e","manuscriptTitle":"Yalbilinya miya (learn together): Privileging the voices of Aboriginal mothers and Elders to develop a community-led breastfeeding program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 21:15:24","doi":"10.21203/rs.3.rs-7540878/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b5260db-6b15-4ca6-960c-75500a27019d","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-17T05:26:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 21:15:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7540878","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7540878","identity":"rs-7540878","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}