Impact of rural habitus on first-time mothers' feeding choices
Authors:   , Weston Karry Lee 
Published: September 2024

Although breastmilk is considered the nutritional gold standard for infants, many U.S. rural infants are not breastfed. The concept of habitus includes the socialization of an individual that shapes perceptions of the outside world and influences behaviors. Exploring rural mothers' habitus could help healthcare professionals to 1) better understand why rural mothers make decisions regarding infant feeding and 2) guide interventions tailored to rural mothers' unique needs. Guided by the concept of habitus, we sought to explore 1) rural mothers' intentions and decision-making around infant feeding their first child, including their unique habitus, and other key community influencing factors, 2) rural mothers' perceptions of how the rural community influenced their infant feeding decisions, and 3) rural mothers' priorities for interventions to support breastfeeding, including needs for information, support, and resources. We developed an interview guide informed by the four constructs that constitute habitus: childhood socialization, education, social class, and predominant feeding in the community. We conducted a qualitative descriptive study to examine the perspectives of first-time mothers in rural Missouri. Using semi-structured interviews (N = 18) via Zoom or by telephone, we asked questions about mothers' decision-making processes regarding how they planned to feed their newborn after delivery. All interviews were transcribed, double-checked for accuracy, and analyzed using line by line coding with NVivo software. The mean age of the 18 mothers was 24 years old (range 18-30) and the mean age of the infants was 6 months old (range 1-11 months). All but one were low income and qualified for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services. Major themes influencing mothers' intentions and decision-making around infant feeding included: 1) I'm educated but not so much on breastfeeding; 2) This is small town culture; 3) I had expectations; and 4) This area lacks resources for mothers. Overall, the mothers in this sample had high expectations during pregnancy to breastfeed discontinued soon after delivery. The mothers' shared experiences of deciding during pregnancy how to feed their infants were impacted by childhood upbringing, family, friends, and communities' views of breastfeeding, as well as community resources such as WIC- a very pro-breastfeeding organization. During pregnancy, the infant nutrition education mothers received strongly encouraged breastfeeding and touted its benefits, and most verbalized the benefits of breastmilk for infant health and immunity. It was clear that the education motivated them to try breastfeeding. However, after delivery, this breastfeeding education was inadequate for these rural mothers in equipping them to overcome the pragmatic issues in being successful at breastfeeding. We hypothesize that the standard breastfeeding education may be adequate for urban women because they have more resources to aide in addressing these pragmatic issues compared to rural women. Hence, the higher rates for breastfeeding found among urban low-income mothers. For rural mothers to be successful in their attempts to breastfeed postnatally, our results point to their needing additional information, especially how to determine if their infant is getting enough nutrition post-delivery and examining messaging in different ways about what to expect in the first days post-delivery when attempting to breastfeed. Future research is necessary to understand what and how to better help women immediately after delivery when the intent is to breastfeed, but the reality ends in feeding their infant formula. Research is also needed to better understand how to effectively communicate that information based on women's habitus and how best to bridge the needed support that may be lacking in rural areas.