Posted Wednesday 4th August 2021
Dr Lesley Dornan, PhD
Motivation and culture can have a major impact on the choices women make about breastfeeding. Having lived overseas for many years I have learnt how cultural influences can impact the goals women set and how they see and believe in themselves . How women achieve those goals is an important part of breastfeeding. We did a research study in Northern Thailand and the aim of our study was to explore the cultural and motivational influences that were communicated by midwives in an Asian setting. The objectives of the study were to identify key influences in breastfeeding education, the underlying motivation of the women receiving care and how culture on the education the women received. Our research question was: What impact does culture have on women’s motivation to breastfeed?
The study was supported by motivational and cultural frameworks [2-3]. During the data collection I observed many different routine breastfeeding sessions led by midwives in both antenatal and postnatal settings in a Thai University hospital. A total of 204 women were observed receiving breastfeeding education from 62 midwives and this included individual and group sessions. A total of 183 breastfeeding mothers then completed a motivational breastfeeding survey to explore how much they valued breastfeeding, how confident they felt and if they thought they would succeed.
In our study we found that in the University hospital where we collected our data the staff and hospital placed a very high value on breastfeeding. This was shown through the policies and practices within all the units where the research was done. This included designated breastfeeding champions on each ward; the highlighting of breastfeeding as a wider public health benefit; the implementation of skin to skin from birth and group sessions where midwives and women talked about the importance and benefits of breastfeeding.
Twice a day, midwives spent focused time with mothers through teaching sessions on the wards which were designed to support mothers to overcome common breastfeeding challenges. Additional classes included a class to help women have confidence they could breastfeed and a postnatal discharge class for women to anticipate and manage postnatal issues . Goals that were suggested in the antenatal classes were revisited in the postnatal education which helped to prevent mixed messages. Cultural stories and references were included in all the education which made the information more relevant to women. The midwives were hands on at times which may have been an issue, but the results of our study suggested most women valued breastfeeding very highly and felt they had been very well supported by the midwives .
We realised as a team that the need for consistent and culturally relevant information that makes sense to mothers as they begin to breastfeed is crucial. Values are a key element of every culture and recognising and when supporting women learning to breastfeed helps women to persevere. Many wider positive cultural influences were included in the teaching sessions, reinforcing the value of breastfeeding and the role of breastfeeding within public health. The underlying value of breastfeeding within the culture, although changing, may have been a positive influence but many women still encountered problems. From our research we understand that consistent and comprehensive goals and knowledge should be offered to help all mothers overcome the barriers they may encounter as they start out on their breastfeeding journey.
1. Dornan L, Sinclair M, Kernohan WG, Suppsan P. An analysis of motivational goals in breastfeeding instruction in a Thai cultural setting. EBM. 2017 15(2): 40-45.
2. Keller JM. Motivational Design for Learning and Performance: the ARCS model approach. Springer; 2010.
3. Gardenswartz L, Rowe A, Digh P, Bennet M. The global diversity desk reference: managing an international workforce. Pfieffer; 2003.
4. Dornan, L. Adapting a motivational Instructional Model to Identify and Analyse Thai Cultural Influences on Breastfeeding Behaviour. Ulster University; 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.694233
More information on this study is available at: