RESEARCH ARTICLES

Social representations of breastfeeding among teenage nursing mother

Rosália Teixeira de Araújo^I; Marizete Argolo Teixeira^II; Lucas Vinícius Bulhões Ribeiro^III; Ana Paula Valasques Barretto^IV; Jamilli Silva Santos^V; Priscila Meira Mascarenhas^VI

^I Enfermeira. Doutoranda em Enfermagem pela Universidade Federal da Bahia. Professora Assistente da Universidade Estadual do Sudoeste da Bahia. Jequié, Bahia, Brasil.E-mail: rosluz@gmail.com
^II Enfermeira. Doutora em Enfermagem pela Universidade Federal da Bahia. Professora Adjunta II da Universidade Estadual do Sudoeste da Bahia. Jequié, Bahia, Brasil. E-mail: marizete88@yahoo.com.br
^III Enfermeiro. Jequié, Bahia, Brasil. E-mail:lvbribeiro@yahoo.com.br
^IV Enfermeira. Graduada pela Universidade Estadual do Sudoeste da Bahia. Enfermeira Assistencial do Município de Maracás. Bahia, Brasil. E-mail: paulinhavb_ba@hotmail.com
^V Enfermeira. Intensivista do Hospital Geral Prado Valadares. Jequié, Bahia, Brasil. E-mail: jamillyss@hotmail.com
^VI Enfermeira. Enfermeira da Estratégia de Saúde da Família e do Hospital Geral Prado Valadares. Jequié, Bahia, Brasil. E-mail: priscila.meira@yahoo.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.11513

ABSTRACT

This qualitative study to investigate what breastfeeding represents to nursing teenage mothers, and to identify the feelings they expressed while breastfeeding, was based on the Theory of Social Representations. It was conducted with 12 nursing teenage mothers at a public hospital in Bahia State. Data were collected through semi-structured interviews and analyzed using qualitative analysis technique. The results showed that the teenage mothers' social representations of breastfeeding are influenced by the meanings given to this practice that are widespread in cultural content passed on from generation to generation, in the media and in their personal experiences, and which direct their conduct in breastfeeding their children. Accordingly, health teams should reflect on the social representations that nursing teenage mothers attribute to breastfeeding, so as to develop care and educational activities to promote, protect and support breastfeeding.

Keywords: Breastfeeding; teenagers; nursing; social representations; nursing mothers.

INTRODUCTION

Breast milk is naturally adapted to meet the nutritional needs and to promote appropriate growth and development in the first six months of a child's life. It is not necessary, therefore, to use any other type of food to feed the child, not even water. However, after the sixth month of the child's life, breastfeeding should be complemented by other foods, but should also be kept until the age of two, because besides being a significant source of energy and nutrients, it is a protective factor against diseases.

By becoming a mother, a woman experiences moments of doubt, fragility and fear. The two main developmental stages in a woman's life, adolescence and pregnancy, are similar and have in common important changes that occur in a relatively short time interval. The occurrence of these two phases at the same time of life brings an exacerbation of these changing processes, increasing then, the risk of changes that may be considered pathological¹.

Thus, it is extremely necessary that the teenage mothers can count on family support and qualified professional support, in order to be able to face the changes in their life, and not to project into the young childthe blame for the problems they have faced. If that happens, the successful breastfeeding will be established.

Studying such topic is relevant, considering the importance of breast milk for both, family and community.Therefore, making lactating-adolescent-mothers acknowledge the social representations of this fact may put in evidence the difficulties in establishing and maintaining breastfeeding. This way it will be possible to promote, protect and support the adolescents and their families in the breastfeeding process.

In face of the exposed, the study aims to find out what breastfeeding is for lactating-adolescent-mothers and identify the feelings expressed by them during the act of breastfeeding.

LITERATURE REVIEW

Breastfeeding is the natural way to feed infants during their first years of life. It's a perfect source able to meet their nutritional, emotional and immunological needs. Breast milk gives children a better quality of life. It protectstheir health and their mother's, and create strong emotional bonds between them, which is very important for helping the child build a socially adjusted personality².

Breastfeeding also provides countless benefits for the women's health, such as the recovery of pre-pregnancy weight, the increasein the interpregnancy intervals, as it acts as a natural method of family planning through lactational amenorrhea. It also contributes to reduce the chances of developing breast and ovarian cancer and prevents women from suffering bone fractures due to osteoporosis³. The success of breastfeeding depends on the interaction between mother and child⁴. However, for a successful practice it also is important the family, community and professional support, added to a positive life story of the mother as for breastfeeding, and their will and readiness to breastfeed.

On the other hand, the practice of breastfeeding can find more difficulties for its establishment in teenage mothers, since they are experiencing adolescence, which is a period where they are adapting to the changes in your body themselves and have to face the transformations that occur during pregnancy, both at the same time. In this phase it is common for the young mother to experience feelings of fear, insecurity, despair, confusion, loneliness, especially when theyfind out about their pregnancy.

Pregnancy during adolescence may can also harm the physical and psychological development of the adolescent. It brings losses to their personal and professional development, besides generating family conflicts and many others that may cause serious damage to the creation of bonds between the mother and her child. Thus the condition of conceiving a child involves the need for intense personal and social restructuring, once it results in the adolescent's physical and mental changes^5.

Most often, these teenagers are in their first pregnancy and therefore are inexperienced and have limited knowledge. They transfer, then, the care of their children to their parents, especially their mothers and grandmothers.

Based on the considerations above, making lactating-adolescent-mothers aware of the social representations of breastfeeding is a way to knowing what their conduct as for the practice of breastfeeding will be and hence it will help plan individualized care that will aid them in facing adversities that may result from this practice.

METHODOLOGY

This study has a qualitative approach based on the Theory of Social Representations (TRS), since it allows to analyze and interpret the complexity of human behavior, without admitting precise rules such as problems and hypotheses ^6.

Just asany other phenomena of social representation present in the culture, institutions, social practices, mass and interpersonal communication and social thoughts,⁷the social representations that lactating-adolescent-mothers attach to breastfeeding have been, are and will be permeating the consensual universe of these teenagers, guiding their actions as for putting breastfeeding in practice.

In this sense, the social actors of this study were 12 lactating-adolescent-mothers who gave birth in the maternity ward of a public hospital in the city of Jequié, Bahia, between August and September 2010. They were chosen randomly and the inclusion criteria were to be aged between 10 and 19 years, to be lactating and to behospitalized in the maternity on the selected days for data collection.

As for the social profile of the surveyed lactating-adolescent-mothers, the age range was between 14 to 19 years, where four of them were single and eight were married. Four of them resided in Jequié-Bahia and eight in cities from the micro-region. With regard to their schooling information, four of them had incomplete primary education, four had complete elementary school, three had incomplete secondary education and only one a full high school degree.

Data were collected through semi-structured interviews with open dialogue between interviewer and interviewed, using a script containing open questions, with which it was possible to discuss freely about the factors that underlie the practice of breastfeeding.

The research project was evaluated by the Ethics Committee of the Universidade Estadual do Sudoeste da Bahia (CEP / UESB) and approved by the Opinion No. 101/2007. It is worth noting that only after the collection of the signatures in the the Informed Consent (IC), signed by the adolescents and their parents in the case of persons under 18, the data collection was started.

Data were analyzed according to thematic content analysis technique⁸ and interpreted in the light of the TRS. The analysis technique of the content is a set of methodological instruments that can be applied to extremely diverse discourses.Thus, the phases of analysis were organized chronologically in three areas: pre-analysis, exploration of the material collected and treatment of results, inference and interpretation of data⁸.

To ensure confidentiality and anonymity of the respondents, they were identified according to the order of the interviews, i.e., E1, E2, E3 and so on.

RESULTS AND DISCUSSION

From the analysis of the reports of the participants in this study, three themes emerged and are analyzed as follows.

Breastfeeding promotes the growth and development of children

The lactating-adolescent-mothers reported that providing exclusively breastfeeding for their children means the same as providing a favorable growth and development, as can be seen in the speeches:

It helpsthe child's development [...]. (E2)

Growth [...]. (E4)

It helps in developing the baby[...]. (E12)

It is important for the baby's growth[...]. (E8)

In these speeches it was possible to identify the social representations of lactating-adolescent-mothers that are centered on the importance of breast milk for the infant's development and their concern for the health of their children.

The growth in the first six months of life is determined by several factors, including exclusive breastfeeding, which provides adequate growth for the child.The introduction of complementary feeding in not necessary before this period^9.

Some studies have shown that breastfeeding for women focuses on meanings-food that are able to provide the weight and the structural growth of the child, as well as the development of their cognitive, psychological, emotional and social functions^10.11.

The campaigns promoted by the Ministry of Health on breastfeeding, the guidelines on prenatal and postpartum, the and information transmitted from generation to generation permeate the imagination of lactating-adolescent-mothers, and help them build their representations, which will drive their conducts towards breastfeeding. Such fact has also been identified in a study carried out with three generations of women from the same family^10.

Lactating-adolescent-mothers, through their reports, agreed with this statement, according to the analysis in the following:

The milk was made ​​ for the baby[...]. (E12)

Because that's what he needs to survive [...]. (E5)

Breast milk has nutrients that the baby needs [...]. (E4)

Good procedure [...]. (E2)

Breastfeeding is an effective strategy for promoting physical and mental health of the young kids. Thus, the biological and psychological benefits resulting from this strategy are incontrovertible ^12.

All children receive some protection even before their birth. During pregnancy the mother sends antibodies to the fetus through the placenta. However, children who are breastfed gain extra protection from antibodies, other proteins and immunologic cells through human milk. Thus, the molecules and cells from that milk actively help children against some infections^13.

Such thinking is present in the minds of the lactating-adolescent-mothers from this study, as observed in the statements:

For the baby to stay strong and healthy[...]. (E6)

Itprovides ahealthy life [...]. (E3)

Because breast milk helps preventthe diseases [...]. (E12)

Protecting him [...]. (E10)

Human milk due to its nutritional and anti-infective properties, protects the health of children, preventingthe diseases.This knowledge can be identified in this study, from the speeches the lactating-adolescent-mothers, as shown above.

Breastfeeding: narrowing the emotional bonds between mother and child

The lactating-adolescent-mothers revealed that breastfeeding is an act of love, care and affection towards the youngkid.Such representations were objectified in the feelings that breastfeeding provides to both mother and child, which are anchored in psycho-affective spheres as described by the participants:

Care, love and affection [...]. (E1)

It represents love, care and affection [...].(E10)

An act of caring for the child [...].(E12)

Even with a significant life change ¹⁴, that is, by becoming a lactating-adolescent-mother, these feelings will be present, since it is known that breastfeeding has psychological benefits for both mother and baby. A pleasurable breastfeeding, eye to eye, and with continuous contact between mother and child, strengthens the affective bonds between them, and consequently, increases intimacy, the exchange of affection, feelings of safety and security in the child besides the self-confidence and sensation of achievement in the woman ². Thus, this act becomes permeated by feelings of love and affection, intensifying them and allowing the strengthening of the bond between mother and child, which is based on the care for the other, that is, for the child^10.

Breastfeeding: the fulfillment of being a mother

For lactating-adolescent-mothers, breastfeeding is an experience of being amother. These representations are anchored in psycho-affective aspects, according to the reports:

It feels good [...]. (E6)

It's a great achievement [...].(E3)

Happiness and pleasure [...]. (E9)

I feel pleasure and love [...]. (E12)

Satisfaction, the pleasure of knowing that my daughter is being fed with my milk, the experience of being a mother[...]. (E7)

Sometimes this experience serves as a ritual of passage from the role of being a girl to the role of being amother/woman. Thereby,the social representation of motherhood is the unique perspective of life for some young girls¹⁵, once it concedes them a moment of full achievement of their femininity and personal satisfaction ^16.. Even ifit means to be living in a period of great change for lactating-adolescent-mothers.

Breastfeeding is a role exclusively of women¹⁶. The affective and social components were the ones more valued by the lactating-adolescent-mothers in this study because.They did not refer to the importance of the practice of breastfeeding for the mother's health, except one of them.

Breastfeeding, in the imaginary of the lactating-adolescent-mothers, was considered as a woman's duty, a need and a responsibility that belongs only to the mother, of nurturing her child. Here are the reports:

My duty as mother[...]. (E11)

Because they need to be breastfed until their sixth month of life[...]. (E3)

It's necessary until they are six months old [...]. (E10)

Thus, for these mothers, breastfeeding is considered an instinctive practice and a vocation in which women provide food for the newborn, based on cultural values, and therefore it's a mother'sduty¹⁷.The study carried out with three generations of women from a same family, also found that the breastfeeding experience for them was anchored, first and foremost, in the basis of responsibility, obligation, sacrifice and donations¹⁰. However, the practice of breastfeeding can be understood merely as an instinctive act, since it needs to be learned and supported by a social network. Many women when at the puerperium experience moments of difficulties, some even with breastfeeding problems, and they believe they must overcome such obstacles, since, for them, this is a naturalized and instinctive practice^18.

Thus, nurses need knowledge and skills about breastfeeding in order to provide assistance to the lactating mothers, and to emphasize the application of the systematization of the nursing care (SNC)¹⁹, so that theyaddress the mothers according to their individual needs.

"[...] it is necessary to behighlighted that these actions must be carried out with the participation of the women and to be constructed from the life experiences. At the same time, we emphasize that the women and their families are the protagonists of such event, throughout all educational process"^{18: 348}.

Regarding the process of comprehensive and the systematic care to the lactating-adolescent, it is up to the nurse to act relating scientific knowledge to the everyday life that will be experienced by the patient, explaining the importance, the benefits of breastfeeding and demystifying beliefs and taboos linked to breastfeeding²⁰.

However, it is noteworthy that the maternal decision of breastfeeding or not is influenced by multiple factors. Thus, the attention driven tothe lactating mothers can not be restricted to offering information, but it should also enable the practice of breastfeeding, highlightingthe reasons that lead some women to stop it in the first months of the baby's life. It's necessary to combat the difficulties that are encountered and to encourage them at the beginning for thecontinuation of breastfeeding, as recommended by national and international institutions^21,22.

In addition, the professional must have a realistic approach, taking into consideration all the constraints involved in the act of breastfeeding. This way, the professional will be able to undress their ideas or preconceptions about breastfeeding, while guiding the woman, and will be willing to understand their context and social relationships¹⁷.

CONCLUSION

The process of formation of the social representations about breastfeeding among the lactating-adolescent-mothers has influences of the meanings about this practice that are cultivated by their culture, popular traditions and knowledge that are transmitted from generation to generation, along with the information provided by the media, especially in the educational campaigns of the Ministry of Health. Their personal experiences as lactating-adolescent-mothers were also valued.

From these influences, the social representations of the participants as for the practice of breastfeeding were anchored in three meanings: Benefits of breastfeeding for the health of the child, narrowing of the emotional ties and fulfillment of being a mother.

Through the analysis of the social representations of the lactating-adolescent-mothers about breastfeeding,it was possible to perceive that they express the role of a lactating mother as an obligatory act, and value the attributes of breastfeeding for the children's health at the expense of their own health.

It was possible to see that the construction of the social representations on breastfeeding is basedonthe condition that includes women as being good mothers, and therefore, the idea that they should donate themselves to their children so that they can grow strong and healthy, without the participation of other family members.

It is necessary that the health team may reflect on such social representations so that they can develop care and educational activities that are capable of handling the complexity of the process of breastfeeding, and therefore to promote it, protect it and support it among adolescents and their families.

In this sense, the TRS contributed to this reflection, but are not limited in this study.

It is expected that this study may direct new research to contribute to the care of lactating-adolescent-mothers, so that breastfeeding can be experienced by them and their families as everyone's responsibility.

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