Using liminality to understand mothers’ experiences of ...

Using liminality to understand mothers’ experiences of long-term breastfeeding:‘betwixt and between’, and‘matter out of place’.
Dr Sally DowlingUniversity of the West of England, Bristol
Outline
Context/backgroundLong-term breastfeedingLiminalityOverviewLiminality and healthLiminality and breastfeedingStudy methodsFindings and discussionUsing liminality to think about long-term breastfeeding
Context/background
Breastmilkis the optimum nutrition source for babies.Important in improving public health and reducing inequalities; UK policy priority.WHO guidanceExclusive bf for 6 monthsContinue for ‘up to two years of age of beyond’ (WHO, 2003:7-8)UK bf initiation rates are high but declinerapidly -34% still bf at 6 months, only 1% exclusively (McAndrewet al, 2012).Long-term breastfeeding is uncommonWomen who do this are considered unusual or oddThis work thinks about bf beyond ‘usual’ limits
Long-term breastfeeding
Small amount of research, mostly from North America/Australia, some recently from the UKFocus on:Difficulties carrying out socially unacceptable/stigmatised practiceGradual withdrawal of support from 6-8 monthsIncreasing pressure/coercion to wean 12 months and beyondImportance of LaLecheLeague supportSecretive/hidden nature of the practice (concealed from health professionals and wider family)Experience of emotional benefits – bonding, close relationshipsHow women make sense of what they doThe relationship between long-term bf and other parenting practices
Liminality - overview
Related ideas – ‘betwixt and between’ Turner, 1969) and ‘matter out of place’ (Douglas, 1966).‘Neither here nor there’Building on work on rites of passage – separation, transition and incorporation.In the liminal state existence is neither how it was before or how it will be afterwards.Culturally prescribed/shared rites of passage enable people to develop new identities.Liminal states can suggest danger/threat.Social consequences of crossing boundaries‘Matter out of place’ – ‘me’ and ‘not me’ products – tabooCommunitas– shared space occupied by those in the liminal phase (also associated with structure and anti-structure).
Liminality and health
Used to examine a range of health issuesExamples include: thesick role, refugees’ status, living with chronic pain and fertilitytreatment, cancer treatment, mental health issuesExplicit links made about being between social identities…Pregnant/not pregnant; fertile/infertile…and to think about space and timeMadge and O’Connor ‘a time out of time’ (2005:84)Has also has been used to think about women’s health issuescervicalcancer screening (Forsset al., 2004), childbirth rituals (Hogan, 2008) and premature birth (Taylor, 2008).
Liminality and breastfeeding
Mahon-Daly and Andrews (2002)Space and place in relation to contemporary experiences of bf.Very well cited paper – findings often referred to but liminality not discussed in depth.Breastfeeding in many communities is a ‘marginal and liminal activity, rarely seen and barely spoken about’ (Dykes, 2006:206).Breastfeeding and liminal experience discussedby Mahon-Daly and Andrews inthree ways:Post-natal period - not pregnant, not ‘normal’; lasts until women stop lactating and reintegrate.Breastfeeding changes women for life – ‘reach new understandings of themselves and their bodies’ (2002:65).Behavioural rituals in which women move in and out of places comfortable to breastfeed.
Study methods
Qualitative design using micro-ethnographic methodsParticipant observation3 groups, over 80 womenBf new-borns to 4 year oldsFace-to-face interviews6 womenBf 11 children, 18 months to 4.5 yearsOnline asynchronous interviews using email4 womenBf 4 children, 14 months to 6.5 yearsIntention – to explore women’s experience of successfully breastfeeding their babies for over six months and whether this could be used to help more women to breastfeed for longer.
Findings - overview
Findings concur with earlier studiesGroup of strong-willed, determined women, ‘doing the right thing’Most ‘always knew’ they would bf, felt that it was ‘natural’For most, long-term bf happened gradually; many found it ‘shocking’ before they bf long-termLinks between long-term bf and other decisions about parenting and child-careDifficult consequences for many (personal well-being, relationships and paid employment)Some had support but for many it is isolatingBreastfeeding in public
Discussion – liminality and long-term breastfeeding
Most breastfeeding women experience integration fairly rapidly; the women in this study remained in a liminal state for some time.Experience continues to be different from those who breastfed and stopped and those who never breastfed.Participants recognised that they were in a different place when other mothers were returning to ‘normal’.They talked about entering a phase from which an exit was not apparent.It was hard to see how to move into another place.They talked about being apart from other mothers.Committed to a way of life without a clear end, a phase with no end
Discussion – liminality and long-term breastfeeding
New understandings of themselves and new ways of communicating with others about their ‘new world’Use of space when breastfeeding – where, who with and moving in and out of different spaces.How spaces are interpreted as both public and private.The use of strategies to bf in public.The use of support groups, ‘like-minded people’ as secure liminal spaces; shared sense of community (virtual as well as ‘real’).The recognition that life would never be the same again; building of new identities.
Discussion – liminality and long-term breastfeeding
Findings support those of Mahon-Daly and Andrews.Breastfeeding can be seen as a time of transition between states – ‘both/either’, ‘not-quite-either’Communitas– inhabiting a common space, identifying with others, sense of belonging.Women feel themselves marked out as different, between social identities.‘...at once no longer classified and not yet classified…’ (Mahdi et al., 1987)Societal expectations about liminal states – these women continue to breastfeed despite societal pressure to wean.
Discussion – liminality and long-term breastfeeding
Liminal states can be unsettlingFor othersFor breastfeeding women‘Matter out of place’Breastmilkinappropriate in specific placesFeeding publicly ‘breaching a cultural taboo’ (Stewart-Knox et al, 2003:267)Uncontainedbreastmilkinterpreted as lack of control; continuing to breastfeed seen as lacking controlOlder children (with teeth and speech) – culturally disturbing and inappropriate
Conclusions
Breastfeeding women can be seen to be in a liminal space and place, some remain like this for extended periods.Some never reincorporate into society as they were before.Women who breastfeed long-term are ‘betwixt and between’ and their actions make theirbreastmilkand their bodies ‘matter out of place’.Supporthelpswomen manage the cultural taboos.Communitasis a helpful concept to understand the role of support groups.Being in a liminal phase stigmatises these women and reinforces their status as people engaging in threatening behaviour – no apparent end.Confirmsthe need to make long-term breastfeeding more culturally acceptable – may encourage more women to breastfeed for longer.
References
Douglas, M. (1966) Purity and danger. Reprint: London/New York, Routledge, 2002.Dykes, F. (2006) The education of health practitioners supporting breastfeeding women: time for critical reflection. Maternal and Child Nutrition, 2:204-216.Forss, A.,Tishelman, C.,Widmark, C. & Sachs, L. (2004). Women’s experiences of cervical cellular changes: an unintentional transition from health to liminality? Sociology of Health and Illness, 26(3):306-325.Hogan, S. (2008) Breasts and the beestings: Re-thinking breastfeeding practices, maternity rituals and maternal attachment in Britain and Ireland. Journal of International Women’s Studies, 10(2):141-160.Madge, C. & O’Connor, H. (2005) Mothers in the making? Exploring liminality in cyber/space. Transactions of the Institute of British Geographers, 30(1):83-97.Mahdi, L.C., Foster, S. & Little, M. eds. (1987) Betwixt & Between: Patterns of Masculine and Feminine Initiation.Chicago:OpenCourt Publishing Co.Mahon-Daly, P. & Andrews, G. (2002) Liminality and breastfeeding: women negotiating space and two bodies. Health and Place, 8: 61-76.
References
McAndrew, F., Thompson, J., Fellows, L., Large, A., Speed, M. & Renfrew, M.J. (2012) Infant Feeding Survey: 2010. NHS Information Centre (online). Available from: http://data.gov.uk/dataset/infant-feeding-survey-2010 [Accessed 13 July 2014]. qualitative analysis of infant feeding perceptions. Journal of human nutrition and dietetics, 16(4):265-273.Taylor, L.S. (2008) A Rites of Passage analysis of the families’ experience of premature birth. JournalStewart-Knox, B, Gardiner, K. & Wright, M. (2003) What is the problem with breast-feeding? AofNeonatal Nursing, 14:56-60.Turner, V. (1969) The Ritual Process. Reprint: New York/London: Aldine Transaction, 2009.World Health Organisation (2003) Global strategy for infant and young child feeding (online). Available from: http://www.who.int/child_adolescent_health/documents/9241562218/en/index.html [Accessed 13 July 2014].
Thanks also to Professor DavidPontin.sally.dowling@uwe.ac.uk