Main Article Content
This review article summarizes the current literature on facilitators and barriers to breastfeeding in Asian American women and provides future research directions. PubMed, EMBASE, CINAHL, Web of Science, and PsycInfo databases were searched for original qualitative or quantitative studies published in English. Reviews and consensus statements were excluded. Findings were synthesized by configuration and a bottom-up approach to thematically formulate the findings. A vote-counting method was used to summarize the results across the studies selected. A total of eight studies were selected. The review included 222 Asian women living in the United States. Our review focused on three themes: (i) cultural and traditional practices that influence breastfeeding; (ii) facilitators to breastfeeding; and (iii) barriers to breastfeeding. This review highlighted several areas in need of further research in Asian American women who have an early cessation of breastfeeding and less access to breastfeeding support services. The differences in cultural beliefs among Asian women who have migrated from different countries indicated no singular belief system. A culturally sensitive and family-centered approach in addressing critical barriers and promoting key facilitators of breastfeeding in Asian American women is needed.
Accessed June 14, 2020.
World Health Organization. Breastfeeding; 2020. Accessed June 10, 2020.
Martin CR, Ling PR, Blackburn GL. Review of infant feeding: key features of breast milk and infant formula. Nutrients. 2016;8(5):279.
Yasmeen T, Kumar S, Sinha S, Haque MA, Singh V, Sinha S. Benefits of breastfeeding for early growth and long term obesity: a summarized review. IJMSDR. 2019;3(1):190-94.
Turfkruyer M, Verhasselt V. Breast milk and its impact on maturation of the neonatal immune system. Curr Opin Infect Dis. 2015;28(3):199-206.
Andreas NJ, Kampmann B, Le-Doare KM. Human breast milk: a review on its composition and bioactivity. Early Hum Dev. 2015;91(11):629-35.
Kim MK, Choi JW. Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study. Int Breastfeed J. 2020;15(1):83.
Qiao J, Dai LJ, Zhang Q, Ouyang YQ. A meta-analysis of the association between breastfeeding and early childhood obesity. J Pediatr Nurs. 2020;53:57-66.
Bjerregaard LG, Pedersen DC, Mortensen EL, Sørensen TIA, Baker JL. Breastfeeding duration in infancy and adult risks of type 2 diabetes in a high‐income country. Matern Child Nutr. 2019;15(4): e12869.
Kirkegaard H, Bliddal M, Støvring H, Rasmussen KM, Gunderson EP, Køber L, et al. Breastfeeding and later maternal risk of hypertension and cardiovascular disease - the role of overall and abdominal obesity. Prev Med. 2018;114: 140-48.
Sharma AJ, Dee DL, Harden SM. Adherence to breastfeeding guidelines and maternal weight 6 years after delivery. Pediatrics. 2014;134(Suppl 1):S42-S49.
Qu G, Wang L, Tang X, Wu W, Sun Y. Association between duration of breastfeeding and maternal hypertension: a systematic review and meta-analysis. Breastfeed Med. 2018;13(5):318-26.
Jäger S, Jacobs S, Kröger J, Fritsche A, Schienkiewitz A, Rubin D, et al. Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis. Diabetologia. 2014;57(7):1355-65.
Centers for Disease Control and Prevention. Rates of any and exclusive breastfeeding by socio-demographics among children born in 2016; 2020.
Accessed June 16, 2020.
Centers for Disease Control and Prevention. Breastfeeding; 2020.
Accessed June 15, 2020.
Robinson K, Fial A, Hanson L. Racism, bias, and discrimination as modifiable barriers to breastfeeding for African American women: a scoping review of the literature. J Midwifery Womens Health. 2019;64(6):734-42.
Bigman G, Wilkinson AV, Pérez A, Homedes N. Acculturation and breastfeeding among Hispanic American women: a systematic review. Matern Child Health J. 2018;22(9):1260-77.
Bentley M, Gavin L, Black MM, Teti L. Infant feeding practices of low-income, African-American, adolescent mothers: An ecological, multigenerational perspective. Soc Sci Med. 1999;49(8):1085-100.
Gross TT, Powell R, Anderson AK, Hall J, Davis M, Hilyard K. WIC peer counselors' perceptions of breastfeeding in African American women with lower incomes. J Hum Lact. 2015;31(1):99-110.
Kim JH, Fiese BH, Donovan SM. Breastfeeding is natural but not the cultural norm: a mixed-methods study of first-time breastfeeding, African American mothers participating in WIC. J Nutr Educ Behav. 2017;49(7 Suppl 2):S151-S161.e1.
Hinson TD, Skinner AC, Lich KH, Spatz DL. Factors that influence breastfeeding initiation among African American women. JOGNN. 2018;47(3):290-300.
Nyange C. Promoting breastfeeding in African-American women. Int J Childbirth Educ. 2018;33(4):14-6.
Berry JW. Psychology of acculturation. The culture and psychology reader. 1995;457.
Shin CN, Reifsnider E, McClain D, Jeong M, McCormick DP, Moramarco M. Acculturation, cultural values, and breastfeeding in overweight or obese, low-income, Hispanic women at 1 month postpartum. J Hum Lact. 2018;34(2):358-64.
Hohl S, Thompson B, Escareño M, Duggan C. Cultural norms in conflict: breastfeeding among Hispanic immigrants in rural Washington state. Matern Child Health J. 2016;20(7):1549-57.
Sharma IK, Byrne A. Early initiation of breastfeeding: A systematic literature review of factors and barriers in South Asia. Int Breastfeed J. 2016;11:17.
Thepha T, Marais D, Bell J, Muangpin S. Facilitators and barriers to exclusive breastfeeding in Thailand: a narrative review. J Comm Pub Health Nurs. 2017;3(1):1-9.
Zhao J, Zhao Y, Du M, Binns CW, Lee AH. Maternal education and breastfeeding practices in China: a systematic review and meta-analysis. Midwifery. 2017;50:62-71.
Zhou M, Bankston III CL. The model minority stereotype and the national identity question: the challenges facing Asian immigrants and their children. Ethn Racial Stud. 2020;43(1):233- 53.
Sangalang CC, Becerra D, Mitchell FM, Lechuga-Peña S, Lopez K, Kim I. Trauma, post-migration stress, and mental health: a comparative analysis of refugees and immigrants in the United States. J Immigr Minor Health. 2019;21(5):909-19.
Da W, Garcia A. Later life migration: sociocultural adaptation and changes in quality of life at settlement among recent older Chinese immigrants in Canada. Act Adapt Aging. 2015;39(3):214-42.
Benza S, Liamputtong P. Pregnancy, childbirth and motherhood: a meta-synthesis of the lived experiences of immigrant women. Midwifery. 2014;30(6): 575-84.
Schmied V, Black E, Naidoo N, Dahlen HG, Liamputtong P. Migrant women’s experiences, meanings and ways of dealing with postnatal depression: a meta-ethnographic study. PLoS One. 2017;12(3):e0172385.
Kuswara K, Laws R, Kremer P, Hesketh KD, Campbell KJ. The infant feeding practices of Chinese immigrant mothers in Australia: a qualitative exploration. Appetite. 2016;105:375-84.
Maharaj N, Bandyopadhyay M. Breastfeeding practices of ethnic Indian immigrant women in Melbourne, Australia. Int Breastfeed J. 2013;8(1):17.
Zhou Q, Younger KM, Cassidy TM, Wang W, Kearney JM. Breastfeeding practices 2008–2009 among Chinese mothers living in Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2020;20(1):51.
Centers for Disease Control and Prevention. About race; 2020.
Accessed June 15, 2020.
Sandelowski M, Leeman J, Knafl K, Crandell JL. Text-in-context: a method for extracting findings in mixed-methods mixed research synthesis studies. J Adv Nurs. 2013;69(6):1428-37.
Sandelowski M, Voils CI, Leeman J, Crandell JL. Mapping the mixed methods–mixed research synthesis terrain. J Mix Methods Res. 2012;6(4):317-31.
Cooper H, Hedges LV, Valentine JC. The handbook of research synthesis and meta-analysis. Russell Sage Foundation; 2019.
Lee S, Bai YK, You S. Ecological factors influencing breastfeeding decisions among Korean immigrant mothers in America. J Child Fam Stud. 2018;27(3):928-43.
Lee A, Brann L. Influence of cultural beliefs on infant feeding, postpartum and childcare practices among Chinese-American mothers in New York City. J Community Health. 2015;40(3):476-83.
Babington L, Patel B. Understanding child feeding practices of Vietnamese mothers. MCN Am J Matern Child Nurs. 2008;33(6):376-81. DOI:10.1097/01.NMC.0000341259.03298.26
Galvin S, Grossman X, Feldman-Winter L, Chaudhuri J, Merewood A. A practical intervention to increase breastfeeding initiation among Cambodian women in the US. Matern Child Health J. 2008;12(4): 545-47.
Han M, Goyal D, Lee J, Cho H, Kim A. Korean immigrant women's postpartum experiences in the United States. MCN Am J Matern Child Nurs. 2020;45(1):42-8.
Kishanrao S. Are Asian mothers influenced by paediatricians in the USA to deprive full benefit of exclusive breastfeeding for first 6 months. Open J Pediatr Child Health. 2020;5(1):003-007.
Mistry Y, Freedman M, Sweeney K, Hollenbeck C. Infant-feeding practices of low-income Vietnamese American women. J Hum Lact. 2008;24(4):406-14.
Straub B, Melvin C, Labbok M. A descriptive study of Cambodian refugee infant feeding practices in the United States. Int Breastfeed J. 2008;3:2.
Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs (NJ): Prentice-Hall; 1980.
Williams PL, Innis SM, Vogel AM, Stephen LJ. Factors influencing infant feeding practices of mothers in Vancouver. Can J Public Health. 1999;90(2):114-19.
Linares AM, Wambach K, Rayens MK, Wiggins A, Coleman E, Dignan MB. Modeling the influence of early skin-to-skin contact on exclusive breastfeeding in a sample of Hispanic immigrant women. J Immigr Minor Health. 2017;19(5):1027-34.
Odeniyi AO, Embleton N, Ngongalah L, Akor W, Rankin J. Breastfeeding beliefs and experiences of African immigrant mothers in high‐income countries: a systematic review. Matern Child Nutr. 2020;16(3):e12970.
Gallegos D, Vicca N, Streiner S. Breastfeeding beliefs and practices of African women living in Brisbane and Perth, Australia. Matern Child Nutr. 2015;11(4):727-36.
Swigart TM, Bonvecchio A, Théodore FL, Zamudio-Haas S, Villanueva-Borbolla MA, Thrasher JF. Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: insights for how to improve future promotion strategies. PloS One. 2017;12(7):e0180185.
Withers M, Kharazmi N, Lim E. Traditional beliefs and practices in pregnancy, childbirth and postpartum: a review of the evidence from Asian countries. Midwifery. 2018;56:158-70.
Fantaye AW, Gunawardena N, Yaya S. Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: a systematic review. PloS One. 2019;14(9):e0222110.
Kuswara K, Knight T, Campbell KJ, Hesketh KD, Zheng M, Bolton KA. Breastfeeding and emerging motherhood identity: an interpretative phenomenological analysis of first time Chinese Australian mothers’ breastfeeding experiences. Women Birth. 2020;S1871-5192(19)30940-0.
Lindsay AC, Le Q, Greaney ML. Infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers: an integrative review of the literature. Int J Environ Res Public Health. 2017; 15(1):21.
Wouk K, Tucker C, Pence BW, Meltzer-Brody S, Zvara B, Grewen K, et al. Positive emotions during infant feeding and breastfeeding outcomes. J Hum Lact. 2020;36(1):157-67.
Fabiyi C, Peacock N, Hebert-Beirne J, Handler A. A qualitative study to understand nativity differences in breastfeeding behaviors among middle-class African American and African-born women. Matern Child Health J. 2016;20(10):2100-11.
Shakya P, Kunieda MK, Koyama M, Rai SS, Miyaguchi M, Dhakal S, et al. Effectiveness of community-based peer
support for mothers to improve their breastfeeding practices: a systematic review and meta-analysis. PloS One. 2017;12(5):e0177434.
Trickey H, Thomson G, Grant A, Sanders J, Mann M, Murphy S, et al. A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settings. Matern Child
Schindler-Ruwisch JM, Roess A, Robert RC, Napolitano MA, Chiang S. Social
support for breastfeeding in the era of mHealth: a content analysis. J Hum Lact. 2018;34(3):543-55.
Meedya S, Win K, Yeatman H, Fahy K, Walton K, Burgess L, et al. Developing and testing a mobile application for breastfeeding support: the Milky Way application. Women Birth; 2020. (In press).
Parker MG, Lopera AM, Kalluri NS, Kistin CJ. “I felt like i was a part of trying to keep my baby alive”: perspectives of hispanic and non-hispanic black mothers in providing milk for their very preterm infants. Breastfeed Med. 2018;13(10):657-65. DOI: 10.1089/bfm.2018.0104
Nguyen TT, Withers M, Hajeebhoy N, Frongillo EA. Infant formula feeding at birth is common and inversely associated with subsequent breastfeeding behavior in Vietnam. J Nutr. 2016;146(10):2102-08.
Pérez-Escamilla R. Breastfeeding in the 21st century: how we can make it work. Soc Sci Med. 2020;244:112331.
Satti NK, Tabassum L, Jamali AA, Hashmat N, Mustafa FT. Myths and perceptions about breast feeding practices among healthcare professionals' family and relatives. Int J Sci Res. 2020;9(1):42-4.
González-Pascual JL, Ruiz-López M, Saiz-Navarro EM, Moreno-Preciado M. Exploring barriers to breastfeeding among chinese mothers living in Madrid, Spain. J Immigr Minor Health. 2017;19(1):74-9.
Joseph J, Brodribb W, Liamputtong P. “Fitting-in Australia” as nurturers: Meta-synthesis on infant feeding experiences among immigrant women. Women Birth. 2019;32(6):533-42.
Delle Donne A, Hatch A, Carr NR, Aden J, Shapiro J. Extended maternity leave and breastfeeding in active duty mothers. Pediatrics. 2019;144(2):e20183795.
Pemo K, Phillips D, Hutchinson AM. Midwives’ perceptions of barriers to exclusive breastfeeding in Bhutan: a qualitative study. Women Birth. 2020;33(4):e377-e384.
Tambani E, Giannì ML, Bezze EN, Sannino P, Sorrentino G, Plevani L, et al. Exploring the gap between needs and practice in facilitating breastfeeding within the neonatal intensive care setting: an Italian survey on organizational factors. Front Pediatr. 2019;7:276.
Hannan KE, Smith RA, Barfield WD, Hwang SS. Association between NICU admission and supine sleep positioning, breastfeeding, and postnatal smoking among mothers of late preterm infants. J Pediatr. 2020;227:114-20.e1.
Murphy TP, McCurdy K, Jehl B, Rowan M, Larrimore K. Jealousy behaviors in early childhood: associations with attachment and temperament. Int J Behav Dev. 2019;44(3):266-72.