Feeding an infant in a foreign land: the experiences of refugee mothers from Vietnam and Myanmar

Abstract

BackgroundPersecution and conflicts in countries like Vietnam and Myanmar force many to flee their countriesto those with more resources, such as Australia, in search of a better life. However, maternalintegration into the new society is often compounded by the task of nurturing her infant while shenavigates unfamiliar and contrasting socio-cultural norms, ideologies and expectations. Whileglobal data show that child malnutrition due to sub-optimal feeding practices are high in lowerincome countries, there is no recent data that showcase the infant feeding experiences of refugeemothers from Vietnam and Myanmar in Australia or globally. Thus, an understanding of the beliefs,practices and experiences related to infant feeding decisions in their new homeland would helphealthcare and policy sectors focus attention on aspects of maternal infant feeding negotiations thatrequire attention.Research objectivesThis research was designed to understand infant feeding beliefs, practices and experiences, and thecultural meanings of maternal and infant health in Vietnamese and Myanmarese refugee women inAustralia. The objectives were to 1) define the post-birth rituals and its connection with infantfeeding; 2) understand the cultural definition and maternal management of optimal infant health inchanging contexts; 3) explore infant feeding experiences in relation to societal norms, networks andsocial structures pre- and post-resettlement; and 4) examine the embodied experiences of nurturingin traditional and modernistic contexts.MethodologyThis study employed qualitative research methods to explore the infant feeding experiences ofVietnamese and Myanmarese mothers who have resettled in Brisbane, Australia.Phenomenological-, feminism-, and postmodern- informed methodological frameworks were usedto guide data collection through in-depth interviewing and drawing methods. Most mothers had onefollow-up interview and were given the freedom to express their voices through artwork at theirpreferred phase of the interview. Data surrounding infant feeding beliefs, practices, experiences andnegotiations in social spheres were gathered. Verbal and visual data were analysed thematically and using the critical visual analytical framework respectively and later juxtaposed with the interviewthemes. There were thirty-eight participants; 16 from Vietnam and 22 from Myanmar. Half of theVietnamese mothers were recent arrivals (l 10 years), while the remainder arrived in Australia aschildren or teenagers (g 20 years). Participants from Myanmar were all recent arrivals (l 10 years),and from four ethnic groups (Karen, Karenni, Chin and Kachin).Results and discussionsThe findings and discussion of this study were situated within four theories: Liminality; MaternalinfantEmbodiment and Inter-embodiment; Motherhood Risk and Responsibility; and BourdieursTheory of Practice. Four main themes were derived from the data: Infant feeding beliefs; Maternalways of knowing infant health and growth; Negotiations of infant feeding beliefs, practices andexperiences in changing socio-cultural and medicalised contexts; and the embodiment of infantfeeding in changing contexts. Breastfeeding was seen as an embodied behaviour and breast milk asan embodied bodily fluid; both were interdependent of the other. Breast milk was thought to be ofoptimal quality for infant growth and development when the mother, infant and culturalenvironment were in a state of elemental harmony and oneness. Childbirth was thought tocontribute to maternal bodily vulnerability and disharmony, while conformity to heat-enhancingpostpartum rituals established a state of bodily strength and elemental harmony. Maternal ill health,emotional stressors and disconnection from support networks and ritualistic environmentscontributed to the use of alternative feeding methods to protect the infant from health risks that maybe transmitted through breast milk. The vulnerability of mothers who were recent arrivals wasfrequently compounded by negotiations with unfamiliar socio-cultural environments. Issues such asthe medicalisation of infant feeding, negotiating lforeignr healthcare systems, work ideologies thatnecessitate maternal-infant separation, and sexualisation of the breast often instilled feelings ofdoubt about their capacity as nurturers. Often, this contributed to the cession of breastfeeding andsubsequent use of infant formula. Mothers who could communicate in English and those who wereeducated in Australia or had familial support networks were able to integrate into and negotiateAustralian norms while maintaining their identity as breastfeeding mothers. This study providesnew knowledge especially in respect to embodied experiences that were predominantly expressedthrough drawing exercises, since some descriptions are inexpressible with words and many recentarrivals, in particular, struggled to verbalise their life journeys. Conclusion and recommendationsSince infant feeding does not stand alone but is tempered with contextual negotiations, multilevelsocietal interventions would be valuable in supporting breastfeeding practice in the context ofrefugee motherhood. It is suggested that fostering a culturally sensitive, knowledgeable andintegrative healthcare system, educational programs, community support groups and social spaceswould aid maternal integration into a new society.