Rev. Enferm. UFSM, v.13, e9, p.1-14, 2023
Submission: 9/23/2022 • Acceptance: 2/14/2023 • Publication: 3/28/2023
Original article
The theoretical concept of “Breastfeeding space” portrayed in the World Breastfeeding Week campaigns*
O conceito teórico “Espaço para amamentar” retratado nas campanhas da Semana Mundial de Aleitamento Materno
El concepto teórico de “Espacio para amamantar” retratado en las campañas de la Semana Mundial de Lactancia Materna
Cosmo Alexandro
da Silva de AguiarI
Amanda
Alcantara de SousaI
Thaís Rodrigues
de AlbuquerqueI
Simone Soares
DamascenoI
Joseph Dimas de
OliveiraI
Rachel de Sá
Barreto Luna Callou CruzI
I Universidade Regional do Cariri (URCA). Crato, Ceará, Brasil
* Manuscript prepared based on the discussions and analyses of the posters from the National Breastfeeding Campaign about the “Breastfeeding space” in fortnightly meetings during one semester in the Research and Extension Group on Children's and Adolescents' Health (Grupo de Pesquisa e Extensão em Saúde da Criança e do Adolescente, GRUPECA) of Universidade Regional do Cariri (URCA).
Abstract
Objective: to analyze how breastfeeding spaces are portrayed in the posters from the National Breastfeeding Campaign, in the light of the Interactive Theory of Breastfeeding. Method: a documentary study carried out in five stages using the Semiotic Analysis of Still Images methodological framework by Gemma Penn. The materials chosen as sample were the thematic images from the World Breastfeeding Week campaigns in Brazil. Results: it was observed that most of the women breastfed in public spaces. The approach to working women's rights and several aspects referring to the COVID-19 pandemic stand out. Conclusion: the space where the breastfeeding process takes place is portrayed in various ways in terms of the physical environment. With regard to the theoretical concept of “Breastfeeding space”, which includes the gestures, postures and behaviors of those who occupy it, the campaigns proved to be limited.
Descriptors: Breastfeeding; Child; Nursing; Social Media; Health Promotion
Resumo
Objetivo: analisar como os espaços para amamentar são retratados nos cartazes da campanha nacional de aleitamento materno, à luz da Teoria Interativa da Amamentação. Método: estudo documental realizado em cinco etapas pelo referencial metodológico de Análise Semiótica de Imagens Paradas por Gemma Penn. Os materiais escolhidos como amostra foram as imagens temáticas das campanhas da Semana Mundial de Aleitamento Materno no Brasil. Resultados: observa-se que a maioria das mulheres estava amamentando em espaços públicos. Destaca-se a abordagem ao direito da mulher trabalhadora e aspectos referentes à pandemia da COVID-19. Conclusão: o espaço em que ocorre o processo de amamentação é retratado de forma diversa quanto ao ambiente físico. No que se refere ao conceito teórico “Espaço para amamentar”, que inclui os gestos, posturas e comportamento dos que o ocupam, as campanhas se mostraram limitadas.
Descritores: Aleitamento Materno; Criança; Enfermagem; Mídias Sociais; Promoção da Saúde
Resumen
Objetivo: analizar de qué manera se retratan los espacios para amamantar en los pósteres de la campaña nacional de lactancia materna, a la luz de la Teoría Interactiva de la Lactancia Materna. Método: estudio documental realizado en cinco etapas conforme al marco metodológico del Análisis Semiótico de Imágenes Fijas de Gemma Penn. Los materiales elegidos como muestra fueron las imágenes temáticas de las campañas de la Semana Mundial de Lactancia Materna en Brasil. Resultados: se observa que la mayoría de las mujeres amamantaba en espacios públicos. Se destacan el enfoque con respecto a los derechos de las mujeres trabajadoras y aspectos referentes a la pandemia de COVID-19. Conclusión: el espacio en el que tiene lugar el proceso de lactancia se retrata de diversas maneras en cuanto al ambiente físico. En lo que refiere al concepto teórico de “Espacio para amamantar”, que incluye los gestos, las posturas y las conductas de quienes lo ocupan, las campañas demostraron ciertas limitaciones.
Descriptores: Lactancia Materna; Niño; Enfermería; Medios de Comunicación Sociales; Promoción de la Salud
It is a consensus that the breastfeeding practice is indispensable for the healthy growth and development of a child, as well as for maternal health, judging by the constant global and national efforts to reduce early weaning and to encourage and support breastfeeding.1 A proper breastfeeding space is implied, knowing that it is influenced by various elements such as family, culture, sociodemographic characteristics, previous experiences and the environment.2-3 Hostile environments, with negative judgments, are barriers to successful breastfeeding4 and, for women, breastfeeding in public spaces causes discomfort, embarrassment and shame, as society is still bound by myths and taboos related to sexuality and objectification of female bodies.5 Similarly, a suboptimal maternity environment can also become an obstacle to exclusive breastfeeding.6
The breastfeeding space is also a concept of the Interactive Theory of Breastfeeding, being characterized as the personal or subjective, individual and situational universe, dependent on relationships and based on a woman's perception about breastfeeding, going beyond the physical territory. For this mid-range Nursing theory “breastfeeding is a dynamic interaction process in which mother and child interact with each other and with the environment to achieve the benefits of human milk, offered directly from the breast to the child, representing an experience that is unique to each event”. Therefore, it is corroborated that the environment exerts an influence on the breastfeeding process.3
Given the potential impact of advertising campaigns and social media for changing the population's health behaviors, it is imperative that governments consider all the evidence and demonstrate commitment to the advancement of breastfeeding policies and programs, in this case, the fight for transposition of structural and social barriers that prevent women from breastfeeding in public places. In this sense, the gaps in the literature should be filled so that the health sector can capture and use educational materials more effectively for health promotion and education.5-7 In view of the above, it is understood that the lower visibility and disclosure of women breastfeeding in public places creates the perception that it is still an unacceptable practice.5 Thus, this study aims at analyzing how breastfeeding spaces are portrayed in the posters from the national breastfeeding campaign, in the light of the Interactive Theory of Breastfeeding.
This is a documentary study carried out from March to June 2021 and which used the Semiotic Analysis of Still Images methodological framework by Gemma Penn, in five stages: 1) selection of the material; 2) denotative inventory; 3) connotative inventory/highest significance levels; 4) syntagmatic relationships; and 5) report. The main objective of a semiotic image analysis is to elucidate signs through conceptual tools, in order to discover how they produce culturally relevant knowledge. Consequently, anchored by the accompanying text, a visual image extracts its significants and names its meanings.8
The following inclusion criteria were adopted: posters from the World Breastfeeding Week campaigns in Brazil, collected from the Oswaldo Cruz Foundation website; and, as exclusion criteria: those that did not portray or where it was not possible to identify the space where the mother and her child would be at the breastfeeding moment. In this sense, the posters included were those corresponding to the following years: 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2019 and 2020.
Subsequently, the denotative analysis was initiated, describing in detail the elements contained in the visual material, between characters and their characteristics, abstractions, colors, representations, relationships and, mainly, spaces. From there, higher significance levels were produced (connotative phase), when questioning the meaning of each element and the relationship between them and the theme. For the purposes of the fourth stage, the theoretical concept of “Breastfeeding space” from the Interactive Theory of Breastfeeding was considered, aiming to examine how this approach occurs in nationwide campaigns to promote breastfeeding. At the end, the results were presented in charts. As this was an analysis of images from publicly available posters, appreciation by a Research Ethics Committee was waived.
After applying the inclusion and
exclusion criteria, 10 posters comprised the sample of this study, which are
shown in the tiles in Figure 1.
Figure 1 – Tiles with the thematic posters from the World Breastfeeding Week campaigns in Brazil.
Source: https://rblh.fiocruz.br/campanhas-nacionais-semana-mundial-de-aleitamento-materno-smam
The analysis and the theoretical concept related to the Breastfeeding space instituted by the Interactive Theory of Breastfeeding are presented in Charts 1 and 2.
Chart 1 – Analysis of the posters from the National Breastfeeding Campaign. Crato – CE, Brazil, 2022.
|
No./Year |
Denotative phase |
Connotative phase |
Breastfeeding space |
|
1 2009 |
Representation of nature. In the foreground, singer Claudia Leitte is sitting down, smiling at the camera and breastfeeding her son, with her breast exposed. |
The representation of nature refers to the importance of on-demand breastfeeding, regardless of the adversities, of the place or of the moment. The mother smiling with her breast exposed indicates satisfaction and comfort while breastfeeding. |
Breastfeeding is portrayed as a calm and satisfying practice. The action of breastfeeding in any time and place is advocated. |
|
2 2010 |
Central image of a woman breastfeeding her child with her breast exposed. In the background there is a white building with arched windows and a small pond. |
The mother is smiling, which may mean that the breastfeeding practice can generate pleasure. |
Public and open environments can be safe and comfortable spaces to breastfeed. |
|
3 2011 |
An environment similar to a park/square. Actress Juliana Paes, breastfeeding while smiling at her son. |
It presupposes that public spaces should also be breastfeeding spaces. The fact that the mother is smiling while breastfeeding can indicate that she finds it a pleasurable practice. |
The leisure environment is presented as a satisfactory space for breastfeeding. |
|
4 2012 |
A countryside environment. Two women are breastfeeding in the background. Singer Wanessa Camargo is in the foreground, breastfeeding, while smiling at the camera. |
The mothers seem to be happy for being breastfeeding their children. It can be interpreted as fraternization between them, symbolizing a maternal support network. |
Natural environments and open spaces are presented as safe and comfortable spaces to breastfeed. |
|
5 2013 |
Ambulatory environment, with children's decor. In the center of the image, actor Marcelo Serrado holds one of the infants and his wife next to him breastfeeds the other. There is a health professional next to them. |
Apparently, the health professional is instructing the parents on how to perform the breastfeeding practice. The father seems involved and participatory in the instructions, which indicates that he and the health professional are members of the woman's support network. |
The presence of a health professional can solve doubts and turn breastfeeding into a calmer practice. |
|
6 2014 |
Actress Nívea Stelmann is seated, breastfeeding. There is a boy on the arm of the chair. Above them we see four paper clouds, each one with a picture of a baby in a different outfit: scientist, physician, judge and dancer. |
The fact that the mother is smiling suggests that breastfeeding is pleasurable. The presence of the boy indicates that he was also breastfed. The paper clouds possibly symbolize that the lactating child can be whatever he wants to be when he grows up with the help of breast milk. The children themselves can comprise the breastfeeding support network. |
The home environment and a closed space are adequate and pleasant for the breastfeeding practice. |
They stand out in the relevant thematic posters, of which the one from 2013 (5) is the first with the presence of symbols from social networks referring to breastfeeding and the Ministry of Health. The 2015 poster (7) addresses working women's right to maternity leave and the 2020 poster (10) presents aspects related to the COVID-19 pandemic, which arrived in the country at the end of 2019.
Chart 2 – Analysis of the posters from the National Breastfeeding Campaign. Crato – CE, Brazil, 2022.
|
No./Year |
Denotative phase |
Connotative phase |
Breastfeeding space |
|
7 2015 |
Presenter Serginho Groisman and his wife Fernanda Molina are in a standing position. In the foreground, we see a woman sitting in an office chair and breastfeeding. Breastfeeding in the workplace after the maternity leave is mentioned. |
The couple in a standing position symbolizes the employers, who are offering an adequate space for their employee to breastfeed. In this context, the employers act as the breastfeeding woman's support network. |
The work environment can be a space for successful breastfeeding, if the ideal conditions are granted, such as favorable environment and time. |
|
8 2016 |
Illustration in the form of circular levels with different colors and designs. In the center there is a woman breastfeeding her child, approximately six months old. |
The concentric circles may represent the spheres into which the planet is divided and refer to breast milk, which is a source of energy and essential nutrients for the infant. The circle with the suns in yellow, followed by the pink circle with the birds and the purple circle with the stars, possibly symbolize the morning, afternoon and night periods, alluding to breastfeeding on demand. The handmade fish and yo-yos indicate working mothers. The text mentions the sustainable nature of breastfeeding. |
It presupposes that any space and moment in which a woman wants to breastfeed and feels comfortable to do so is characterized as adequate. |
|
9 2019 |
The environment is similar to a bed. A woman is breastfeeding, an adolescent girl is watching her and a man is in front of her. The phrase asserts the importance of breastfeeding, both for the family and for society. |
The breastfeeding moment seems to be pleasurable for the family, which is united around the dyad and smiling. The man and the adolescent girl are part of the woman's support network. |
The home environment seems to be comfortable for the woman and her child, with privacy and family support. |
|
10 2020 |
In the environment, it is possible to see four people: a health professional wearing an N95 mask, the mother sitting down, with a fabric mask and breastfeeding, and a man standing next to the woman, also wearing a fabric mask. |
The fact that all three adults present in the image are wearing masks mentions the prevention measures against contamination by the SARS-CoV-2 virus, the COVID-19 causing agent, which provoked the pandemic at the end of 2019. |
Outpatient and health care spaces emerge as possible spaces for breastfeeding. |
Of the ten posters that made up the sample, four show women breastfeeding in public spaces (2009, 2010, 2011, 2012), of which one illustrates a countryside setting (2009), the courtyard of the Prof. Fernando Figueira Comprehensive Medical Institute (Instituto de Medicina Integral, IMIP) (2010), a street park (2011) and a lake (2012). Two presented outpatient environments (2013, 2020) and another showed a professional one (2015). In addition, two posters portrayed breastfeeding in a home space (2014, 2019) and another showed a representation of the planet in a general way (2016).
In six campaigns, the protagonist of the image was a famous woman (singer or actress) or the wife of a famous person (2009, 2011, 2012, 2013, 2014, 2015). The representation of black-skinned women appeared in three posters (2012, 2016, 2020). In all of them, the mothers appear smiling or seem satisfied with nurturing their children, in addition to having their breasts exposed while breastfeeding.
Breastfeeding women want to feel comfortable, accepted, supported and welcome. However, public environments still provoke unpleasant feelings in mothers due to unwanted attention, the male gaze and the sensation of being attributed sexual object connotations during breastfeeding. A study conducted with mothers in Australia and Sweden highlighted that the presence of a support network (a friend, family member or partner) is useful for accepting breastfeeding in public spaces.9 Saudi Arabian mothers state that maternal comfort while breastfeeding in some social environments is related to the intention to breastfeed exclusively.10
To make breastfeeding in public spaces more comfortable, breastfeeding rooms have been built in shopping malls, airports and workplaces.11 The mothers can feel safe inside the rooms, where they will be sheltered and find support from other women.
In all campaigns analyzed in the sample, in which women are breastfeeding in public spaces, their breasts are exposed. This shows concern in promoting social change based on a reflection on the reasons that generate preconceptions about this practice, as there is a tendency for mothers to cover their breasts with a cloth or diaper to breastfeed in these spaces.5,9 On the other hand, the photographs that accompany the breastfeeding campaigns do not show nipples, but hide them with careful positioning of the infants' heads, oftentimes in softly lit and diffused styles that perpetuate romantic views of motherhood.12
This fact is related to the results found in this study on the portraits of already established breastfeeding, when the children, for the most part, are not newborns and all the mothers appear smiling and satisfied with the breastfeeding process, which is praised as natural and beautiful. Breastfeeding is the first moment in which the romanticized notions of being a mother are confronted with the reality of negative notions, such as pain and fatigue related to the process.13
Although breastfeeding was portrayed in the posters as pleasurable and permeated with positive feelings, especially joy for the mothers, it is known that they face numerous difficulties during this time, especially in the initial stages. This is both due to technical issues and complications in the breast, such as breast engorgement, mastitis and nipple fissures. These problems are generally related to errors in posture and latch on to the breast and can exert a direct impact on the duration of breastfeeding.14 Prenatal interventions that address these issues can increase exclusive breastfeeding intention and duration.10
It is observed that none of the campaigns addressed the “Golden Hour”, that is, the first hour of the neonate's life, in which the beginning of early breastfeeding is closely related to the success of exclusive breastfeeding and to the increase in prolactin production by the mother.15
It is also noted that the theme about pregnant mothers who breastfeed was not addressed. This practice has been controversial due to the professionals' concern with its possible consequences. However, data from a systematic review suggest that breastfeeding during pregnancy was not related to unfavorable maternal or neonatal outcomes.16
With regard to the miscarriage risk, of the 19 studies identified, seven show similar rates among pregnant women (0% - 15.6%) and non-pregnant women (0% - 19.6%) who were breastfeeding. In relation to premature birth, the rates varied between 2.2% and 7.7% in pregnant women who were breastfeeding and between 0% and 10.3% in those who were not doing so. Therefore, this indicates that the evidence is insufficient to clearly establish the implications of breastfeeding during pregnancy for mothers or newborns.16
In the women's perception, the home environment is the most comfortable and safe space. Many mothers time their outings so that their child's feeding takes place at home or to express breast milk.17 When understanding the breastfeeding space from the perspective of the Interactive Theory of Breastfeeding, it is considered that it influences breastfeeding and that this process also depends on the relationships and situations imposed by the personal, historical and sociocultural context in which a woman lives.3,5
Therefore, in the home space, the mother's relationship with her partner, with the child's grandparents and with other family members in the form of support can be a predictor of improved breastfeeding results.18 In addition, implied in the home context, an observational study found a strong association between the increase in the duration and probability of exclusive breastfeeding up to six months of the child's life and the proximity degree of the infant to the mother during the night.19
The workplace is an important component of working mothers' social support network and can be associated with the duration of breastfeeding.20 When returning from a maternity leave, which lasts 120 days, women have the right to two special breaks lasting half an hour each, for breastfeeding during the workday, which should occur until the newborn is six months old. In facilities with at least 30 women over 16 years of age, there should be an appropriate place for childcare. These places for the care of children, during the breastfeeding period, should have at least a nursery, a breastfeeding room, a dietetic kitchen and a bathroom.21
Among working mothers, lack of information is still present with regard to the safety laws referring to the breastfeeding practice, which consequently opens a gap so that companies do not assume responsibility towards support and assistance for breastfeeding.22
With regard to breastfeeding in the presence of health professionals in outpatient environments, there are reports of feelings of comfort and well-being that are related to the representative figure of the professionals and their authority, which can reduce the sensation of embarrassment in women.5 In fact, early breastfeeding initiation has higher rates among women who attended four or more prenatal consultations, showing the health professionals' substantial role in supporting and encouraging breastfeeding.23
In this perspective, the nurses who play an important role in helping pregnant women during the breastfeeding process stand out. From prenatal care to the puerperal visits, these professionals are the ones who work closest to the women, with positive possibilities of encouraging and supporting exclusive breastfeeding.
In the 2016 campaign, the theme of sustainability is noted, which may have been influenced by the international agreements that focused on environmental problems. As an example, there is the agreement on the Millennium Development Goals, which took place in the previous year, with 17 targets directly linked to breastfeeding.24 Also in 2016, the Paris agreement was formalized, in which the member countries assumed responsibilities for the reduction of greenhouse gases and climate change25 and validity of the Kigali amendment, adding hydrofluorocarbons to the list of substances that must be controlled in terms of emission by the countries involved.26
The fact that the campaign informs about the scope of the benefits of breast milk beyond the child, combined with global concerns about preservation of the environment, can increase mothers' adherence to breastfeeding by producing a sense of accomplishment and satisfaction by complying with the expectations of scientific authorities.
The 2020 campaign addressed the COVID-19 pandemic, which significantly affected breastfeeding spaces and experiences. While some mothers were able to breastfeed longer, others felt forced to stop before they were ready to do so. Hospitals discharged mothers and their newborns early in time and limited visits and consultations, reducing the time spent on specialized lactation care, education and technical assistance.27-28
In view of the sudden pandemic crisis, which led to millions of deaths worldwide, the gap in knowledge about breast milk contamination by the virus led to considerable uncertainty in the everyday clinical practice regarding the infants' safety, increasing the risk of weaning. Despite this, there is consensus in the scientific community that the separation of all mother-infant dyads with suspected or confirmed SARS-CoV-2, regardless of the severity of the disease, can lead to a constellation of preventable diseases and deaths among infants and women all over the planet, and this must be considered in the assistance provided by the health services.29
The time-dependent protective effect of exclusive breastfeeding against viral infections outweighs the risk of discontinuing it and, thus, guidelines from the relevant international and national agencies recommend breastfeeding by mothers infected with SARS-CoV-2, provided that the protective measures are strictly followed, such as frequently changing face masks and hand hygiene before handling any surface required for breastfeeding or milking.30
Most of the selected posters contained famous people and their children starring in breastfeeding, which can be understood as appeals from these public personalities for greater engagement and awareness on the part of the population. It is worth noting that, in some posters, there is information that the artists participated in the campaign free of charge, which alludes to philanthropy and to the fact that raising public awareness would be more important, rather than paying, emphasizing the importance of the theme.
As a study limitation, we should mention the number of posters that allowed identifying the physical space in the breastfeeding record, restricting the findings in relation to the environments presented.
However, the research aims at contributing to the knowledge related to the breastfeeding process by analyzing how it is represented in advertising campaigns in the World Breastfeeding Weeks released by the Ministry of Health. Thus, the understanding of breastfeeding and the spaces in which it can be performed by the nursing mother is expanded, as long as it is comfortable to do so.
Based on this knowledge, it becomes feasible to plan health education and the active participation of health professionals, including nurses, as well as undergraduate students, aiming at adequate learning for pregnant women, providing guidelines, discussions and timely support for mothers and newborns.
The breastfeeding space is portrayed in the posters from the National Breastfeeding Campaigns in different ways in terms of physical space, such as squares, fields, the work environment, health institutions, home and even globally, the planet. The presence of these different places possibly indicates the spaces in which women can breastfeed their children, if comfortable to do so.
Despite this, regarding the theoretical concept of “Breastfeeding space”, which includes the gestures, postures and behaviors of those who occupy it, the campaigns proved to be limited, by portraying women appearing to be extremely happy to breastfeed, which connotes the breastfeeding process as easy and always pleasurable, not reflecting the reality of all women.
It is understood that the breastfeeding space in nationally relevant campaigns should be representative of the real situations inherent to breastfeeding, in order to reach greater adherence to breastfeeding and contribute to achieving the agreed upon targets.
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Authorship contributions
1 – Cosmo Alexandro da Silva de Aguiar
Nursing student - cosmoaguiar84@gmail.com
Conception and/or development of the research and/or writing of the manuscript, approval of the final version.
2 – Amanda Alcantara de Sousa
Corresponding author
Nurse. MSc student in Nursing - allcantaramanda@gmail.com
Conception and/or development of the research and/or writing of the manuscript, approval of the final version.
3 – Thaís Rodrigues de Albuquerque
Nurse. MSc in Nursing - thais.alb@urca.br
Conception and/or development of the research and/or writing of the manuscript, approval of the final version.
4 – Simone Soares Damasceno
Nurse. MSc in Nursing - simone.damasceno@urca.br
Review and approval of the final version.
5 – Joseph Dimas de Oliveira
Nurse. PhD in Nursing - joseph.oliveira@urca.br
Review and approval of the final version.
6 – Rachel de Sá Barreto Luna Callou Cruz
Nurse. PhD in Health - rachel.callou@hotmail.com
Review and approval of the final version.
Scientific Editor in Chief: Cristiane Cardoso de Paula
Associate Editor: Graciela Dutra Sehnem
How to cite this article
Aguiar CAS, Sousa AA, Albuquerque TR, Damasceno SS, Oliveira SD, Cruz RSBL. The theoretical concept of “Breastfeeding space” portrayed in the World Breastfeeding Week campaigns. Rev. Enferm. UFSM. 2023 [Access on: Year Month Day]; vol.13, e9: 1-14. DOI: https://doi.org/10.5902/2179769271768