and individual levels, an exploratory mixed method research design was employed. After 17 separate focus group discussions with parents and grandparents of non- Aboriginal and Aboriginal Australians, and subsequent data collection through questionnaires, evidence supports the position that grandparents do indirectly influence parents’ behaviour with regard to breastfeeding and paediatric vaccinations.
Although it is clear grandparents have an influence, the direction of the influence is harder to pin down. Only in the Aboriginal focus groups was there evidence that grandparents had a direct influence on parenting. Whether the influence is positive or negative depends on grandparents’ lived experience of breastfeeding and paediatric vaccination. Grandparents’ behaviours, attitudes and beliefs are indirectly picked up through seeing and hearing about the grandparents’ and broader families’ experiences. Therefore, parents’ breastfeeding behaviour and paediatric vaccination uptake depends on the manner in which they have embodied grandparents’ attitudes and behaviour towards breastfeeding and paediatric vaccines.
10.2 GRANDPARENTAL INFLUENCE OF BREASTFEEDING BEHAVIOUR
As mammals, breastfeeding is the most common source of infant feeding, however, this does not imply it is a simple given. A breastfeeding mother must negotiate dominant ideologies, attitudes and behaviours of those in her physical and social ecology (Dykes, 2005; McDade & Worthman, 1998). Nuclear families have become the norm in WEIRD societies and parents are separated by distance and time from grandparents in WEIRD societies. Some of this is remedied through technology, which allows regular communication and the sharing of ideas and beliefs across generations. Both focus group discussions and questionnaire data showed frequent communication
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still exists between mothers and maternal grandmothers suggesting the exchange of beliefs and attitudes which could influence parenting behaviours is present.
The diversity in age and culture of parents and grandparents meant that their knowledge, beliefs and attitudes were informed by the popular infant feeding culture in which they were raised as children and at the time of the birth of their children (Dykes, 2005; Grassley & Eschiti, 2008). Non-Aboriginal Australians who participated in focus groups expressed positive attitudes and beliefs towards breastfeeding, but the extent to which this informed their behaviour depended on the context of their breastfeeding ecologies. Grandmothers in particular did not express positive attitudes towards breastfeeding and were surprised about the duration for which their daughters breastfed. The lack of a statistically significant effect of family influence on breastfeeding behaviour can be attributed to grandparents and especially mothers’ and grandmothers’ diverse knowledge and beliefs in breastfeeding. In the instances that grandparents did share breastfeeding experiences it was not always positive and therefore is not likely to have been influential, especially if the mother was attending antenatal classes and was being educated on the benefits of breastfeeding. The positive attitude seen both in the focus groups and from the questionnaire data is evidence that parents and grandparents are aware that breastmilk is the best source of infant nutrition. It does not translate to meeting the WHO recommendations (behaviour), however, suggesting there is a strong effect of external factors on breastfeeding behaviour. The generation of grandmothers have not all had a positive experience with their own breastfeeding experiences. Some were even explicitly advised not to breastfeed. They are not all knowledgeable about the myriad benefits of breastfeeding, strongly suggestive of the need to educate grandparents.
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Among mothers with a strong British heritage breastfeeding during their formative years was associated with classism. While social class did not come into conversation, the notion of Victorian ideologies informing breastfeeding practices were eluded to (Huck, 1994, 1995). Breastfeeding, and the breast are still highly sexualised, which was raised as an issue particularly in the Aboriginal focus groups, and there is a strong need for the broader community to get beyond that influence to maintain the view that breastfeeding is the optimal source of nutrition for infants to ensure a healthier future.
Culture, in all its complexity informs infant feeding practices and is a variable that plays a critical role in breastfeeding behaviour. Aboriginal and Torres Strait Islander participants have a positive attitude towards breastfeeding. Their knowledge of breastfeeding and the benefits of breastmilk are extensive. The knowledge transfer across generations is explicit and interaction between family members around child health is focused on the benefits to the child. Elders opinions are valued, and advice is followed through on, this is very similar to the findings of an extensive literature review of the influence of older women in 85 different cultural settings (USAID, 2011). Therefore, culture is the variable that could help understand how grandparents could have in the past and could again in the future, influence breastfeeding behaviour.
But the complexity of breastfeeding in the context of a WEIRD society, where a mother must work away from her infant is a challenge in and of itself. This could potentially negate, through formal child care, and promote, through grandparental child care an influence on breastfeeding behaviour. Medicalised births, the increasing rates of caesarean sections and older age at first birth (Arora et al., 2017; McIntyre et al., 2000) are all variables that can and do contribute to sub-optimal breastfeeding behaviour among mothers. Finally, the general positive attitudes and beliefs toward breastfeeding
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provided by health workers may be masking any positive benefit grandparents are likely to have had in the past.
10.3 GRANDPARENTAL INFLUENCE ON PAEDIATRIC VACCINATION