Healthy infant feeding traditions are embedded in cultural approaches to childrearing. However, dramatic changes in infant feeding and oral health practices were identified by the research participants as being connected to larger shifts away from cultural based childrearing. The reliance on biomedical advice around infant feeding, coupled with the drastic changes in diet including the influence of processed, high sugar, high sodium food, the low prevalence of breast feeding, as well as an overall lack of education on oral health practices have shaped the “culture” of poor infant feeding and overall care for the mouths of babies in the community. These changes in infant feeding practices and oral health cannot be understood within a vacuum, and the wider social and cultural context of the community is required.
Breastfeeding and healthy teeth were seen as linked by respondents. The participants were aware that even when it was milk or formula in the bottle, improper feeding techniques and a lack of oral care resulted in tooth decay:
I see more bottle feeding than I do breastfeeding which I think should be more breast feeding. When they bottle feed, they don’t take them off until they’re 2 or 3 yrs old. It makes things worse. By the time they get off they don’t have the proper teeth, that’s when they have to go for the surgery and I see a lot of that in Norway House.
This paper focusses specifically on areas related to breast and bottle feeding practices. The primary themes identified included breastfeeding attitudes, social support for mothers and birthing, supporting healthy infant feeding through community programs, and unhealthy bottle feeding practices.
Breastfeeding attitudes
Participants noted that breastfeeding was socially acceptable not only in the home, but openly in public during the time they were having babies. One of our oldest respondents discussed how she would openly breastfeed in public: “at the store if he was hungry I would breastfeed right there. If there was no chair I would ask for one and say “I want to breastfeed my baby”, so they would. I was not shy because everybody was breastfeeding then”.
The participants discussed breastfeeding as a natural process, which was expected and encouraged in the community. One respondent discussed the challenges of breastfeeding while working:
I breastfed all my kids and I still had a full time job. I would go home at lunch time. I would schedule everything around breastfeeding…you had to go home do it on your lunch break make sure you had, we didn’t have breast pumps back then.
Respondents noted that young women today are challenged with social attitudes in the community that do not promote breastfeeding. One respondent discussed the challenges trans-generational teaching of traditional values and childrearing to her children and grandchildren:
They said that they didn’t like the feeling of breast feeding; it hurts. They tried. It only hurts for a while. It don’t care how I explained things to her, they’ll say “mom this is 2000 it’s not those days” so if I talk to them about the old ways, it’s not the way it is now. A lot of our young people don’t want to follow the traditional way they want to go this way. Just like me being a traditional woman I go teach them, they won’t listen but if it was a white woman teaching they would listen.
Physical space in the public community to breastfeed was also identified as a barrier. There are no designated areas in the community for breastfeeding mothers. Locations such as the mall, the recreation centre, and even the clinic does not have areas designed for mothers who wish to have some private space to breastfeed. This is a particular challenge for women who feel a sense of shyness or need a private space to relax to breastfeed.
Social support for mothers and birthing
Like many women living in remote, rural Canadian communities, the women of Norway House are not able to deliver their babies in their home community and are evacuated to Thompson or Winnipeg. Until the 1970s, women in Norway House were able to birth at the community hospital unless they were assessed as a high-risk pregnancy or delivery, at which time they were subsequently evacuated to a tertiary center for care. In recent years, the provincially funded Kinosao Sipi Midwifery Clinic has operated within the hospital and serves women during the pre and postnatal periods and arranges transportation to the tertiary center for clients.
Birthing and breastfeeding was indelibly linked for the participants. The majority of the respondents gave birth prior to the mandatory evacuation policy and was able to give birth in the community close to their spouses, children and family. Respondents discussed the role of support for new mothers from family members as being an essential aspect of healthy infant feeding and subsequently good oral health. Some women described being well supported when they were having children, and received advice on breastfeeding and other aspects of childrearing. One respondent discussed this “I think breastfeeding came from my grandmother. My grandmother always instilled in us that breast feeding was the best way”. Another woman (humorously) describes how she shares the importance of breastfeeding with young women “they (Elders) always wanted the mothers to breast feed their kids. That’s why god gave you those things (breasts)! Those are not play things! That’s how they explained it to you; for your babies not for your husbands!”
Mentorship from Elders including grandparents, aunties and mothers was important for not only practicing healthy child rearing methods, but also for social support. In the childrearing days of the participants we interviewed, women were living with extended families which enabled a supportive environment for childrearing. One participant describes this “in those days we lived with families. We didn’t have a home. We had to live with my mother in law. She did a lot of teaching on how to look after my children when they get sick. …they were my great teachers.” Another respondent discussed the role of her aunties: “That was the roles of my aunties. They taught me how to take care of my babies, how to feed them, how to not to put too much stuff so they won’t get stomach aches. They used to teach them how to give them water but while breast feeding. They told me I didn’t need to give them anything but my breast”. Another participant described this support: “There’s lack of knowledge I guess because at my age at the time I was having babies I had support from older ladies that have knowledge of breastfeeding”.
Several respondents discuss the role of their in-laws in supporting her during pregnancy and as a mother: “my father in law always used to make fire, make sure everything was ok for me. Being pregnant every year wasn’t easy. He was very supportive even though he was an alcoholic. He made sure I wouldn’t run out in things, he was always there for me”. One respondent discussed a technique of applying pressure to her breasts, which was taught by her grandmother:
My grandmother taught me how to tie myself. My grandmother would make me those things you wrap around, a belt; so you don’t get so engorged. Then you always had to learn when to drink because you don’t drink at a certain period until you’re ready. You learn all that.
Spousal support was also noted by participants as being the key to healthy infant feeding. One respondent describes this: “I had a lot of support by my husband. He was always there. When I needed to sleep he would be the one….he basically stayed home. That makes a big difference within the dad.” Another respondent discussed a similar “my husband was a family guy. He was helping me with the babies. He would hold them, and hug them. He was working outside of the home. He was gone just during the day.”
One of the respondents who lived outside of the community when she was giving birth described how her birthing experience and subsequent hospital stay outside of the community impacted her ability to breastfeed. She related her experience to the new mothers who have to give birth outside of the community who choose not to breastfeed: “because I was young, same with these young people…no one was breastfeeding. I had four other women in the ward with me at the time and none of those women were breastfeeding.” While women are in the community, they have access to “mom and baby” programs including the Canadian Prenatal Nutrition Program (CPNP) as well as the Maternal Child Health Child Health Program – Strengthening Families (MCH-SF). While women are waiting to give birth outside of the community, they do not have access to these services and programs. The critical period of time when women give birth and are able to take up breastfeeding is interrupted by having to give birth away from primary support systems by birthing in outside referral centres. For women in Norway House, their return trip to the community from a Winnipeg referral centre takes place on a nine hour bus ride or from Thompson, a three hour bus ride, which is not conducive to breastfeeding.
Participants also discussed trying to support their grandchildren who are now having children themselves and some of the generational gaps. As one respondent described “back then you were taught to listen to what the elders tell you, you did it. You didn’t question. You just did it because that was our upbringing. You don’t talk back; you do the thing you’re told to do and that’s what I did”.
Another respondent described their situation in trying to change poor infant feeding behavior:
There are a lot of grandparents that do try and help. They get offended or they don’t like to hear it. It’s not like we’re trying to get mad at them but give them at advice like that; for the kids. Today they don’t want hear this. Sometimes I’ll have my granddaughters for 3 or 4 days, then I wouldn’t give them pop or juice, they get cranky. They go home then they’re back on the cup/bottle.
Respondents shared concerns about the oral health and overall health of new babies in the community. They felt there were many factors distracting them from caring for their infants. Issues with spouses, addictions, poverty were all identified as impacting the ability of women to properly feed their infants. As one grandmother stated “they don’t make the time. There’s less of that bond and it’s easier to just give them the bottle”.