Exclusive Breastfeeding as a Complex Adaptive System: A Qualitative Study

Abstract

Background: Breastfeeding is a public health issue which has a major effect on the infant growth and development, in addition to the mothers themselves. Benefits of breastfeeding are well-researched from both physiological and sociocultural perspectives. What is missed is the tactile nature of breastfeeding that function as a semiotic medium, that is, a communicative medium for values and meanings of motherhood, love, happiness, security and wholeness. Objectives: The objective of this study is to explore the essential meanings that become a mental model embodied by adherent mothers to exclusive breastfeeding. Methods: An interpretative phenomenological analysis approach was used to examine the lived experiences of 20 exclusively breastfeeding mothers, their age (20-40), were interviewed in Karbala pediatric teaching hospital, from November 2019 to April 2020. Data was collected using a face-to-face, semi-structured interview, and then transcribed in full and analyzed using thematic approach. Results: Thematic analysis of data uncovered a key theme (mental model) which viewed breastfeeding as a tactile medium. a communicative medium that makes semiotic interactions possible. The need for touch is primary for mothers and infants that explains the importance of early skin to skin contact. Touch semiotically translated by mothers and infants as empathy \ co-feeling, communication of values and meaning that explains the exclusiveness of breastfeeding and continuation. The function of the breastfeeding as a semiotic interface transforms the mothers and infants into a self-determined autopoietic couple, that is, a complex adaptive system. Breastfeeding became a context, spatiotemporal semiotic space where the emergence of motherhood, love, happiness, wellbeing was embodied. The second theme is the function of breastfeeding as a social medium that fulfil the expectation of the family and community about what is like to be a good mother. Third theme stranded for the biomedical model about breastfeeding that viewed it as a physiological medium providing healthy, nutritious, clean milk. Conclusion: Exclusive breastfeeding is an emergent phenomenon resulting from the intertwining of the mothers and infants as a dyad, that is, as a complex adaptive system. The butterfly effect that trigger this intertwining is the touch, the function of breastfeeding as tactile medium embodied through Kangaroo mother care (KMC) and early skin to skin contact\touch that facilitate the emergence of the motherhood and exclusive breastfeeding as self-determined symbolic process. Using touch as a mental model can reframe the discourse of health care system from medicalization to personalization, from linear thinking to system thinking. This tactile model can be used for scaling up breastfeeding program as response to the calls of WHO to use system thinking for health care strengthening and the breastfeeding Lancet Series that used complexity science to scale up the breastfeeding programs in a complex adaptive world.