Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers’ perspectives

  • Author Footnotes
    1 ORCID:
    McKenzie Ken Maviso
    Correspondence to: Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko 111, National Capital District, Papua New Guinea.
    1 ORCID:
    Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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  • Lillian Maye Kaforau
    School of Foundation Studies, Pacific TAFE Science Technology & Environment, University of South Pacific, Honiara Campus, Solomon Islands
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  • Carolyn Hastie
    School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia
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  • Author Footnotes
    1 ORCID:
Published:August 10, 2022DOI:



      Almost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed.


      To explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices.


      A critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers’ narratives.


      Analysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers’ differing views and positions on infant feeding practices and their influence on breastfeeding.


      This study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers’ influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.


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      1. World Health Organization (WHO). Exclusive breastfeeding for optimal growth, development and health of infants 2019. 〈〉.

        • Kim Y.J.
        Immunomodulatory effects of human colostrum and milk.
        Pedia Gastroenterol. Hepatol. Nutr. 2021; 24: 337-345
        • Victora C.G.
        • Bahl R.
        • Barros A.J.D.
        • França G.V.A.
        • Horton S.
        • Krasevec J.
        • et al.
        Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.
        Lancet. 2016; 387: 475-490
        • Lee M.K.
        • Binns C.
        Breastfeeding and the risk of infant illness in asia: a review.
        Int. J. Environ. Res. Public Health. 2020; : 17
        • Chowdhury R.
        • Sinha B.
        • Sankar M.J.
        • Taneja S.
        • Bhandari N.
        • Rollins N.
        • et al.
        Breastfeeding and maternal health outcomes: a systematic review and meta-analysis.
        Acta Paediatr. 2015; 104: 96-113
        • Rollins N.C.
        • Bhandari N.
        • Hajeebhoy N.
        • Horton S.
        • Lutter C.K.
        • Martines J.C.
        • et al.
        Why invest, and what it will take to improve breastfeeding practices?.
        Lancet. 2016; 387: 491-504
        • Quesada J.A.
        • Méndez I.
        • Martín-Gil R.
        The economic benefits of increasing breastfeeding rates in Spain.
        Int. Breastfeed. J. 2020; 15: 34
        • Agunbiade O.M.
        • Ogunleye O.V.
        Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: implications for scaling up.
        Int. Breastfeed. J. 2012; 7: 5
        • Kronborg H.
        • Foverskov E.
        Multifactorial influence on duration of exclusive breastfeeding; a Danish cohort study.
        PLOS ONE. 2020; 15e0238363
        • Cohen S.S.
        • Alexander D.D.
        • Krebs N.F.
        • Young B.E.
        • Cabana M.D.
        • Erdmann P.
        • et al.
        Factors associated with breastfeeding initiation and continuation: a meta-analysis.
        J. Pediatr. 2018; 203
        • Chakona G.
        Social circumstances and cultural beliefs influence maternal nutrition, breastfeeding and child feeding practices in South Africa.
        Nutr. J. 2020; 19: 47
        • Maviso M.K.
        • Ferguson B.
        • Kaforau L.M.
        • Capper T.
        A qualitative descriptive inquiry into factors influencing early weaning and breastfeeding duration among first-time mothers in Papua New Guinea’s rural eastern highlands.
        Women Birth. 2022; 35: e68-e74
        • Mangrio E.
        • Persson K.
        • Bramhagen A.-C.
        Sociodemographic, physical, mental and social factors in the cessation of breastfeeding before 6 months: a systematic review.
        Scand. J. Caring Sci. 2018; 32: 451-465
        • Chopel A.
        • Soto D.
        • Joiner B.
        • Benitez T.
        • Konoff R.
        • Rios L.
        • et al.
        Multilevel factors influencing young mothers’ breastfeeding: a qualitative CBPR study.
        J. Hum. Lact. 2019; 35: 301-317
        • Nsiah-Asamoah C.
        • Doku D.T.
        • Agblorti S.
        Mothers’ and Grandmothers’ misconceptions and socio-cultural factors as barriers to exclusive breastfeeding: a qualitative study involving Health Workers in two rural districts of Ghana.
        PLoS One. 2020; 15e0239278
        • Bezner Kerr R.
        • Dakishoni L.
        • Shumba L.
        • Msachi R.
        • Chirwa M.
        “We Grandmothers Know Plenty”: Breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi.
        Soc. Sci. Med. 2008; 66: 1095-1105
        • Gross M.
        • Van der Sand I.C.P.
        • Girardon-Perlini N.M.O.
        • Cabral F.B.
        Influence of grandmothers on infant feeding: what they say to their daughters and granddaughters.
        Acta Paul. Enferm. 2011; 24: 534-540
        • Rodriguez-Vazquez R.
        • Jiménez-Fernández R.
        • Corral-Liria I.
        • Cabrera-Fernandez S.
        • Losa-Iglesias M.E.
        • Becerro-de-Bengoa-Vallejo R.
        Intergenerational transmissible meanings in breastfeeding in Spain: a phenomenological study.
        J. Pediatr. Nurs. 2020; 51: e108-e114
        • Rodriguez Vazquez R.
        • Losa-Iglesias M.E.
        • Corral-Liria I.
        • Jiménez-Fernández R.
        • Becerro-de-Bengoa-Vallejo R.
        Attitudes and expectations in the intergenerational transmission of breastfeeding: a phenomenological study.
        J. Hum. Lact. 2017; 33: 588-594
        • Ferreira T.D.M.
        • Piccioni L.D.
        • Queiroz P.H.B.
        • Silva E.M.
        • Vale I.N. do
        Influence of grandmothers on exclusive breastfeeding: cross-sectional study.
        Einst. 2018; : 16
        • Grassley J.S.
        • Spencer B.S.
        • Law B.
        A grandmothers’ tea: evaluation of a breastfeeding support intervention.
        J. Perinat. Educ. 2012; 21: 80-89
        • Thet M.M.
        • Khaing E.E.
        • Diamond-Smith N.
        • Sudhinaraset M.
        • Oo S.
        • Aung T.
        Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: qualitative findings from mothers, grandmothers, and husbands.
        Appetite. 2016; 96: 62-69
        • Negin J.
        • Coffman J.
        • Vizintin P.
        • Raynes-Greenow C.
        The influence of grandmothers on breastfeeding rates: a systematic review.
        BMC Pregnancy Childbirth. 2016; 16: 91
        • Karmacharya C.
        • Cunningham K.
        • Choufani J.
        • Kadiyala S.
        Grandmothers’ knowledge positively influences maternal knowledge and infant and young child feeding practices.
        Public Health Nutr. 2017; 20: 2114-2123
      2. National Statistical Office [PNG], ICF. Papua New Guinea Demographic and Health Survey 2016–18. Port Moresby, Papua New Guinea & Rockville, Maryland, USA: NSO & ICF; 2019.

      3. X. Hou. Stagnant Stunting Rate Despite Rapid Economic Growth in Papua New Guinea? Factors Correlated with Malnutrition Among Children Under Five. Factors Correlated with Malnutrition Among Children Under Five (June 10, 2015). World Bank Policy Research Working Paper. 2015 Jun 10 (7301).

        • McGlynn P.J.
        • Renzaho A.M.
        • Pham M.D.
        • Toole M.
        • Fisher J.
        • Luchters S.
        Critical examination of evidence for the nutritional status of children in Papua New Guinea-a systematic review.
        Asia Pac. J. Clin. Nutr. 2018; 27: 1-18
        • Kuzma J.
        Knowledge, attitude and practice related to infant feeding among women in rural Papua New Guinea: a descriptive, mixed method study.
        Int. Breastfeed. J. 2013; 8: 16
        • Miyoshi M.
        • Hawap J.
        • Nishi N.
        • Yoshiike N.
        Nutritional status of children and their mothers, and its determinants in urban capital and rural highland in Papua New Guinea.
        J. Nutr. Health Sci. 2015; 2: 10-15744
        • Terry B.
        • Kebio L.
        • Kuzma J.
        Knowledge, attitude and practice of mothers towards breastfeeding in rural Papua New Guinea: a mixed method study.
        Papua N. Guin. Med. J. 2015; 58: 22
        • Fairclough N.
        Critical Discourse Analysis: The Critical Study of Language. second ed. Routledge, London, UK2013
        • Langdridge D.
        Phenomenology and critical social psychology: directions and debates in theory and research.
        Soc. Personal. Psychol. Compass. 2008; 2: 1126-1142
        • Northoff G.
        • Smith D.
        The subjectivity of self and its ontology: From the world–brain relation to the point of view in the world.
        Theory Psychol. 2022;
      4. National Statistical Office [PNG]. 2011 National Population and Housing Census of Papua New Guinea. Port Moresby, Papua New Guinea: 2013.

      5. M. Alvi, A manual for selecting sampling techniques in research, Munich Personal RePEC Archive, Germany, 2016.

        • DeJonckheere M.
        • Vaughn L.M.
        Semi-structured interviewing in primary care research: a balance of relationship and rigour.
        Fam. Med Com. Health. 2019; 7e000057
        • Oliver D.G.
        • Serovich J.M.
        • Mason T.L.
        Constraints and opportunities with interview transcription: towards reflection in qualitative research.
        Soc. Forces. 2005; 84: 1273-1289
        • Aubel J.
        The role and influence of grandmothers on child nutrition: culturally designated advisors and caregivers.
        Matern Child Nutr. 2012; 8: 19-35
        • Angelo B.H.
        • de B.
        • Pontes C.M.
        • Sette G.C.S.
        • Leal L.P.
        Knowledge, attitudes and practices of grandmothers related to breastfeeding: a meta-synthesis.
        Rev. Lat. Am. Enferm. 2020; 28
        • Concha N.
        • Jovchelovitch S.
        Grandmothers: Central scaffolding sources impacting maternal and infant feeding practices in Colombia.
        Matern. Child Nutr. 2021; 17e13162
        • Bektas G.
        • Boelsma F.
        • Gündüz M.
        • Klaassen E.N.
        • Seidell J.C.
        • Wesdorp C.L.
        • et al.
        A qualitative study on the perspectives of Turkish mothers and grandmothers in the Netherlands regarding the influence of grandmothers on health related practices in the first 1000 days of a child’s life.
        BMC Public Health. 2022; 22: 1364
        • Bernie K.
        The factors influencing young mothers’ infant feeding decisions: the views of healthcare professionals and voluntary workers on the role of the baby’s maternal grandmother.
        Breastfeed. Med. 2014; 9: 161-165
        • James L.
        • Sweet L.
        • Donnellan-Fernandez R.
        Self-efficacy, support and sustainability – a qualitative study of the experience of establishing breastfeeding for first-time Australian mothers following early discharge.
        Int. Breastfeed. J. 2020; 15: 98
        • Ranch M.M.
        • Jämtén S.
        • Thorstensson S.
        • Ekström-Bergström A.C.
        First-time mothers have a desire to be offered professional breastfeeding support by pediatric nurses: an evaluation of the mother-perceived-professional support scale.
        Nurs. Res. Pract. 2019; 20198731705