"Too Old" and "Too Cold": Discomfort Towards Photographs of Breastfeeding Beyond Infancy and Public Breastfeeding in Nova Scotia, Canada

Background: Social norms and public perception of breastfeeding are well-established predictors of breastfeeding outcomes; however, little is known about perceptions of breastfeeding beyond infancy or public breastfeeding among the public in Nova Scotia, Canada. Research Aim: To explore public opinion about breastfeeding beyond infancy and public breastfeeding. Methods: In this cross-sectional study participants were recruited from public spaces in Nova Scotia, Canada. Using photo elicitation methods, participants (N = 229) viewed six photographs of breastfeeding children aged 2 weeks, 13 months, and 2.5 years, one photograph captured at home, and the other in a public space (a cafe, a store, or outdoors). Participants were asked to score their self-rated comfort with each photograph on a 10.0 cm visual analog scale and asked to share their feelings about each photograph (open-ended responses). Results: Mean (SD) visual analog scale comfort scores for photographs differed by location (private, 7.9 [2.2]; public, 7.3 [2.6]; p < .05) and child age (2 weeks, 8.5 [2.0]; 13 months, 7.5 [2.6]; 2.5 years, 6.9 [3.0]; p < .05). Participants who identified as women and parents self-reported significantly higher comfort with all photographs, while younger participants and urban dwellers were generally less comfortable. Open-ended responses varied considerably, but a higher proportion of negative comments were reported for older children feeding in public spaces (e.g., 2.5-year-old in public: "Inappropriate. Indecent. Abnormal."). Conclusion: Given the importance of social norms in supporting breastfeeding, future public health campaigns should strive to normalize breastfeeding beyond infancy, and in public spaces.