The demographic data represent the women included in the study to describe the sample from each country, where in total 10,451 women participated in the study (Sweden n = 1252, Australia n = 7602 and Ireland n = 1597) (Table 2). The average age among the participants from the different countries was similar, with the Australian women being the youngest (mean 32.5 years), followed by the Swedish women (mean 32.7 years) and the women from Ireland (mean 34.9 years). The majority of the women in all three countries had some form of university education, with the Swedish and Irish participants being at a slightly higher level of education. Data regarding the number of children each woman gave birth to was very consistent with most participants giving birth to one child: Sweden 44.1%, Australia 45.5%, and Ireland 42.1%. Most of the participants had also breastfed one child and were actively breastfeeding when the data collection was carried out.

Table 2 Overview of themes and subthemes

The results are presented under the themes and corresponding subthemes. Table 1 provides an overview of themes and subthemes. A comparison of the number one most important subtheme between the three countries is offered as noted in Table 3.

Table 3 Subtheme frequencies for what the women ranked as number one most important and needed to encourage a breastfeeding culture Theme: active supportive interventions needed for breastfeeding

The subthemes that are captured under this theme are ‘Make breastfeeding visible in society’; ‘Healthcare professionals support and knowledge regarding breastfeeding’; ‘Education of the public’ and ‘Inviting environment’.

Subtheme

‘Make breastfeeding visible in society’

The subtheme ‘Make breastfeeding visible in society’ includes comments regarding making breastfeeding a ‘normal’ part of life that was commonly seen in society. The women wanted breastfeeding to be viewed as something women chose to do to nourish and be close to their children. They aspired to a society where no one else sees breastfeeding as unacceptable. The desire that public breastfeeding be seen as visible emerged, as they felt supported when seeing other breastfeeding women:

People should feed as and when is needed. If we all treat it as normal it will be more readily accepted. When a taboo is made of it then it becomes a problem. [Aus; 4]

Many women shared how it would be useful if breastfeeding in public were a common act where breastfeeding women felt comfortable to be observed in public. The reality of seeing breastfeeding mothers in the public space should make it the norm, regardless of whether the child was an infant or toddler. They also suggested that it would be normalizing if more famous people were to support, speak openly and express positive views about breastfeeding. Positive portrayals of breastfeeding in advertising on mainstream media, social media, in films, art and newspapers was mentioned as helpful factors to make breastfeeding visible in society and that celebrities could talk more openly and positively about public breastfeeding. Respondents also expressed a need for promoting breastfeeding on all levels in the social and political hierarchy to reflect a society which promotes and legitimizes public breastfeeding.

Subtheme

‘Healthcare professionals’ support and knowledge regarding breastfeeding’.

Our participants wanted timely, concrete, and updated information from health care professionals (HCP) regarding breastfeeding and breastfeeding in public during the antenatal and postpartum periods, as they noted that the information given was often insufficient and out of date. Adequate information and encouragement from HCP could contribute to a greater feeling of comfort for the women in a public breastfeeding situation, which in turn, could increase the occurrence of and influence on perceptions of breastfeeding in society.

That maternity care (antenatal classes, maternity ward etc.) encourage to breastfeed in public. [Swe; 462]

Additional information was requested about the importance of breastfeeding, with regard to nutrition as well as attachment and bonding. Furthermore, it was communicated that the information from HCP regarding the benefits of breastmilk compared to commercial milk formula assisted in making the decision and commitment to breastfeed.

Subtheme

‘Education of the public’.

The women shared how universal breastfeeding education is an important aspect of normalizing breastfeeding in public. Providing accurate information to the public in general, and early education in schools were considered to be important ways to shift cultural attitudes. Women suggested that this information should begin as early as possible in the school system and should be reinforced at recurring intervals. They also voiced a need for education to convey knowledge about breastfeeding health benefits for the child such as optimal and individualized nutrition; antibody transfer that promotes immunity; and that breastfeeding is important, natural and promotes the child’s sense of security. Further knowledge among the general public was considered important to better understanding and acceptance towards public breastfeeding.

Educate children, teenagers, men and older people that it’s natural and best for baby. . and it’s what breasts are for. [Ire; 106]

The women reported that education can promote knowledge and decrease the likelihood of being harassed with negative comments while breastfeeding in public. The women also insisted that information needed to be given to people in general that breastfeeding women need to respond to their child’s signals and that breastfeeding is recommended.

Subtheme

‘Inviting environment’.

Clearly marked out spaces were requested, with signs welcoming breastfeeding mothers to contribute to a more comfortable atmosphere. The wish for a clarification that breastfeeding was welcome was emphasized, not to occur solely in a predetermined separate room promoted as the only place where breastfeeding was accepted, thus contributing to uneasiness and insecurity with breastfeeding in a public domain. Finally, women also suggested how breastfeeding-adapted clothes were important in a supportive environment and facilitated public breastfeeding for women.

Breastfeeding spaces other than those tucked away in the toilets at shopping centres. [Aus; 117]

Theme: the obvious right of breastfeeding women and children to take a seat in the public sphere

The three subthemes that make up this theme around the rights of women and children include ‘Zero tolerance for others’ unwanted opinions’; ‘Focus on the needs and rights of the breastfeeding dyad’; and ‘Desexualize breastfeeding and women’s bodies in society’.

Subtheme

‘Zero tolerance for others’ unwanted opinions’.

When encountering a breastfeeding woman in the public sphere, a wish for greater respect from the surrounding citizens was expressed. The women emphasized that people in general should not have to defend how they were providing nutrition to their infant. Instead, breastfeeding should be considered as the norm.

Anyone being rude / derogatory to a mum should be asked to leave the premises. [Ire; 1538]

Women asked for verbal support or civil courage from other citizens, when they were exposed to derogatory comments.

Subtheme

‘Focus on the needs and rights of the breastfeeding dyad’.

The rights of women to choose where and when they feed their baby was paramount to women in our study, a legally accepted place in the public sphere. Otherwise, there is a risk that women feel isolated in their home. Society needs to be inclusive where women and their breastfeeding children can participate in everyday life, not being restricted to separate rooms or places for breastfeeding. Our participants also noted that society has a responsibility to support the mother and child dyad also in breastfeeding and fundamental needs of the child, as stated by the women.

That the needs of a newborn child regarding nutrition and closeness have to be satisfied irrespective of location. Otherwise, there is a risk that mothers stay at home, isolating themselves. [Swe; 1020]

Subtheme

‘Desexualize breastfeeding and women’s bodies in society’.

The women expressed a desire that their breasts should be recognized for their function in providing breast milk, not as a sexual attribute. They stated that they wanted to “take back” the right to their own body and not have to be subject to awkward glances or adverse stares from members of the public. The participants expressed that the breast should be accepted for its vital function of breastfeeding, not as the main feature of lingerie advertisements. Equality between the sexes was brought up as a factor that impacted the sexualization of the breast.

Raise boys and educate men that breastfeeding/breasts have no sexual connection. [Swe; 878]

Comparison of the most important factors to encourage a culture of public breastfeeding

The subthemes that captured Australian, Swedish and Irish women’s perceptions of what they ranked as the number one most important factor to encourage a breastfeeding culture is presented in Table 3. When comparing the ranking of each of the subthemes, the commonalities were regarding the importance of the visibility of breastfeeding in society. ‘Education of the public’ was the second most highly ranked subtheme across all countries as a suggestion to improve the culture for women breastfeeding in public. The need for the surrounding environment to be inviting was ranked third across all countries. The women from Sweden and Ireland ranked ‘Healthcare professionals support and knowledge regarding breastfeeding’ as the fourth most important issue. Australia women ranked ‘Desexualizing breastfeeding and the female body’ (9%), closely followed by ‘Focusing on the needs and rights of the breastfeeding dyad’ (8%) and ‘Zero tolerance to others’ unwanted opinions’ (6%). Australian women ranked ‘Healthcare professionals support and knowledge regarding breastfeeding’ in seventh place, which was lower than the ranking in the other two countries.