Initially, out of a list of 36 Latinas, 31 met the inclusion criteria. But finally, 19 were selected because six of them refused to participate at the last minute and another six women did not have the available time to participate, the necessary connectivity for the video call, or enough emotional stability. The total number of participants was based on data saturation. These 19 participants were between 22 and 43 years old and came from six different countries in Latin America, mainly Peru. Nevertheless, there was heterogeneity of home countries (Table 2). Those who had a longer BF duration were associated with an advanced educational level, multiparity, a regular administrative situation at the time the baby was born, and participating in BFSG.
During the data analysis, two main categories and ten interrelated subcategories emerged (Table 3).
3.1 Breastfeeding Barriers
3.1.1 Work conditions. This was the main obstacle because there were no places prepared for breastmilk (BM) expression and storage nor was there enough time for pumping at work. Furthermore, precarious working conditions forced the women to spend most of the day working, preventing BF.
"... if they express their milk, where do they store it? ... the majority ... resort to formula." (MML-5).
"... you have that pressure ... either you stop working to breastfeed or you continue to work so that you can get food for everyone." (MML-9)
3.1.2 Precarious socioeconomic conditions. In addition, the interviewed mothers said that, if their administrative situation is irregular, they could only access precarious jobs without maternity leave because degrees’ homologation is difficult.
"... if we don't have documentation... who is going to give you your salary while you are on leave?... how are we going to cover what we have to pay?" (MML-2)
“Another limiting factor is the shortage of clothing specifically designed for working nursing mothers or the high prices of the existing clothing." (MML-12)
3.1.3 Lack of support: health professionals, family, and society. On the one hand, the women identified unpleasant experiences with some healthcare professionals. In addition, the professionals played a paternalistic role that the participants found difficult to trust because they encouraged the women to interrupt BF and they were not very updated.
"Health professionals are not trained... it is horrible how little they know about BF... he called me negligent…" (MML-1)
On the other hand, study participants also stated that the extended family can negatively interfere with the BF process. They offer inadequate or erroneous information and encourage mothers to substitute formula milk (FM) for BM.
"... I was not breastfeeding all the time required and it was because of the inadequate information that I had around me... they [family] are trapping you until you switch to FM." (MML-12)
Besides, the participants frequently stated that they feel questioned and judged by society whether they give prolonged BF, or whether they decide or are forced to interrupt it early.
“But in society, there are many people who see me on the street, with the child… [and they say to her]: 'Are you still breastfeeding the baby? When are you going to stop?’… Sometimes, I break down, I feel frustrated… nervous because everyone comes and tells you that this is not right [extending BF for a long time]."(MML-5)
Finally, a third of the interviewees stated that the aesthetic component is another barrier imposed by society in their culture. However, our participants recognize that biological function prevails over aesthetics.
"I felt sad and accused ... because people didn’t want me to breastfeed my children so that my breasts wouldn’t droop." (MML-9)
3.1.4 Physiological changes, pain, and fatigue. Women emphasized that the most common problems were ankyloglossia (frenulum) or nipple abnormalities (umbilical nipples or cracks). These impeded a proper grip, requiring training for effective BF. In addition, most said they wanted to quit BF because of pain and fatigue. Although pain is intense, it diminishes over time. Meanwhile, tiredness increases due to continued demands.
“I encountered the cracks, the pain, the frenulum issue… that was what prevented my baby from eating well. " (MML-12)
3.1.5 Ignorance and erroneous beliefs. Everyone recognized that a component that greatly hinders BF was insufficient BF knowledge, such as breast stimulation techniques, BF postures, interferences, or a lack of scientific information.
"... A difficulty that mothers have is the misinformation on ... unknown subjects: braces, interferences, pacifiers." (MML-1)
One-third of the interviewees also highlighted erroneous BF beliefs, among which predominated insufficient BM perception.
"Women are afraid of not having enough milk to give to their babies and that is when they stop breastfeeding and start using formula." (MML-19)
3.2 Breastfeeding Facilitators
3.2.1 Support networks: partner, health professionals, and family. Participants acknowledged their partners as the main source of support. Partners were essential to opt for BF instead of FM, as well as in collaborative functions with the baby and household chores. Likewise, the participants highlighted support networks made up of mothers, sisters, or close friends.
"If he hadn't made this big effort with me, I probably wouldn't have been nursing for 25 months." (MML-3)
These women also viewed the health professionals who positively influenced them as indispensable to their successful BF. They identified the midwife as the closest professional who provided them with knowledge, support, and accompaniment throughout the process.
"I really received a good explanation from my midwife, she was very participatory." (MML-5)
3.2.2 Host country versus Home country. Most of the participants identified the host country (Spain) as a BF facilitator. Here, they have found more institutional resources to support BF, as well as more updated and official information. Conversely, half of the interviewees thought that their home country also favored their BF process because they could have family councils and a greater support network there.
"... there are more institutionalized resources here, as BF groups ... and more informal and traditional information over there." (MML-10)
Some participants highlighted that differences in BF duration were not due to cultural issues. They suggested they were caused by individual factors (lack of means to access resources such as BFSG) or the vital moment they were going through.
"I believe that access to BFSG... more than a cultural barrier, it’s a technological [media] barrier." (MML-3)
3.2.3 Religious practices/worship. One-third of the sample recognized the importance of the religious component or worship as a resource of support and accompaniment in the most difficult moments of BF. This was highlighted by mothers belonging to minority religious groups such as Evangelists or Jehovah's Witnesses.
"Emotionally, you feel good, that you can do it… people of your same church also give you support and you feel more secure [Evangelist]." (MML-2)
3.2.4 Appropriate attitude, knowledge, and experience. All the participants showed a good attitude towards BF and recognized that it was the best way to feed their babies. Moreover, most of them attended antenatal classes during pregnancy and showed adequate knowledge about BF advantages, as well as a satisfactory BF experience. "It's tailor-made, like the perfect and exclusive food for your baby ... there are only advantages." (MML-10)
3.2.5 Breastfeeding support groups. Longer BF periods were observed in mothers who participated in BFSG compared to those who did not, as represented in Table 4. In the first group, the mean duration was 18 months, compared to 13 months for mothers who did not participate in BFSG. Furthermore, tandem BF was more frequently observed in mothers who participated in BFSG. The participants in BFSG had a high educational level, such as university or postgraduate levels, whereas the women who did not get involved in BFSG habitually had vocational training or A level education.
The participants considered it important to increase the number BFSGs to help new mothers or experienced mothers by providing knowledge or recycling previous ideas. The interviewees highlighted various functions of BFSG such as: offering up-to-date knowledge; psychological support; women’s empowerment; and recreation and social interaction.
"... it has been a revelation because of the high-quality information ... I have learned much more with them than from any professional." (MML-1)
“Those little tribes are like my… oasis, my relief.” (MML-3)
“… they give you the chance to meet other people, interact… that is the best thing because you come from another country, you don't know anyone and that helps you a lot. " (MML-15)