Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Sandra Thomas

Committee Members

Mitizi Davis, Johnie Mozingo, Howard Pollio


Research indicates that breast milk is superior to formula as a source of infant nutrition. Research also indicates that infants born to impoverished women and women who are nutritionally at risk are at increased risk of a host of neonatal complications. Despite this evidence, women enrolled in the USDA's Special Supplemental Food Program for Women, Infants and Children (WIC) are less likely to initiate and continue to breastfeed their infants than women in the general population.

This existential phenomenological research study was performed to explore the experience of making infant nutrition decisions for infants 6 months of age and younger by women enrolled in the WIC program in East Tennessee. Thirteen participants were recruited from the Knox County Health Department's WIC program. After consenting to participate in the study women were interviewed by the researcher. The interviews were audiotaped, and opened with the question: "What was it like for you deciding how to feed you baby?" The audiotapes were listened to and transcribed by the researcher. Transcripts were analyzed individually and as a group for meaning units which were then grouped into themes. An inter-disciplinary phenomenology group at the University of Tennessee assisted in this process and validated the researcher's findings.

The initial decision, entitled Deciding and the Influence of Others, was made by participants before or during pregnancy. The themes "Breast is best" versus "They can make formula so good it doesn't really matter." Participants' perceptions of cultural approval/disapproval of formula feeding and breastfeeding strongly influenced this initial decision.

The women experienced the implications and reality of their decisions during the second phase, entitled, "Living with One's decision." This phase involved the following sub themes: "I can't do this!"; "I'm in it for the long haul!"; and "Whatever [formula] the child likes is what he should get": Changing Formula Brands. During this phase women who were breastfeeding decided to continue or to stop, and women who were formula feeding their infants decided whether or not to continue using the formula approved by WIC.

The third stage of the decision-making process is entitled, Coming to Terms with One's Decision: Freedom versus Guilt. The findings indicate that there are numerous opportunities for nurses and health care professionals to support this vulnerable population of women as they make their infant nutrition decisions.

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