From Mary Amelia Health Center.

1. Introduction to the Layers
of Diversity
Part 2

2. Tutorial Outline
• Four Layers of Diversity Model
• Focus on External and Organizational
Dimensions
• Disparities in Breastfeeding
• Ethnic and economic
• Barriers to Breastfeeding

3. Learning Objectives
 Understand the complexity of diversity
including its less visible aspects
 Introduction to the last two layers of
diversity
 Review of ethnic and economic disparities
and barriers to breastfeeding

4. 3. External dimensions: these include aspects of our lives which we
have some control over, which might change over time, and
which usually form the basis for decisions on careers and work
styles. This layer often determines, in part, with whom we
develop friendships and what we do for work. This layer also tells
us much about whom we like to be with, and decisions we make
in hiring, promotions, etc., at work.
4. Organizational Dimensions: this layer concerns the aspects of
culture found in a work setting. While much attention of diversity
efforts is focused on the internal dimensions, issues of
preferential treatment and opportunities for development or
promotion are impacted by the aspects of this layer.
Layers of Diversity

5. The Four Layers Model

6. Personality
Includes individual’s likes and dislikes, values, and beliefs. Personality is shaped
early in life and is both influenced by, and influences, the other three layers throughout one’s
lifetime and career choices
Internal Dimensions
These include aspects of diversity over which we have no control (except physical
ability which can change voluntarily or involuntarily). This dimension is the layer in which
many divisions between and among people exist and which forms the core of many diversity
efforts, These dimensions include the first thing we see in other people, such as race or
gender and on which we make many assumptions and base judgments.
External dimensions
These include aspects of our lives which we have some control over, which might
change over time, and which usually form the basis for decisions on careers and work styles.
This layer often determines, in part, with whom we develop friendships and what we do for
work. This layer also tells us much about whom we like to be with, and decisions we make in
hiring, promotions, etc., at work.
Organizational Dimensions
This layer concerns the aspects of culture found in a work setting. While much
attention of diversity efforts is focused on the internal dimensions, issues of preferential
treatment and opportunities for development or promotion are impacted by the aspects of this
layer.
The Four Layers of Diversity

7. • Breastfeeding rates are lower among younger,
less-educated, primiparous (given birth to only
one child), single, and lower-income mothers
• The highest rates of breastfeeding initiation and
continuation (6 months) are found among
Hispanic women (40%), compared with White
(37%) and African American mothers (20%)
Ethnic and Economic Differences
in Breastfeeding in the United
States

8. • Geographic isolation, few economic resources,
and limited access to health care are factors that
may influence women’s feeding decisions
• Male opinion within the family can also have a
strong influence on initiation and duration of
breastfeeding.
Some Other Factors to Consider
Regarding Breastfeeding in
Different Populations

9. • Lower rates of breastfeeding initiation and
exclusivity than national rates
• Some reasons for choosing not to breastfeed
• Return to work
• Lack of breastfeeding assistance
• WIC participation
• Food packages often include infant
formula
Barriers to Breastfeeding in Rural
Populations

10. • Father’s opinion has been identified as one of
the most important factors that influence
mothers when deciding to breastfeed
• Some reasons why men advise their partners
not to breastfeed
 Disapproval of their partner’s breastfeeding in
public
 Objectification of the breast as an erotic, sexual
object
 Jealousy
 Misconceptions
Male Population

11. Culture and Breastfeeding
Elements of Culture
 Social relationships
 Human nature
◦ Innately good or bad
 Time
◦ Natural flow of events,
◦ Scheduling and planning
◦ Respect for past traditions
 Social stratification
◦ Classes, socio-economic levels
 Cultural complexity
◦ How one interacts with her
culture
Culture of Breastfeeding
 Nursling nature
◦ Good, bad, manipulative
 Timing of breastfeeding
◦ Finding opportune times
to breastfeed
 Mother- Nursling relationship
 Activity
◦ Being able to perform
other activities and not
spending too much time
breastfeeding

12. Applying the
Culture of
Breastfeeding
 Nurslings’ Nature
◦ Promotes independence of a child,
tries not to spoil
 Timing of Breastfeeding
◦ Breastfeeding not supported at work
◦ Time management, keeping a child
on a schedule
 Activity
◦ Active culture, always seeking to
accomplish something
◦ Mothering is not always viewed as an
accomplishment
The cultural elements of
breastfeeding change
dependent on the
culture of the mother
and child.
The example shows
some of the cultural
elements of
breastfeeding as they
relate to mainstream
American culture.
Mainstream American Culture

13. Applying the
Culture of
Breastfeeding
 Teen views of
breastfeeding
◦ Embarrassment of
feeding in public
◦ Limit their activities.
Breastfeeding will “tie
them down.”
◦ Will cause the child to
be too dependant on
the mother and lead
to problems later in
life.
An article by Nelson
(2009) looks at American
teenagers views of
breastfeeding.
These ideas about
breastfeeding that fit into
the categories discussed
on the previous slide.
13

14. Goals for Healthcare Workers in
Breastfeeding
 Validating mother’s views and opinions
 Normalizing the breastfeeding experience
 Respecting Cultural Distress
◦ Recognizing how breastfeeding may conflict with cultural
beliefs and finding ways to mitigate those challenges
 Creating community through peer support
 Accommodating Coping Style
◦ Individualistic vs. collective
◦ Recognizing and adapting to the coping style

15. Practices That Work
• Incentives for breastfeeding mothers
• Loving Support Project
Women, Infants, and Children (WIC) Case
Study

16. Women, Infants and Children
Although research by Chin, Myers and Magnus
(2008) associated participation in WIC with
lower rates of breastfeeding, WIC has
initiated a strong campaign to promote
breastfeeding.
The following highlight the practices WIC uses
to promote breastfeeding among minority
populations. Their methods include:
incentives, peer support, and targeted
cultural campaigning.

17. WIC Incentives
By using
incentives, WIC
promotes
breastfeeding
and offers
support for
mothers who
face financial
challenges or
work-related
barriers
 WIC mothers choosing to breastfeed are
provided information through
counseling and breastfeeding
educational materials.
 Breastfeeding mothers receive follow-
up support through peer counselors.
 Breastfeeding mothers are eligible to
participate in WIC longer than non-
breastfeeding mothers.
 Mothers who exclusively breastfeed their
infants receive an enhanced food
package.
 Breastfeeding mothers can receive
breast pumps, breast shells or
nursing supplements to help support
the initiation and continuation of
breastfeeding

18. WIC “Loving
Support Makes
Breastfeeding
Work”
Campaign
• Campaign sponsored by WIC
and Best Start Social Marketing
• Used to promote breastfeeding
in States
• Provides information on how
other states have successfully
implemented or expanded peer
support breast feeding programs
• Provides information about
training workers
This document created by
WIC shares the successes
of several States WIC
supported breastfeeding
peer counseling programs.
Click the link below to
access the document.
Breastfeeding Peer Support – Implementation
and Expansion Resource
http://www.nal.usda.gov/wicworks/Learning
_Center/bfshowcase.pdf

19. Breastfeeding: A
Magical Bond of Love
• WIC initiative specifically
designed to promote
breastfeeding in Hispanic
families
• Created from a study that
looked at the perceptions
that Hispanic women have
of breastfeeding in the
United States
• Provides educational
materials for mothers,
fathers, and grandmothers
in English and Spanish
http://www.nal.usda.gov/wicworks/Learning_Center/support_bond.html

20. Promotional Videos
 Video by Mississippi
WIC is highly
representative of
minority populations in
the state
 Highlight minorities
populations
breastfeeding
◦ Teenage mothers
◦ Single mothers
◦ Black, Hispanic and Asian
mothers
http://vimeo.com/13649529

21. Review Questions
1. According to the Four Layers Model, why is the
organizational dimension important to address
when discussing diversity?
2. Ethnic and Economic factors of breastfeeding fall
under which layer(s) of diversity?
3. Why is it important to address the male perception
of breastfeeding? Which layer(s) of diversity do you
feel a woman may be affected by it?
4. Review the WIC case study. What makes it a
successful program?

22. References
Amelio, R. (2012). The four layers of diversity. Color Magazine. Retrieved from
http://www.colormagazineusa.com/index.php?option=com_content&view=article&id=21
9:the-four-layers-of-diversity&catid=46:business
Benefits & Incentives. (2012). Food & Nutrition Services (USDA). Retrieved from
http://www.fns.usda.gov/wic/Breastfeeding/mainpage.HTM
Flower, K., Willoughby, M., Cadigan, R., Perrin, E., & Randolph, G. (2008). Understanding
breastfeeding initiation and continuation in rural communities: a combined
qualitative/quantitative approach. Maternal & Child Health Journal, 12(3): 402-414
Good-Mojab, C., (2000). The cultural art of breastfeeding. Leaven, 36(5): 87-91. Retrieved
from http://www.llli.org/llleaderweb/LV/LVOctNov00p87.html
Henderson, L., McMillan, B., Green, J.M., & Renfrew. M.J. (2011). Men and Infant Feeding:
Perceptions of Embarrassment, Sexuality, and Social Conduct in White Low-Income
British Men. Birth, 38:1.
Kelly, Y.J., Watt, R. G., & Nazroo, J.Y. (2006). Racial/Ethnic differences in breastfeeding
initiation and continuation in the united kingdom and comparison with findings in the
united states. Pediatrics, 118(5): 1428-1435.
Mississippi State Department of Health. Breastfeeding: another way of saying ‘I love you’.
Retrieved from http://vimeo.com/13649529
National WIC Association. (2006). Implementing and expanding breastfeeding peer
counseling programs: sharing WIC success stories and experiences. 2006 Nutrition and
Breastfeeding Conference. Retrieved from http://www.nal.usda.gov/wicworks/Learning
_Center/bfshowcase.pdf
Nelson, A.M. (2009). Adolescent attitudes, beliefs, and concerns regarding breastfeeding.
MCN Am J Matern Child Nurs, 34(4):249-55.