Objective To determine perceptions, beliefs and experiences affecting breast-feeding in Marshallese mothers residing in Northwest Arkansas, USA. Design A qualitative, exploratory study using a brief survey and focus groups. Marshallese women, 18 years or older who had a child under 7 years of age, were included in the study. Setting Community-based organization in Northwest Arkansas. Results The majority of mothers viewed breast milk as superior to formula, but had concerns about adequate milk supply and the nutritional value of their milk. The primary barriers to exclusive breast-feeding in the USA included public shaming (both verbal and non-verbal), perceived milk production and quality, and maternal employment. These barriers are not reported in the Marshall Islands and are encountered only after moving to the USA. Breast-feeding mothers rely heavily on familial support, especially the eldest female, who may not reside in the USA. The influence of institutions, including the Special Supplemental Nutrition Program for Women, Infants, and Children, is strong and may negatively affect breast-feeding. Conclusions Despite the belief that breast milk is the healthiest option, breast-feeding among Marshallese mothers is challenged by numerous barriers they encounter as they assimilate to US cultural norms. The barriers and challenges, along with the strong desire to assimilate to US culture, impact Marshallese mothers' perceptions, beliefs and experiences with breast-feeding. Copyright © The Authors 2016.

minority health immigrants Marshallese breast-feeding Obesity Migrants health disparities Paediatric Infant feeding Pacific Islanders Community-based participatory research

Emigrants and Immigrants Acculturation female Humans breast milk Mothers cultural factor ethnology Arkansas Health Knowledge, Attitudes, Practice Micronesia Federated States of Micronesia Breast Feeding attitude to health Milk, Human human mother migrant