Factors Influencing Initiation of Breast-feeding among Urban Women

ABSTRACT

The objective of our study was to identify factors associated with the initiation of breast-feeding in a poor urban area. One hundred postpartum, nonadolescent, non-drug using mothers, 50 breast-feeding and 50 formula feeding, were consecutively interviewed. Breast-feeding women were more likely to be born outside of the United States (42 versus 14%, p = 0.002), have more years of education (12.1 ± 1.9 versus 10.9 ± 1.7, p = 0.002), be employed either prior to or during pregnancy (38 versus 16%, p = 0.000), be married (46 versus 26%, p = 0.037), be a nonsmoker (86 versus 64%, p = 0.011), have more prenatal visits (8.4 ± 7.3 versus 5.0 ± 5.9, p = 0.010), or have a breast-feeding mother (48 versus 26%, p = 0.023). There were no differences in age or ethnicity. The father of the breast-feeding baby was more likely to be better educated (12.0 ± 2.8 versus 10.5 ± 3.6 years, p = 0.022) and to work full-time (68 versus 40%, p = 0.005). Eighty-four percent of formula feeders knew that breast milk was better for their babies but decided not to breast-feed due to concerns of pain, smoking, and work. Sixty-three percent of women made the choice to breast-feed prior to the pregnancy, 26% during the pregnancy, and 11% after delivery. Significantly more multiparas decided prior to the pregnancy compared with primaparas. We recommend that breast-feeding education should be started prior to the first pregnancy and tailored to the concerns of the women.

KEYWORDS

Breast-feeding - urban - ethnicity - acculturation - smoking - education

REFERENCES

• 1 American Academy of Pediatrics. Breast-feeding and the use of human milk. Work Group on Breastfeeding.  Pediatrics . 1997;  100 1035-1039
• 2 Department of Health and Human Services. Promoting Health, Preventing Disease: Objectives for the Nation Rockville, MD: US Department of Health and Human Services; 1980
• 3 Healthy People 2000; National Health Promotion and Disease Prevention Objectives. Washington, DC: US Department of Health and Human Services. Government Printing Office; DHHS publication No. 91-50213; 1990
• 4 Healthy People 2010; Objectives for Improving Health. Office of Disease Prevention and Health Promotion. US Department of Health and Human Services. November 2000. Available at: http://www.healthypeople.gov/Document/HTML/Volume2/16MICH.htm#_Toc494699668. Accessed May 21, 2003
• 5 Ryan A S, Wenjun Z, Acosta A. Breastfeeding continues to increase into the new millennium.  Pediatrics . 2002;  110 1103-1109
• 6 Ryan A S. The resurgence of breastfeeding in the United States.  Pediatrics . 1997;  99 E12
• 7 Li R, Zhao Z, Mokdad A, Barker L, Grummer-Strawn L. Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey.  Pediatrics . 2003;  111 1198-1201
• 8 Forste R, Weiss J, Lippincott E. The decision to breastfeed in the United States: does race matter?.  Pediatrics . 2001;  108 291-296
• 9 MacGowan R J, MacGowan C A, Serdula M K, Lane J M, Joesoef R M, Cook F H. Breast-feeding among women attending women, infants, and children clinics in Georgia, 1987.  Pediatrics . 1991;  87 361-366
• 10 Rassin D K, Markides K S, Baranowski T, Richardson C J, Mikrut W D, Bee D E. Acculturation and the initiation of breastfeeding.  J Clin Epidemiol . 1994;  47 739-746
• 11 Serdula M K, Cairns K A, Williamson D F, Fuller M, Brown J E. Correlates of breast-feeding in a low-income population of whites, blacks, and southeast Asians.  J Am Diet Assoc . 1991;  91 41-45
• 12 Rossiter J C. Attitudes of Vietnamese women to baby feeding practices before and after immigration to Sydney, Australia.  Midwifery . 1992;  8 103-112
• 13 Dennis C L. Breastfeeding initiation and duration: a 1990- 2000 literature review.  J Obstet Gynecol Neonatal Nurs . 2002;  31 12-32
• 14 Becerra J E, Smith J C. Breastfeeding patterns in Puerto Rico.  Am J Public Health . 1990;  80 694-697
• 15 Lumley J, Oliver S, Waters E. Interventions for promoting smoking cessation during pregnancy.  Cochrane Database Syst Rev . 2000;  2 CD001055
• 16 Edwards N, Sims-Jones N, Breithaupt K. Smoking in pregnancy and postpartum: relationship to mothers' choices concerning infant nutrition.  Can J Nurs Res . 1998;  30 83-98
• 17 Kistin N, Benton D, Rao S, Sullivan M. Breast-feeding rates among black urban low-income women: effect of prenatal education.  Pediatrics . 1990;  86 741-746
• 18 Wagner C L, Hulsey T C, Southgate W M, Annibale D J. Breastfeeding rates at an urban medical university after initiation of an educational program.  South Med J . 2002;  95 909-913
• 19 Arora S, McJunkin C, Wehrer J, Kuhn P. Major factors influencing breastfeeding rates: mother's perception of father's attitude and milk supply.  Pediatrics . 2000;  106 E67