The Impact of Maternal Attitudes, Experiences, and Support on Breastfeeding Discontinuation in the First Four Months
Purpose: The AAP recommends exclusive breastfeeding for the first six months of an infant's life. However, in the U.S., only a minority of women accomplish this goal. According to the CDC, 4 of every 5 U.S. infants initiate breastfeeding, but only 1 of every 5 are exclusively breastfed through 6 months of age. Maternal age, education level, marital status, race/ethnicity, income, and previous breastfeeding experience have all been well-associated with breastfeeding duration. Our goal was to identify maternal attitudes, experiences, and support associated with breastfeeding duration in the first 4 months. Methods: Mothers were recruited from an academic general pediatrics clinic upon bringing their infant for a 2-week, 2-month, or 4-month well child visit. Participants completed a questionnaire about socio-demographic, medical, and psycho-social factors including social support, media exposure, attitudes and feelings while breastfeeding. Bivariate analysis was done using chi-square and independent sample t-test. Further analysis was then done using logistic regressions. Results: Of the 158 mothers recruited, 149 provided data for analysis. The sample had strong representation of groups known to have lower breastfeeding rates. 77.9% were uninsured or had public insurance, 52.3% had a high school education or less, 41.8% described themselves as black or African American, and 57.7% did not report a spouse living with them. Just over half of the respondents were still breastfeeding (55%), 27.5% had discontinued, and 16.8% never started. The time to discontinuation averaged 21.9 ± 16.2 days. Factors associated with continued breastfeeding include having family members (p=0.042), especially a mother (p < 0.001), who has breastfed or a close friend or relative that is supportive of breastfeeding (p=0.011). Mothers who were still breastfeeding were more likely to feel fulfilled (p=0.004), relaxed (p < 0.001), and confident (p=0.009) while nursing and less likely to feel pain (p=0.041). Logistic regressions found that feeling relaxed while breastfeeding decreased the odds of discontinued breastfeeding when controlling for maternal age, race, education, insurance, and marital status (p=0.005, Odds Ratio=0.057). Meanwhile, mothers who thought breastfeeding would be easy were more likely to have discontinued breastfeeding (p=0.033). Most (82.3%) of mothers reported exposure to breastfeeding material on social media, but it was more strongly associated with mothers who discontinued (p=0.062). No other types of media exposure were associated with breastfeeding cessation. Conclusion: Positive maternal experiences while breastfeeding is associated with breastfeeding continuation. More research is needed to explore the effects of maternal experience and the role of social media exposure on breastfeeding, considering the pervasive use of such media in this age group. Support from significant others and close friends or relatives may be protective against obstacles many women face while breastfeeding. Identifying and assuring a personal breastfeeding ally for mothers may help increase breastfeeding duration in vulnerable populations.
- Copyright © 2018 by the American Academy of Pediatrics