Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To determine factors associated with breastfeeding in rural communities.
We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N = 1292) of infants born September 2003–2004 and (2) a parallel ethnographic study (N = 30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding.
Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance.
Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.
- Breastfeeding and the use of human milk. Pediatrics 115: pp. 496-506 CrossRef
- Li, R., Darling, N., Maurice, E., Barker, L., Grummer-Strawn, L. M. (2005) Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 National Immunization Survey. Pediatrics 115: pp. e31-e37 CrossRef
- Healthy People 2010: Understanding and improving health. US Government Printing Office, Washington, DC
- HHS Blueprint for action on breastfeeding. US Government Printing Office, Washington, D.C
- Li, R., Ogden, C., Ballew, C., Gillespie, C., Grummer-Strawn, L. (2002) Prevalence of exclusive breastfeeding among US infants: The Third National Health and Nutrition Examination Survey (Phase II, 1991–1994). American Journal of Public Health 92: pp. 1107-1110
- Chandra, A., Martinez, G. M., Mosher, W. D., Abma, J. C., Jones, J. (2005) Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat Series 23: pp. 1-160
- Gaston, M. H. (2001) 100% access and 0 health disparities: changing the health paradigm for rural women in the 21st century. Women’s Health Issues 11: pp. 7-16 CrossRef
- Chatterji, P., Brooks-Gunn, J. (2004) WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers. American Journal of Public Health 94: pp. 1324-1327
- Kurinij, N., Shiono, P. H., Ezrine, S. F., Rhoads, G. G. (1989) Does maternal employment affect breast-feeding?. American Journal of Public Health 79: pp. 1247-1250
- Kuan, L. W., Britto, M., Decolongon, J., Schoettker, P. J., Atherton, H. D., Kotagal, U. R. (1999) Health system factors contributing to breastfeeding success. Pediatrics 104: pp. e28 CrossRef
- Ertem, I. O., Votto, N., Leventhal, J. M. (2001) The timing and predictors of the early termination of breastfeeding. Pediatrics 107: pp. 543-548 CrossRef
- Taveras, E. M., Capra, A. M., Braveman, P. A., Jensvold, N. G., Escobar, G. J., Lieu, T. A. (2003) Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 112: pp. 108-115 CrossRef
- Taveras, E. M., Li, R., Grummer-Strawn, L. (2004) Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics 113: pp. e283-e290 CrossRef
- Clark, S. J., Savitz, L. A., & Randolph, R. K. (2001). Rural children’s health. Western Journal of Medicine, 178, 142–147.
- Bentley, M. E., Dee, D. L., Jensen, J. L. (2003) Breastfeeding among low income, African-American women: Power, beliefs and decision making. Journal of Nutrition 133: pp. 305S-309
- Phares, T. M., Morrow, B., Lansky, A., Barfield, W. D., Prince, C. B., Marchi, K. S., Braveman, P. A., Williams, L. M., & Kinneburgh, B. (2004). Surveillance for disparities in maternal health-related behaviors-Selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001. In: Surveillance Summaries, July 2, 2004, MMWR, 53(No.SS-4), 1–13.
- Ponza, M., Devaney, B., Ziegler, P., Reidy, K., Squatrito, C. (2004) Nutrient intakes and food choices of infants and toddlers participating in WIC. Journal of American Diet Association 104: pp. S71-S79 CrossRef
- Ryan, A. S. (1997) The resurgence of breastfeeding in the United States. Pediatrics 99: pp. e12 CrossRef
- Hilson, J., Rasmussen, K., Kjolhede, C. (1997) Maternal obesity and breast-feeding success in a rural population of white women. American Journal of Nutrition 66: pp. 1371-1378
- Hall, R. T., Mercer, A. M., Teasley, S. L. (2002) A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age. The Journal of Pediatrics 141: pp. 659-664 CrossRef
- Killersreiter, B., Grimmer, I., Buhrer, C., Dudenhausen, J. W., Obladen, M. (2001) Early cessation of breast milk feeding in very low birthweight infants. Early Human Development 60: pp. 193-205 CrossRef
- Merewood, A., Brooks, D., Bauchner, H., MacAuley, L., Mehta, S. D. (2006) Maternal birthplace and breastfeeding initiation among term and preterm infants: A statewide assessment for Massachusetts. Pediatrics 118: pp. e1048-1054 CrossRef
- Kaufman, A. S., Kaufman, N. L. (1994) Kaufman Functional Academic Skills Test (K-FAST). American Guidance Service, Circle Pines, Minnesota
- Krause, N., Jay, G. (1994) What do global health items measure?. Medical Care 9: pp. 930-942 CrossRef
- Reich, W., Todd, R., Joyner, C. A., Neuman, R. J., Heath, A. C. (2003) Reliability and stability of mothers’ reports about their pregnancies with twins. Twin Research 6: pp. 85-88 CrossRef
- Runyan, D. K. Monitoring child health and well-being in large population surveys. In: Thornton, A eds. (2001) Well-being of children and families: Research and data needs. University of Michigan Press, Ann Arbor, Michigan
- Research Triangle Institute. (2004). SUDAAN language manual. Release 9.0 ed. Research Triangle Park, NC: Research Triangle Institute.
- Binder, D. A. (1983) On the variances of asymptotically normal estimators from complex surveys. International Statistical Review 51: pp. 279-292 CrossRef
- Ahluwalia, I. B., Morrow, B., Hsia, J. (2005) Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics 116: pp. 1408-1412 CrossRef
- Ryan, A. S., Zhou, W. (2006) Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978–2003. Pediatrics 117: pp. 1136-1146 CrossRef
- Schwartz, J. B., Popkin, B. M., Tognetti, J., Zohoori, N. (1995) Does WIC participation improve breast-feeding practices?. American Journal Public Health 85: pp. 729-731 CrossRef
- US Department of Agriculture Food, Nutrition Service. (1987). The National WIC evaluation: An evaluation of the special supplemental food program for women, infants and children, Volume 1: Summary. Alexandria, Virginia: US Department of Agriculture.
- Tuttle, C. R. (2000) An open letter to the WIC program: The time has come to commit to breastfeeding. Journal of Human Lactation 16: pp. 99-103 CrossRef
- WIC food packages: Time for a change. Institute of Medicine, Washington, DC
- Ahluwalia, I. B., Tessaro, I., Grummer-Strawn, L. M., MacGowan, C., Benton-Davis, S. (2000) Georgia’s breastfeeding promotion program for low-income women. Pediatrics 105: pp. e85 CrossRef
- Hanson, M. B., Hellerstedt, W. L., Desvarieux, M., Duval, S. J. (2003) Correlates of breast-feeding in a rural population. American Journal of Health Behavior 27: pp. 432-444
- Visness, C., Kennedy, K. (1997) Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey. American Journal of Public Health 87: pp. 945-950
- Gross, S. M., Caulfield, L. E., Bentley, M. E. (1998) Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. Journal of American Diet Association 98: pp. 143-148 CrossRef
- Ryan, A., Martinez, G. (1989) Breast-feeding and the working mother: a profile. Pediatrics 83: pp. 524-531
- Gielen, A., Faden, R., O’Campo, P., Brown, C., Paige, D. (1991) Maternal employment during the early postpartum period: effects on initiation and continuation of breast-feeding. Pediatrics 87: pp. 298-305
- Kimbro, R. T. (2006) On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women. Maternal and Child Health Journal 10: pp. 19-26 CrossRef
- Mozingo, J. N., Davis, M. W., Droppleman, P. G., Merideth, A. (2000) “It wasn’t working”: Women’s experiences with short-term breastfeeding”. American Journal of Maternal Child Nursing 25: pp. 120-126 CrossRef
- Raisler, J. (2000) Against the odds: breastfeeding experiences of low income mothers. Journal of Midwifery & Women’s Health 45: pp. 253-263 CrossRef
- Shaw, E., Kaczorowski, J. (1999) The effect of a peer counseling program on breastfeeding initiation and longevity in a low-income rural population. Journal of Human Lactation 15: pp. 19-25 CrossRef
- Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach
Maternal and Child Health Journal
Volume 12, Issue 3 , pp 402-414
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Maternal employment
- Industry Sectors
- Author Affiliations
- 1. Charles Drew Community Health Center, Piedmont Health Services, 221 North Graham-Hopedale Road, Burlington, NC, USA
- 2. Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
- 3. Center for Developmental Science, University of North Carolina, Chapel Hill, NC, USA
- 4. Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA