Maternal and Child Health Journal

, Volume 12, Issue 3, pp 402-414

First online:

Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach

  • Kori B. FlowerAffiliated withCharles Drew Community Health Center, Piedmont Health Services Email author 
  • , Michael WilloughbyAffiliated withFrank Porter Graham Child Development Institute, University of North Carolina
  • , R. Jean CadiganAffiliated withCenter for Developmental Science, University of North Carolina
  • , Eliana M. PerrinAffiliated withDivision of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina
  • , Greg RandolphAffiliated withCharles Drew Community Health Center, Piedmont Health Services
  • , The Family Life Project Investigative Team

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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 Rural Low-income Ethnography WIC Maternal employment