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Canadian Journal of Public Health

, Volume 100, Issue 5, pp 376–380 | Cite as

Risk Factors for Cessation of Breastfeeding Prior to Six Months Postpartum among a Community Sample of Women in Calgary, Alberta

  • Heather L. KehlerEmail author
  • Katie H. Chaput
  • Suzanne C. Tough
Quantitative Research
  • 1 Downloads

Abstract

Objectives

To describe the rates of breastfeeding initiation and breastfeeding for at least six months and identify risk factors for failing to breastfeed for six months among a community sample of mothers in Calgary, Alberta.

Methods

A cohort of women (n=1737) who participated in a longitudinal study of prenatal support and who could be contacted when their child was three years old (n=1147) were invited to participate in a follow-up telephone questionnaire. Of these 1147 women, 780 (69% participating rate) participated and provided breastfeeding data. Risk factors for early cessation of breastfeeding prior to six months were identified using bivariate and multivariable strategies.

Results

Of the 780 women, 95.6% initiated breastfeeding and 71.6% continued to breastfeed for at least six months. Risk factors identified for early cessation included younger maternal age, obesity prior to pregnancy, lower maternal education, working full-time or intending to within the first year, history of depression, depression or anxiety during pregnancy, poor social support, and smoking during pregnancy (all p<0.05). Multivariable analysis revealed that working full-time or intending to within the first year, lower maternal education, obesity prior to pregnancy and anxiety during pregnancy most increased a woman’s risk of early cessation (all p<0.05).

Conclusion

Nearly all mothers initiated breastfeeding and 70% continued to breastfeed for six months, although subgroups of women remained at an elevated risk of early cessation. Research to better understand breastfeeding decisions among women with the risk factors identified is needed to facilitate the development of more effective breastfeeding promotion strategies.

Key words

Breastfeeding cessation risk factors epidemiology 

Résumé

Objectifs

Décrire les taux d’initiation de l’allaitement maternel et d’allaitement pendant au moins six mois et cerner les facteurs de risque d’arrêt précoce de l’allaitement (avant six mois) dans un échantillon communautaire de mères vivant à Calgary (Alberta).

Méthode

Nous avons invité une cohorte de femmes (n=1 737) ayant pris part à une étude longitudinale sur le soutien prénatal et qui ont pu être contactées quand leur enfant a atteint l’âge de trois ans (n=1 147) à répondre à un questionnaire de suivi téléphonique. De ces 1 147 femmes, 780 (69 %) ont participé au suivi et fourni des données sur l’allaitement. Les facteurs de risque d’arrêt précoce de l’allaitement ont été cernés à l’aide d’analyses bivariées et multivariées.

Résultats

De ces 780 femmes, 95,6 % avaient allaité et 71,6 % avaient continué pendant au moins six mois. Les facteurs de risque d’arrêt précoce étaient la jeunesse de la mère, l’obésité antérieure à la grossesse, un faible niveau d’instruction maternel, le fait de travailler à plein temps ou d’avoir l’intention de le faire avant un an, des antécédents de dépression, la dépression ou l’anxiété durant la grossesse, un manque de soutien social et le tabagisme durant la grossesse (p<0,05 dans tous les cas). L’analyse multivariée a montré que le fait de travailler à plein temps ou d’avoir l’intention de le faire avant un an, un faible niveau d’instruction maternel, l’obésité avant la grossesse et l’anxiété durant la grossesse étaient les facteurs qui augmentaient le plus le risque d’arrêt précoce de l’allaitement (p<0,05 dans tous les cas).

Conclusion

Presque toutes les mères avaient allaité et 70 % avaient continué à le faire pendant six mois, mais certains sous-groupes présentaient un risque élevé d’arrêt précoce. Il faudrait pousser la recherche pour mieux comprendre les décisions liées à l’allaitement chez les femmes qui présentent les facteurs de risque cernés, afin de faciliter l’élaboration de stratégies de promotion de l’allaitement plus efficaces.

Mots clés

allaitement maternel arrêt précoce facteurs de risque épidémiologie 

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References

  1. 1.
    Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153. Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022. Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Publication No. 07-E007, 2007.Google Scholar
  2. 2.
    Kramer M. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am J Clin Nutr 2003;78:291–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Bhandari N, Bahl R, Mazumdar S. Effect of community-based promotion of exclusive breastfeeding on diarrheal illness and growth: A cluster randomized controlled trial. Lancet 2003;361:1418–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Chantry CJ, Howard CR, Auinger P. Full breastfeeding and associated decrease in respiratory tract infection in US children. Pediatrics 2006;117(425):432.Google Scholar
  5. 5.
    van Odjik J, Kull I, Borres MP. Breastfeeding and allergic disease: A multidis-ciplinary review of the literature (1966-2001) on the mode of early feeding and its impact on later atopic manifestations. Allergy 2003;58:833–43.CrossRefGoogle Scholar
  6. 6.
    Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin North Am 2001;48:125–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Health Canada. Exclusive Breastfeeding Duration: 2004 Health Canada Recommendation. Ottawa, ON: 2004.Google Scholar
  8. 8.
    World Health Organization. Gloabl strategy for infant and young child feeding. Geneva, Switzerland: World Health Organization, 2003.Google Scholar
  9. 9.
    Health Indicators. Statistics Canada, Canadian Community Health Survey, 2003. 2005. Available online at: https://doi.org/www.statcan.ca/english/freepub/82-221-XIE/2005001/nonmed/behaviours4.htm (Accessed September 5, 2007).Google Scholar
  10. 10.
    Forster DA, McLachlan HL, Lumley J. Factors associated with breastfeeding at six months postpartum in a group of Australian women. Int Breastfeeding J 2006;(1):1–18.CrossRefGoogle Scholar
  11. 11.
    Avery M, Duckett LJ, Dodgson J. Factors associated with very early weaning among primiparas intending to breastfeed. Matern Child Health J 1998;2:167–79.PubMedCrossRefGoogle Scholar
  12. 12.
    Blyth RJ, Creedy DK, Dennis CL, Moyle W, Pratt J, De Vries SM, et al. Breastfeeding duration in an Austrailian population: The influence of modifiable antenatal factors. J Hum Lact 2004;20:30–38.PubMedCrossRefGoogle Scholar
  13. 13.
    Grossman LK, Fitzsimmons SM, Larsen-Alexander JB, Sachs L, Hartner C. The infant feeding decision in low and upper income women. Clin Pediatr 1990;29:30–37.CrossRefGoogle Scholar
  14. 14.
    Lande B, Anderson LF, Baerug A, Trygg KU, Lund-Larsen K, Veierod MB, Bjorneboe GE. Infant feeding practices and associated factors in the first six months of life: The Norwegian infant nutrition survey. Acta Paediatr 2003;92(2):152–61.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Li L, Li S, Ali M, Ushijima H. Feeding practices of infants and their correlates in urban areas of Beijing, China. Pediatr Int 2003;45:400–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Lynch SA, Koch AM, Hislop TG, Coldman AJ. Evaluating the effect of a breastfeeding consultant on the duration of breastfeeding. Can J Public Health 1986;77(3):190–95.PubMedGoogle Scholar
  17. 17.
    Nolan L, Goel V. Sociodemographic factors related to breastfeeding in Ontario: Results from the Ontario Health Survey. Can J Public Health 1995;86(5):309–12.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Schwartz K, D’Arcy HJ, Gillespie B, Bobo J, Longeway M, Foxman B. Factors associated with weaning in the first 3 months postpartum. J Fam Pract 2002;51(5):439–44.PubMedGoogle Scholar
  19. 19.
    Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003;108–15.Google Scholar
  20. 20.
    Vogel A, Hutchinson BL, Mitchell EA. Factors associated with the duration of breastfeeding. Acta Paediatr 1999;88:1320–26.PubMedCrossRefGoogle Scholar
  21. 21.
    Waldenstrom U, Aarts C. Duration of breastfeeding and breastfeeding problems in relation to length of postpartum stay: A longitudinal cohort study of a national Swedish sample. Acta Paediatr 2004;93(5):669–76.PubMedCrossRefGoogle Scholar
  22. 22.
    Yeoh BH, Eastwood J, Phung H, Woolfenden S. Factors influencing breastfeeding rates in south-western Sydney. J Paediatr Child Health 2007;43:249–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Donath S, Amir LH. Rates of breastfeeding in Australia by State and socio-economic status: Evidence from the 1995 National Health Survey. J Paediatr Child Health 2000;36:164–68.PubMedCrossRefGoogle Scholar
  24. 24.
    Papinczak TA, Turner CT. An analysis of personal and social factors influencing initiation and duration of breastfeeding in a large Queensland maternity hospital. Breastfeeding Review 2000;8:25–33.PubMedGoogle Scholar
  25. 25.
    Rutishauser IHE, Carlin JB. Body mass index and duration of breastfeeding: A survival analysis during the first six months of life. J Epidemiol Community Health 1992;46:559–65.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Hilson J, Rasmussen K, Kjolhede C. Maternal obesity and breast-feeding success in a rural population of white women. Am J Clin Nutr 1997;66:1371–78.PubMedCrossRefGoogle Scholar
  27. 27.
    Donath SM, Amir LH. Does maternal obesity adversely affect breastfeeding initiation and duration? J Paediatr Child Health 2000;36:482–86.PubMedCrossRefGoogle Scholar
  28. 28.
    Employment Insurance (EI) and maternity, parental and sickness benefits. Service Canada. 2008. Available online at: https://doi.org/www1.servicecanada.gc.ca/en/ei/types/special.shtml#much (Accessed February 20, 2008).
  29. 29.
    Tough S, Johnson D, Siever J, Jorgenson G, Slocombe L, Lane C, et al. Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A randomized control trial in Canada. Birth 2005;33:183–95.CrossRefGoogle Scholar
  30. 30.
    Health Canada. Canadian Guidelines for Body Weight Classification in Adults. Ottawa: Minister of Public Works and Government Services Canada, 2003.Google Scholar
  31. 31.
    Kellner R. A symptom questionnaire. J Clin Psychiatry 1987;48:268–74.PubMedGoogle Scholar
  32. 32.
    McCubbin H, Patterson J, Glynn T. Social Support Index (SSI). McCubbin H, Thompson A. Family Assessment for Research and Practice. Madison, WI: University of Wisconsin, 1982.Google Scholar
  33. 33.
    Rosenberg MJ. Society and the Adolescent Self-Image. Middletown, CT: Wesleyan University Press, 1989.Google Scholar
  34. 34.
    Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782–86.PubMedCrossRefGoogle Scholar
  35. 35.
    Yang Q, Wen SW, Dubois L, Chen Y, Walker M, Krewski D. Determinants of breastfeeding initiation and duration. Can J Obstet Gynaecol 2004;26:975–81.CrossRefGoogle Scholar
  36. 36.
    Haiek NL, Gauthier D, Brosseau D, Rocheleau L. Understanding breastfeeding behaviour: Rates and shifts in patterns in Quebec. J Human Lactation 2007;23:24–31.CrossRefGoogle Scholar
  37. 37.
    Reid V, Meadows-Oliver M. Postpartum depression in adolescent mothers: An integrative review of the literature. J Pediatric Health Care 2007;21(5):289–98.CrossRefGoogle Scholar
  38. 38.
    Falceto OG, Giugliani ER, Fernandez CL. Influence of parental mental health on early termination of breast-feeding: A case-control study. J Am Board Fam Pract 2004;17:173–83.PubMedCrossRefGoogle Scholar
  39. 39.
    Sheehan D, Krueger P, Watt S, Sword W, Bridle B. The Ontario Mother and Infant Survey: Breastfeeding outcomes. J Human Lactation 2001;17(3):211–19.CrossRefGoogle Scholar
  40. 40.
    Evers S, Doran L, Schellenberg K. Influences on breastfeeding rates in low income communities in Ontario. Can J Public Health 1998;89(3):203–7.PubMedGoogle Scholar
  41. 41.
    Yang Q, Wen SW, Dubois L, Chen Y, Walker MC, Krewski D. Determinants of breast-feeding and weaning in Alberta, Canada. Can J Obstet Gynaecol 2004;26(11):975–81.CrossRefGoogle Scholar
  42. 42.
    Nyboe Anderson A, Lund-Anderson C, Falck Larsen J, Juel Christensen J, Legros JJ, Lous F. Suppressed prolactin but normal neurophysin levels in cigarette smoking breast-feeding women. Clinical Endocrinol 1982;17:363–68.CrossRefGoogle Scholar
  43. 43.
    Mennella JA, Yourshaw LM, Morgan LK. Breastfeeding and smoking: Short-term effects on infant feeding and sleep. Pediatrics 2007;120(3):497–502.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Chapman DJ, Phung H. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc 1999;99:450–54.PubMedCrossRefGoogle Scholar
  45. 45.
    Chapman DJ, Perez-Escamilla R. Maternal perception of the onset of lactation is a valid, public health indicator of lactogenesis stage II. J Nutr 2000;130:2972–80.PubMedCrossRefGoogle Scholar
  46. 46.
    Dewey KG, Nommsen LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behaviour, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003;112(3):607–19.PubMedCrossRefGoogle Scholar
  47. 47.
    Rasmussen KM, Kjolhede CL. Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics 2004;113:e465–e471.PubMedCrossRefGoogle Scholar
  48. 48.
    Mok E, Multon C, Piguel L, Barroso E, Goua V, Christin P, et al. Decreased full breastfeeding, altered practices, perceptions, and infant weight change of prepregnant obese women: A need for extra support. Pediatrics 2008;121;e1319–e1324.PubMedCrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2009

Authors and Affiliations

  • Heather L. Kehler
    • 1
    Email author
  • Katie H. Chaput
    • 2
  • Suzanne C. Tough
    • 3
  1. 1.Decision Support Research TeamCalgary Health RegionCalgaryCanada
  2. 2.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  3. 3.Departments of Paediatrics and Community Health SciencesUniversity of CalgaryCalgaryCanada

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