Maternal and Child Health Journal

, Volume 12, Issue 3, pp 402–414 | Cite as

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

  • Kori B. FlowerEmail author
  • Michael Willoughby
  • R. Jean Cadigan
  • Eliana M. Perrin
  • Greg Randolph
  • The Family Life Project Investigative Team



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 



North Carolina




Women, infants and children supplemental nutrition program


Odds ratio


Confidence interval


American Academy of Pediatrics


Family Life Project


Temporary assistance for needy families



The authors gratefully acknowledge the Family Life Project field sites and research assistants in North Carolina and Pennsylvania, and thank families for their participation. The study was funded by grant PO1HD039667 from the National Institute of Child Health and Human Development. The authors report no conflict of interest. Support for R. Jean Cadigan was provided by the National Institute of Child Health and Human Development (grant 5-T32-HD007376: Human Development: Interdisciplinary Research Training) to the Center for Developmental Science, University of North Carolina, Chapel Hill. Support for Eliana M. Perrin was provided by the National Institute of Child Health and Human Development (grant #HD01441). We thank Debra Skinner and Margaret Bentley for manuscript review.


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Kori B. Flower
    • 1
    Email author
  • Michael Willoughby
    • 2
  • R. Jean Cadigan
    • 3
  • Eliana M. Perrin
    • 4
  • Greg Randolph
    • 1
  • The Family Life Project Investigative Team
  1. 1.Charles Drew Community Health CenterPiedmont Health ServicesBurlingtonUSA
  2. 2.Frank Porter Graham Child Development InstituteUniversity of North CarolinaChapel HillUSA
  3. 3.Center for Developmental ScienceUniversity of North CarolinaChapel HillUSA
  4. 4.Division of General Pediatrics and Adolescent Medicine, Department of PediatricsUniversity of North CarolinaChapel HillUSA

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