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. Flower
  • Michael Willoughby
  • R. Jean Cadigan
  • Eliana M. Perrin
  • Greg Randolph
  • The Family Life Project Investigative Team
Article

Abstract

Objective

To determine factors associated with breastfeeding in rural communities.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Breastfeeding Rural Low-income Ethnography WIC Maternal employment 

Abbreviations

NC

North Carolina

PA

Pennsylvania

WIC

Women, infants and children supplemental nutrition program

OR

Odds ratio

CI

Confidence interval

AAP

American Academy of Pediatrics

FLP

Family Life Project

TANF

Temporary assistance for needy families

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Kori B. Flower
    • 1
  • 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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