Abstract
Objectives
Despite known health benefits of breastfeeding, the Navajo have low reported frequency of breastfeeding initiation and support. We evaluated breastfeeding frequencies and practices in the predominately Navajo community of rural San Juan County, Utah, to identify factors that affect breastfeeding decisions and duration.
Methods
We performed retrospective chart review for 135 infants aged 0 to 12 months, and surveys of 85 mothers of infants aged 0 to 2 years, and eight primary care providers. We characterized demographic factors using counts/percentages and medians/inter-quartile ranges, and compared mothers who breastfed for 6 months or less versus greater than 6 months.
Results
In 96 infants with complete feeding documentation, 86 infants (90%) received some breast milk and 36 infants (38%) were exclusively breastfed at age 2 months. In 67 infants with complete feeding documentation at ≥ 6 months, 22 infants (33%) were exclusively breastfed 6 months. Most mothers knew about breastfeeding benefits. In 56 mothers whose infants were aged ≥ 6 months at the time of the survey, breastfeeding for more than 6 months had been planned by 44 mothers (79%) but performed by only 29 mothers (52%). Mothers who breastfed for > 6 months were more likely to have been influenced by WIC and less likely to have introduced formula at an early age. Barriers to breastfeeding included maternal pain, latch difficulties, and concerns about inadequate milk supply. Primary care providers reported limited confidence in providing breastfeeding support but would support telehealth-driven interventions.
Conclusions for Practice
Practical, culturally sensitive interventions, including telehealth and improved provider education, may improve breastfeeding outcomes and community health in this underserved population.
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Data Availability
All de-identified data is available upon request.
Code Availability
Analysis was performed using R [21] (R Core team, Vienna, Austria).
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Acknowledgements
This research was supported by an American Academy of Pediatrics 2018 Community Access to Child Health (CATCH) Planning grant, and the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764). We are grateful to the mothers and providers who participated in this study and support from the Navajo Nation Human Research Review Board; Shiprock Navajo Agency; Naatsis’áán (Navajo Mountain), Ooljéé’ Tó (Oljato), Naakaii Tó (Mexican Water), Tʼáá Bííchʼį́įdii (Aneth), and Tʼiis Názbąs (Teec Nos Pos) Chapters; University of Utah Pediatric Clinic 6 (University Pediatric Clinic) and Well Baby Nursery; University of Utah Department of Pediatrics; Dr. Alan Pruhs from Association of Utah Community Health; University of Utah Baby Friendly Initiative; Michael Jensen, MBA, MHA, CEO of the Utah Navajo Health System; Erika Lindley, MPH, Director of the Women’s and Children’s Service Line at the University of Utah; University of Utah Telehealth Department; Navajo Nation Breastfeeding Coalition; and San Juan County and Navajo Nation Women, Infants, and Children (WIC) Programs.
Funding
This research was supported by an American Academy of Pediatrics 2018 Community Access to Child Health (CATCH) Planning grant, and the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).
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Dr. LLB, with support from Dr. CHS, obtained the grant that funded the study. Dr. LLB and Ms. RT served as co-Primary Investigators for the study, ensuring all study goals were met in accordance with expectations from both the funder and the Navajo Nation leadership. Ms. RT also provided critical guidance to ensure that our study was conducted in a culturally appropriate manner. Mrs. JC and Dr. MMM played a critical role in development of the surveys and over all study design and implementation. Dr. CHS, Dr. LLB, Mr. GJS, Ms. YJ, and Mr. TB conducted the data analysis. All authors contributed significantly in the writing and editing of the manuscript and approved the final version for submission.
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The study was reviewed and approved by University of Utah Institutional Review Board and from the Navajo Nation Human Research Review Board.
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Brown, L.L., Talker, R., Stoddard, G.J. et al. Breastfeeding Attitudes and Practices in a Rural Utah Navajo Community. Matern Child Health J 26, 397–406 (2022). https://doi.org/10.1007/s10995-021-03247-8
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DOI: https://doi.org/10.1007/s10995-021-03247-8