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Factors Associated with Intention to Breastfeed Among Low-Income, Inner-City Pregnant Women

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Objectives: To examine the relationship between sociodemographic factors, maternal characteristics, and intention to breastfeed among low-income, inner-city pregnant women. Methods: English and Spanish speaking low-income women recruited from local Philadelphia health centers were surveyed at the time of their first prenatal care visit. At the time of the visit, respondents were asked whether or not they planned to breastfeed their infant. The responses of 2,690 women were included in these analyses. Multivariate logistic regression was used to assess the independent associations of race/ethnicity, nativity status, education, and other factors on the odds of intending to breastfeed. Results: About half (53%) of the respondents reported that they intended to breastfeed their infant. In adjusted logistic regression models, immigrant black (adjusted OR [aOR] 5.82; 95% confidence interval [CI] 3.86, 8.77), other Hispanic (who were predominantly foreign-born) (aOR 6.05; 95% CI 3.92, 9.33), and island-born Puerto Rican (aOR 3.48; 95% CI 2.04, 5.95) women were significantly more likely to report that they intended to breastfeed than non-Hispanic whites. Somewhat surprisingly, non-Hispanic, US-born African Americans in this low-income sample were more likely to report that they intended to breastfeed than non-Hispanic white respondents (aOR 1.59; 95% CI 1.20, 2.11). Lower education, not living with the baby's father, multiparous pregnancy, and smoking were negatively and independently associated with intention to breastfeed. Maternal age, household income, public housing, and depressive symptoms were not significant predictors of breastfeeding intention in adjusted multivariate models. Conclusions: Significant differences were documented in breastfeeding intention in our sample of low-income, inner-city women. Most notable was the higher likelihood of anticipated breastfeeding among our immigrant sub-groups when compared with non-Hispanic white women. An unexpected finding was the higher likelihood of anticipated breastfeeding among native-born, non-Hispanic African American women than among non-Hispanic white respondents. Because intentions are important predictors of future behavior, more focus needs to be directed towards breastfeeding promotion during the prenatal period and towards a better understanding of why some mothers intend to breastfeed while others do not.

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REFERENCES

  1. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 1997;100:1035–1039.

    Article  Google Scholar 

  2. Dobson B, Murtaugh MA. Position of the American Dietetic Association: breaking the barriers to breastfeeding. J Am. Diet Assoc 2001;101(10): 1213–1220.

    Article  PubMed  Google Scholar 

  3. Cushing AH, Samet JM, Lambert WE, Skipper BJ, Hunt WC, Young SA, McLaren LC. Breastfeeding reduces risk of respiratory illness in infants. Am. j Epidemiol 1998;147(9):863–870.

    PubMed  CAS  Google Scholar 

  4. Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993;91(5):867–872.

    PubMed  CAS  Google Scholar 

  5. Frank AL, Taber LH, Glezen WP, Kasel GL, Wells CR, Paredes A. Breastfeeding and respiratory virus infection. Pediatrics 1982;70(2):239–245.

    PubMed  CAS  Google Scholar 

  6. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990;336:1519–1523.

    Article  PubMed  CAS  Google Scholar 

  7. Morrow-Tlucak M, Haude RH, Ernhart CB. Breastfeeding and cognitive development in the first two years of life. Social Sci Med 1988;26:635–639.

    Article  CAS  Google Scholar 

  8. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 Vols. U.S. Government Printing Office, Washington, DC, 2000.

  9. Ryan AS, Zhou W, Acosta A. Breastfeeding continues to increase into the new millennium. Pediatrics 2002;110(6):1103–1109.

    Article  PubMed  Google Scholar 

  10. Ryan AS. The resurgence of breastfeeding in the United States. Pediatrics 1997;99(4):e12.

    Article  PubMed  Google Scholar 

  11. Wright AL. The rise of breastfeeding in the United States. Pediatric Clinic of North America 2001;48(1): 1–12.

    Article  CAS  Google Scholar 

  12. Forste R, Weiss J, Lippincott E. The decision to breastfeed in the United States: Does Race matter? Pediatrics 2001;108(1):291–296.

    Article  PubMed  CAS  Google Scholar 

  13. Kurinij N, Shiono PH, Rhoads GG. Breastfeeding incidence and duration in black and White women. Pediatrics 1988;81(3):365–371.

    PubMed  CAS  Google Scholar 

  14. Miller JE. Racial/Ethnic Differences in Breastfeeding Initiation and Continuation in the U.S. Paper Presented at the Annual Meeting of the Population Association of America, April 2001, Washington, DC 2003.

  15. Peterson CE, DaVanzo, J. Why are teenagers in the United States less likely to breast-feed than older women? Demography 1992;29(3):431–450.

    Article  PubMed  CAS  Google Scholar 

  16. Weimann CM, DuBois JC, Berenson, AB. Racial/Ethnic differences in the decision to breastfeed among adolescent mothers. Pediatrics 1998;101(6):1–8.

    Article  PubMed  Google Scholar 

  17. Mahoney MC, James, DM. Predictors of anticipated breastfeeding in an urban, low-income setting. J Fam Practice 2000;49(6):529–533.

    CAS  Google Scholar 

  18. Kessler LA, Gielen AC, Diener-West M, Paige, DM. The effect of a woman's significant other on her breastfeeding decision. J Human Lactation 1995;11(2):103–109.

    Article  CAS  Google Scholar 

  19. Fishbein M, Ajzen, I. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Addison-Wesley, Reading, MA, 1975.

    Google Scholar 

  20. Dix, DN. Why women decide not to breastfeed. Birth 1991;18(4):222–225.

    Article  PubMed  CAS  Google Scholar 

  21. Grossman LK, Larsen-Alexander JB, Fitzsimmons SM, Cordero, L. Breastfeeding among low-income, high-risk women. Clin.Pediatr 1989;28(1):38–42.

    Article  CAS  Google Scholar 

  22. O’Campo P, Faden RR, Gielen AC, Wang, MC. Prenatal factors associated with breastfeeding duration: recommendations for prenatal interventions. Birth 1992;19(4):195–201.

    Article  PubMed  CAS  Google Scholar 

  23. Kramer, MS. Poverty, WIC, and promotion of breastfeeding. Pediatrics 1991;87:399–400.

    PubMed  CAS  Google Scholar 

  24. Chung EK, McCollum KF, Elo IT, Lee HJ, Culhane, JF. Maternal depressive symptoms and infant health practices among low-income women. Pediatrics 2004;113:e523–e529.

    Google Scholar 

  25. Mandl KD, Troncik EZ, Brennan TA, Alpert HR, Homer, CJ. Infant health care use and maternal depression. Arch Pediatr Adolesc Med 1999;153:808–813.

    PubMed  CAS  Google Scholar 

  26. McLennan JD, Kotelchuck, M. Parental prevention practices for young children in the context of maternal depression. Pediatrics 2000;105:1090–1095.

    Article  PubMed  CAS  Google Scholar 

  27. Fein SB, Roe, B. The effect of work status on initiation and duration of breast-feeding. Am J Public Health 1998;88:1042–1046.

    Article  PubMed  CAS  Google Scholar 

  28. Roe B, Whittington LA, Fein SB, Teisl, MF. Is there competition between breast-feeding and maternal employment? Demography 1999;36:157–171.

    Article  PubMed  CAS  Google Scholar 

  29. StataCorp. Stata Statistical Software: Release 7.0. Stata Corporation, College Station, TX, 2001.

  30. Gabriel A, Gabriel KR, Lawrence, RA. Cultural values and biomedical knowledge: choices in infant feeding. Soc Sci Med 1986;23(5):501–509.

    Article  PubMed  CAS  Google Scholar 

  31. Giugliani ERJ, Caiaffa WT, Vogelhut J, Witter FR, Perman, JA. Effect of breastfeeding support from different sources on mothers' decision to breastfeed. J Human Lactation 1994;10(3):157–161.

    Article  CAS  Google Scholar 

  32. Guttman N, Zimmerman, DR. Low-income mothers’ views on breastfeeding. Soc Sci Med 2000;50(10):1457–1473.

    Article  PubMed  CAS  Google Scholar 

  33. Matich JR, Sims, LS. A comparison of social support variables between women who intend to breast or bottle feed. Soc Sci Med 1992;34(8):919–927.

    Article  PubMed  CAS  Google Scholar 

  34. Ahluwalia IB, Tessaro I, Grummer-Strawn LM, MacGowan C, Benton-Davis, S. Georgia's breastfeeding promotion program for low-income women. Pediatrics 2000;105(6):e85.

    Article  PubMed  Google Scholar 

  35. Naylor, A. Baby-friendly hospital initiative: protecting, promoting, and supporting breastfeeding in the twenty-first century. Pediatr Clin North Am 2001;48: 475–483.

    PubMed  CAS  Google Scholar 

  36. Pérez-Escarnilla R, Pollitt E, Lönnerdal B, Dewey, KG. Infant feeding policies in maternity wards and their effect on breast-feeding success: An analytical overview. Am. J Public Health 1994;84(1):89–97.

    PubMed  Google Scholar 

  37. Wright A, Rice S, Wells, S. Changing hospital practices to increase the duration of breastfeeding. Pediatrics 1996;97(5):669–675.

    PubMed  CAS  Google Scholar 

  38. Reifsnider E, Eckhart D, Prenatal breastfeeding education: Its effect on breastfeeding among WIC participants. J Human Lactation 1997;13(2):121–125.

    Article  CAS  Google Scholar 

  39. Caulfield LE, Gross SM, Bentley ME, Bronner Y, Kessler L, Jensen J, Weathers B, Paige, DM. WIC-based interventions to promote breastfeeding among African-American women in baltimore: Effects on breastfeeding initiation and continuation. J Human Lactation 1998;14(1):15–22.

    Article  CAS  Google Scholar 

  40. Schwartz JB, Popkin BM, Tognetti J, Zohoori, N. Does WIC participation improve breast-feeding practices? Am J Public Health 1995;85(5):729–731.

    PubMed  CAS  Google Scholar 

  41. Black RF, Blair JP, Jones VN, DuRant, RH. Infant feeding decisions among pregnant women from a WIC population in Georgia. J Am Dietet Assoc 1990;90:255–259.

    CAS  Google Scholar 

  42. Kistin N, Benton D, Rao S, Sullivan, M. Breast-feeding rates among Black urban low-income women: Effect of prenatal education. Pediatrics 1990;86(5):741–746.

    PubMed  CAS  Google Scholar 

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AKNOWLEDGMENTS

This research was supported by grants from the National Institute of Child Health and Human Development (NICHD HD 36462) and the Center for Disease Control and prevention (CDC/ATPM TS-0626 and TS-561 and CDC/ATPM TS-286 14/14). The authors would like to thank three anonymous reviewers and the editors for their constructive comments. The authors also thank Tina Riley, Shafi Rahman, and the team of interviewers for their contributions to this research. The contents of this paper are solely the responsibility of the authors and do not represent the official views of the NICHD/NIH or the CDC.

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Authors and Affiliations

  1. Public Policy Institute of California, San Francisco, California, USA

    Helen J. Lee PhD, MA

  2. Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

    Margarita R. Rubio MA, Kelly F. McCollum MPH & Jennifer F. Culhane PhD, MPH

  3. Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Irma T. Elo PhD, MPA

  4. Department of General Pediatrics, A.I. duPont Hospital for Children and Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA

    Esther K. Chung MD, MPH

  5. Public Policy Institute of California, 500 Washington Street, Suite 800, San Francisco, CA, 94111, USA

    Helen J. Lee PhD, MA

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  1. Helen J. Lee PhD, MA
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  2. Margarita R. Rubio MA
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Correspondence to Helen J. Lee PhD, MA.

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Lee, H.J., Rubio, M.R., Elo, I.T. et al. Factors Associated with Intention to Breastfeed Among Low-Income, Inner-City Pregnant Women. Matern Child Health J 9, 253–261 (2005). https://doi.org/10.1007/s10995-005-0008-5

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