Predictors of Anticipated Breastfeeding in an Urban, Low-Income Setting

,

Original Research

Predictors of Anticipated Breastfeeding in an Urban, Low-Income Setting

J Fam Pract. 2000 June;49(6):529-533

By

Martin C. Mahoney, MD, PhD

References

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BACKGROUND: Although the proportion of women who breastfeed is known to vary by demographic group, breastfeeding practices have not been sufficiently studied among urban, lower income African American populations seen in family medicine centers.

METHODS: A cross-sectional design was used to examine demographic, clinical, and attitudinal factors that affect anticipated infant feeding practices reported by postpartum women from a low-income, urban family practice setting. Data was analyzed using chi-square, odds ratios (OR), and multiple logistic regression techniques.

RESULTS: Among 66 respondents, only 3 subjects (4.5%) indicated that they planned to breastfeed exclusively, while an additional 11 subjects (16.7%) reported plans to use a combination of bottle-feeding and breastfeeding. Based on univariate analyses, women with less than 12 years of education were less likely to report anticipated breastfeeding. Otherwise, breastfeeding plans were not associated with subject demographic features or with reproductive characteristics. Respondents planning to bottle-feed noted that breastfeeding was too complicated. Logistic regression demonstrated an inverse relationship between level of maternal education and anticipated breastfeeding (OR=0.13, 95% confidence interval [CI], 0.05-0.35), and a direct association for encouragement from the baby’s father or the woman’s mother to breastfeed and anticipated breastfeeding (OR=12.4; 95% CI, 4.92-31.4).

CONCLUSIONS: This study reports unique data regarding anticipated infant feeding practices among patients from an urban, low-income community served by a family medicine center. Findings from this study will be used to develop a family-centered educational intervention involving the mothers, grandmothers, and partners of pregnant patients to promote the benefits of breastfeeding in this community.

Healthy People 2000, a national agenda for attention to health promotion and disease-prevention activities, has established a target that 75% of mothers will breastfeed at the time of their postpartum hospital discharge and 50% will continue to breastfeed through 6 months.¹ Breastfeeding offers several advantages, including the provision of a convenient balanced nutritional source, promotion of bonding between mother and infant, and conferral of an immunologic advantage because breastfed infants are less prone to respiratory and enteric infections.^2,3 Breastfeeding has also been reported to contribute to infant cognitive development and to decrease the risk of chronic diseases during childhood.⁴ Despite these documented benefits, the proportion of women who currently breastfeed their newborns remains suboptimal at 50%.¹

Breastfeeding practices vary by ethnicity, education, socioeconomic status, and maternal age.^5,6 The lowest rates are observed among young and undereducated mothers, as well as among African American mothers.^6,7 Among low-income groups, breastfeeding is initiated by approximately one third of mothers and is continued for 6 months by only 9%.⁷ Since low-income, minority populations commonly experience a higher prevalence of various infant health problems, breastfeeding seems especially important in benefiting infants from these communities.

Factors that influence breastfeeding have not been sufficiently studied among urban, low-income populations seen in family medicine centers. In an attempt to expand our knowledge of infant feeding practices among indigent populations, this research explored correlates of planned breastfeeding among postpartum women in a low-income, urban family practice setting.

Methods

This research project used a structured survey instrument to assess anticipated infant feeding practices among newly postpartum women from an urban family medicine site. This cross-sectional study was approved by the hospital Institutional Review Board. Informed consent was obtained from all participants.

Study Population

This study was completed among patients from an academic family medicine training site in Upstate New York. This facility-the Family Medicine Center (FMC), a community-based residency practice located in an urbanized area-offers a variety of medical services, including provision of comprehensive and longitudinal ambulatory family medical care. The FMC is situated in a health professional shortage area; a significant proportion of patients seen at the facility can be represented as economically disadvantaged and minority (eg, African American).

Study participants included postpartum women from the FMC who gave birth between January 1996 and June 1997. There were no restrictions based on race or age. Nearly 84% (67/80) of all eligible postpartum patients were invited to participate. No systematic patterns were identified among the subset of postpartum women (n=13) who did not receive survey forms, and no systematic bias was identified among the postpartum women not interviewed. Surveys were completed for 98.5% (66/67) of the patients asked to participate. Interviews were conducted while subjects were postpartum in-patients at an affiliated tertiary care hospital where patients from the FMC are routinely admitted for deliveries.

Survey Instrument

Using a structured survey instrument, we obtained data on demographics, relevant clinical history, and past infant feeding practices, as well as several items relating to current infant feeding plans and attitudes. Survey responses were based on both a medical chart review and an interview administered to subjects by trained individuals.