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Research shows that a doctor's advice to breastfeed, early return to work, and other factors influence continued breastfeeding

The Agency for Healthcare Research and Quality (AHRQ)
Research Activities Online Newsletter, October, 2003

The American Academy of Pediatrics recommends exclusive breastfeeding of infants for the first 6 months, continuing to 1 year or beyond. Despite this recommendation and the acknowledged benefits of breastfeeding, only about 29 percent of U.S. women are still breastfeeding their infants at 6 months, and black women are less likely to breastfeed than white women.

Two recent studies supported in part by the Agency for Healthcare Research and Quality examined factors influencing breastfeeding. The first study, jointly funded with the National Institute of Child Health and Human Development, demonstrates that women are more likely to continue breastfeeding their infants at 4 months if their clinicians encourage them to do so and if they don't return to work or school. The second study (HS09782) concludes that lower rates of breastfeeding advice from health care professionals do not account for lower rates of breastfeeding among black women. Both studies are discussed here.

Taveras, E.M., Capra, A.M., Braveman, P.A., and others (2003, July). "Clinician support and psychosocial risk factors associated with breastfeeding discontinuation." Pediatrics 112(1), pp. 108-115.

Clinician encouragement of breastfeeding, recognition and treatment of postpartum depression, and policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may increase the numbers of women who continue to breastfeed their infants, conclude these researchers. They prospectively studied mothers and infants enrolled in an HMO who were at low risk for health problems. The mothers and infants participated in a randomized controlled trial of postpartum home visits. They interviewed the mothers in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks postpartum to examine the association of sociodemographic and other factors with breastfeeding.

Of the 1,163 mother-newborn pairs in the group, 87 percent initiated breastfeeding, 75 percent were breastfeeding at the 2-week interview, but only 55 percent were breastfeeding at the 12 week interview. Women who lacked confidence in their ability to breastfeed at the initial interview were nearly three times as likely to discontinue breastfeeding at 2 weeks as more confident women. Early breastfeeding problems, Asian race/ethnicity, and lower education were also associated with discontinuation of breastfeeding at 2 weeks.

Nearly half (47 percent) of mothers had returned to work or school by the 12-week interview. These women were much more likely than other women to discontinue breastfeeding at 12 weeks postpartum, as were women who experienced problems breastfeeding or pumping their breast milk at work or school. The majority of problems reported among women who returned to work were restricted schedules and breaks (51 percent) and insufficient privacy (20 percent). Among women who returned to school, the absence of on-site child care (23 percent) was a problem. Women with postpartum depression at 2 weeks were also more likely to discontinue breastfeeding at 12 weeks. Mothers were 40 percent less likely to discontinue breastfeeding at 12 weeks postpartum if they were encouraged by their clinician to breastfeed.

Beal, A.C., Kuhlthau, K., and Perrin, J.M. (2003, July). "Breastfeeding advice given to African American and white women by physicians and WIC counselors." Public Health Reports 118, pp. 368-376.

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The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important supplemental nutrition program for low-income pregnant and nursing women and their children. Prenatal breastfeeding advice from WIC nutrition counselors and from nurses and doctors has been shown to increase breastfeeding rates. Although black women are less likely than white women to receive breastfeeding advice and more likely to receive advice on bottle feeding from WIC counselors, they are as likely as white women to receive breastfeeding advice from medical providers, according to this study. Thus, lower rates of breastfeeding advice do not fully account for lower rates of breastfeeding among black women.

Cultural factors, which could not be assessed in this study, likely account for much of the remaining difference, conclude the researchers. They used data from the 1988 National Maternal and Infant Health Survey, which identifies factors related to poor pregnancy outcomes. It is the only national survey collecting data on breastfeeding behaviors and prenatal breastfeeding advice. The researchers compared self-reported rates of medical provider and WIC advice to breastfeed among 3,966 white women and 4,791 black women with a live birth in 1988. Several factors known to be associated with less adequate health care and lower breastfeeding rates (lack of insurance, lower income, young maternal age, and less education) were more common among the black women.

Black women were much less likely than white women to report breastfeeding their infants (24 vs. 59 percent). After controlling for other sociodemographic factors, black women were as likely as white women to receive breastfeeding advice from doctors, midwives, and nurses. However, being black was the only factor associated with less breastfeeding advice and a greater likelihood of advice on bottle feeding from WIC nutrition counselors. Since these data were collected, WIC has begun several new initiatives to promote breastfeeding, note the researchers.

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