Skip to main content
Erschienen in: Maternal and Child Health Journal 3/2008

01.05.2008

Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach

verfasst von: Kori B. Flower, Michael Willoughby, R. Jean Cadigan, Eliana M. Perrin, Greg Randolph, The Family Life Project Investigative Team

Erschienen in: Maternal and Child Health Journal | Ausgabe 3/2008

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat American Academy of Pediatrics Section on Breastfeeding. (2005). Breastfeeding and the use of human milk. Pediatrics, 115, 496–506.CrossRef American Academy of Pediatrics Section on Breastfeeding. (2005). Breastfeeding and the use of human milk. Pediatrics, 115, 496–506.CrossRef
2.
Zurück zum Zitat Li, R., Darling, N., Maurice, E., Barker, L., & Grummer-Strawn, L. M. (2005). Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 National Immunization Survey. Pediatrics, 115, e31–e37.PubMedCrossRef Li, R., Darling, N., Maurice, E., Barker, L., & Grummer-Strawn, L. M. (2005). Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 National Immunization Survey. Pediatrics, 115, e31–e37.PubMedCrossRef
3.
Zurück zum Zitat US Department of Health, Human Services. (2000). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: US Government Printing Office. US Department of Health, Human Services. (2000). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: US Government Printing Office.
4.
Zurück zum Zitat US Department of Health, Human Services. (2000). HHS Blueprint for action on breastfeeding. Washington, D.C.: US Government Printing Office. US Department of Health, Human Services. (2000). HHS Blueprint for action on breastfeeding. Washington, D.C.: US Government Printing Office.
5.
Zurück zum Zitat Li, R., Ogden, C., Ballew, C., Gillespie, C., & Grummer-Strawn, L. (2002). Prevalence of exclusive breastfeeding among US infants: The Third National Health and Nutrition Examination Survey (Phase II, 1991–1994). American Journal of Public Health, 92, 1107–1110.PubMed Li, R., Ogden, C., Ballew, C., Gillespie, C., & Grummer-Strawn, L. (2002). Prevalence of exclusive breastfeeding among US infants: The Third National Health and Nutrition Examination Survey (Phase II, 1991–1994). American Journal of Public Health, 92, 1107–1110.PubMed
6.
Zurück zum Zitat Chandra, A., Martinez, G. M., Mosher, W. D., Abma, J. C., & Jones, J. (2005). Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat Series, 23(25), 1–160. Chandra, A., Martinez, G. M., Mosher, W. D., Abma, J. C., & Jones, J. (2005). Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat Series, 23(25), 1–160.
7.
Zurück zum Zitat Gaston, M. H. (2001). 100% access and 0 health disparities: changing the health paradigm for rural women in the 21st century. Women’s Health Issues, 11, 7–16.CrossRef Gaston, M. H. (2001). 100% access and 0 health disparities: changing the health paradigm for rural women in the 21st century. Women’s Health Issues, 11, 7–16.CrossRef
8.
Zurück zum Zitat Chatterji, P., & Brooks-Gunn, J. (2004). WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers. American Journal of Public Health, 94, 1324–1327.PubMed Chatterji, P., & Brooks-Gunn, J. (2004). WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers. American Journal of Public Health, 94, 1324–1327.PubMed
9.
Zurück zum Zitat Kurinij, N., Shiono, P. H., Ezrine, S. F., & Rhoads, G. G. (1989). Does maternal employment affect breast-feeding? American Journal of Public Health, 79, 1247–1250.PubMed Kurinij, N., Shiono, P. H., Ezrine, S. F., & Rhoads, G. G. (1989). Does maternal employment affect breast-feeding? American Journal of Public Health, 79, 1247–1250.PubMed
10.
Zurück zum Zitat Kuan, L. W., Britto, M., Decolongon, J., Schoettker, P. J., Atherton, H. D., & Kotagal, U. R. (1999). Health system factors contributing to breastfeeding success. Pediatrics, 104, e28.PubMedCrossRef Kuan, L. W., Britto, M., Decolongon, J., Schoettker, P. J., Atherton, H. D., & Kotagal, U. R. (1999). Health system factors contributing to breastfeeding success. Pediatrics, 104, e28.PubMedCrossRef
11.
Zurück zum Zitat Ertem, I. O., Votto, N., & Leventhal, J. M. (2001). The timing and predictors of the early termination of breastfeeding. Pediatrics, 107, 543–548.PubMedCrossRef Ertem, I. O., Votto, N., & Leventhal, J. M. (2001). The timing and predictors of the early termination of breastfeeding. Pediatrics, 107, 543–548.PubMedCrossRef
12.
Zurück zum Zitat Taveras, E. M., Capra, A. M., Braveman, P. A., Jensvold, N. G., Escobar, G. J., & Lieu, T. A. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112, 108–115.PubMedCrossRef Taveras, E. M., Capra, A. M., Braveman, P. A., Jensvold, N. G., Escobar, G. J., & Lieu, T. A. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112, 108–115.PubMedCrossRef
13.
Zurück zum Zitat Taveras, E. M., Li, R., Grummer-Strawn, L., et al. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics, 113, e283–e290.PubMedCrossRef Taveras, E. M., Li, R., Grummer-Strawn, L., et al. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics, 113, e283–e290.PubMedCrossRef
14.
Zurück zum Zitat Clark, S. J., Savitz, L. A., & Randolph, R. K. (2001). Rural children’s health. Western Journal of Medicine, 178, 142–147. Clark, S. J., Savitz, L. A., & Randolph, R. K. (2001). Rural children’s health. Western Journal of Medicine, 178, 142–147.
15.
Zurück zum Zitat Bentley, M. E., Dee, D. L., & Jensen, J. L. (2003). Breastfeeding among low income, African-American women: Power, beliefs and decision making. Journal of Nutrition, 133, 305S–309.PubMed Bentley, M. E., Dee, D. L., & Jensen, J. L. (2003). Breastfeeding among low income, African-American women: Power, beliefs and decision making. Journal of Nutrition, 133, 305S–309.PubMed
16.
Zurück zum Zitat Phares, T. M., Morrow, B., Lansky, A., Barfield, W. D., Prince, C. B., Marchi, K. S., Braveman, P. A., Williams, L. M., & Kinneburgh, B. (2004). Surveillance for disparities in maternal health-related behaviors-Selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001. In: Surveillance Summaries, July 2, 2004, MMWR, 53(No.SS-4), 1–13. Phares, T. M., Morrow, B., Lansky, A., Barfield, W. D., Prince, C. B., Marchi, K. S., Braveman, P. A., Williams, L. M., & Kinneburgh, B. (2004). Surveillance for disparities in maternal health-related behaviors-Selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001. In: Surveillance Summaries, July 2, 2004, MMWR, 53(No.SS-4), 1–13.
17.
Zurück zum Zitat Ponza, M., Devaney, B., Ziegler, P., Reidy, K., & Squatrito, C. (2004). Nutrient intakes and food choices of infants and toddlers participating in WIC. Journal of American Diet Association, 104, S71–S79.CrossRef Ponza, M., Devaney, B., Ziegler, P., Reidy, K., & Squatrito, C. (2004). Nutrient intakes and food choices of infants and toddlers participating in WIC. Journal of American Diet Association, 104, S71–S79.CrossRef
18.
Zurück zum Zitat Ryan, A. S. (1997). The resurgence of breastfeeding in the United States. Pediatrics, 99, e12.PubMedCrossRef Ryan, A. S. (1997). The resurgence of breastfeeding in the United States. Pediatrics, 99, e12.PubMedCrossRef
19.
Zurück zum Zitat Hilson, J., Rasmussen, K., & Kjolhede, C. (1997). Maternal obesity and breast-feeding success in a rural population of white women. American Journal of Nutrition, 66, 1371–1378. Hilson, J., Rasmussen, K., & Kjolhede, C. (1997). Maternal obesity and breast-feeding success in a rural population of white women. American Journal of Nutrition, 66, 1371–1378.
20.
Zurück zum Zitat Hall, R. T., Mercer, A. M., & Teasley, S. L., et al. (2002). A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age. The Journal of Pediatrics, 141, 659–664.PubMedCrossRef Hall, R. T., Mercer, A. M., & Teasley, S. L., et al. (2002). A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age. The Journal of Pediatrics, 141, 659–664.PubMedCrossRef
21.
Zurück zum Zitat Killersreiter, B., Grimmer, I., Buhrer, C., Dudenhausen, J. W., & Obladen, M. (2001). Early cessation of breast milk feeding in very low birthweight infants. Early Human Development, 60, 193–205.PubMedCrossRef Killersreiter, B., Grimmer, I., Buhrer, C., Dudenhausen, J. W., & Obladen, M. (2001). Early cessation of breast milk feeding in very low birthweight infants. Early Human Development, 60, 193–205.PubMedCrossRef
22.
Zurück zum Zitat Merewood, A., Brooks, D., Bauchner, H., MacAuley, L., & Mehta, S. D. (2006). Maternal birthplace and breastfeeding initiation among term and preterm infants: A statewide assessment for Massachusetts. Pediatrics, 118, e1048–1054.PubMedCrossRef Merewood, A., Brooks, D., Bauchner, H., MacAuley, L., & Mehta, S. D. (2006). Maternal birthplace and breastfeeding initiation among term and preterm infants: A statewide assessment for Massachusetts. Pediatrics, 118, e1048–1054.PubMedCrossRef
23.
Zurück zum Zitat Kaufman, A. S., Kaufman, N. L. (1994). Kaufman Functional Academic Skills Test (K-FAST). Circle Pines, Minnesota: American Guidance Service. Kaufman, A. S., Kaufman, N. L. (1994). Kaufman Functional Academic Skills Test (K-FAST). Circle Pines, Minnesota: American Guidance Service.
24.
Zurück zum Zitat Krause, N., & Jay, G. (1994). What do global health items measure? Medical Care, 9, 930–942.CrossRef Krause, N., & Jay, G. (1994). What do global health items measure? Medical Care, 9, 930–942.CrossRef
25.
Zurück zum Zitat Reich, W., Todd, R., Joyner, C. A., Neuman, R. J., & Heath, A. C. (2003). Reliability and stability of mothers’ reports about their pregnancies with twins. Twin Research, 6, 85–88.PubMedCrossRef Reich, W., Todd, R., Joyner, C. A., Neuman, R. J., & Heath, A. C. (2003). Reliability and stability of mothers’ reports about their pregnancies with twins. Twin Research, 6, 85–88.PubMedCrossRef
26.
Zurück zum Zitat Runyan, D. K. (2001). Monitoring child health and well-being in large population surveys. In: Thornton A (Ed). Well-being of children and families: Research and data needs. Ann Arbor, Michigan: University of Michigan Press. Runyan, D. K. (2001). Monitoring child health and well-being in large population surveys. In: Thornton A (Ed). Well-being of children and families: Research and data needs. Ann Arbor, Michigan: University of Michigan Press.
27.
Zurück zum Zitat Research Triangle Institute. (2004). SUDAAN language manual. Release 9.0 ed. Research Triangle Park, NC: Research Triangle Institute. Research Triangle Institute. (2004). SUDAAN language manual. Release 9.0 ed. Research Triangle Park, NC: Research Triangle Institute.
28.
Zurück zum Zitat Binder, D. A. (1983). On the variances of asymptotically normal estimators from complex surveys. International Statistical Review, 51, 279–292.CrossRef Binder, D. A. (1983). On the variances of asymptotically normal estimators from complex surveys. International Statistical Review, 51, 279–292.CrossRef
29.
Zurück zum Zitat Ahluwalia, I. B., Morrow, B., & Hsia, J. (2005). Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics, 116, 1408–1412.PubMedCrossRef Ahluwalia, I. B., Morrow, B., & Hsia, J. (2005). Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics, 116, 1408–1412.PubMedCrossRef
30.
Zurück zum Zitat Ryan, A. S., & Zhou, W. (2006). Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978–2003. Pediatrics, 117, 1136–1146.PubMedCrossRef Ryan, A. S., & Zhou, W. (2006). Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978–2003. Pediatrics, 117, 1136–1146.PubMedCrossRef
31.
Zurück zum Zitat Schwartz, J. B., Popkin, B. M., Tognetti, J., & Zohoori, N. (1995). Does WIC participation improve breast-feeding practices? American Journal Public Health, 85, 729–731.CrossRef Schwartz, J. B., Popkin, B. M., Tognetti, J., & Zohoori, N. (1995). Does WIC participation improve breast-feeding practices? American Journal Public Health, 85, 729–731.CrossRef
32.
Zurück zum Zitat US Department of Agriculture Food, Nutrition Service. (1987). The National WIC evaluation: An evaluation of the special supplemental food program for women, infants and children, Volume 1: Summary. Alexandria, Virginia: US Department of Agriculture. US Department of Agriculture Food, Nutrition Service. (1987). The National WIC evaluation: An evaluation of the special supplemental food program for women, infants and children, Volume 1: Summary. Alexandria, Virginia: US Department of Agriculture.
33.
Zurück zum Zitat Tuttle, C. R. (2000). An open letter to the WIC program: The time has come to commit to breastfeeding. Journal of Human Lactation, 16, 99–103.PubMedCrossRef Tuttle, C. R. (2000). An open letter to the WIC program: The time has come to commit to breastfeeding. Journal of Human Lactation, 16, 99–103.PubMedCrossRef
34.
Zurück zum Zitat Committee to Review the WIC Food Package. (2005). WIC food packages: Time for a change. Washington, DC: Institute of Medicine. Committee to Review the WIC Food Package. (2005). WIC food packages: Time for a change. Washington, DC: Institute of Medicine.
35.
Zurück zum Zitat Ahluwalia, I. B., Tessaro, I., Grummer-Strawn, L. M., MacGowan, C., & Benton-Davis, S. (2000). Georgia’s breastfeeding promotion program for low-income women. Pediatrics, 105, e85.PubMedCrossRef Ahluwalia, I. B., Tessaro, I., Grummer-Strawn, L. M., MacGowan, C., & Benton-Davis, S. (2000). Georgia’s breastfeeding promotion program for low-income women. Pediatrics, 105, e85.PubMedCrossRef
36.
Zurück zum Zitat Hanson, M. B., Hellerstedt, W. L., Desvarieux, M., & Duval, S. J. (2003). Correlates of breast-feeding in a rural population. American Journal of Health Behavior, 27, 432–444.PubMed Hanson, M. B., Hellerstedt, W. L., Desvarieux, M., & Duval, S. J. (2003). Correlates of breast-feeding in a rural population. American Journal of Health Behavior, 27, 432–444.PubMed
37.
Zurück zum Zitat Visness, C., & Kennedy, K. (1997). Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey. American Journal of Public Health, 87, 945–950.PubMed Visness, C., & Kennedy, K. (1997). Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey. American Journal of Public Health, 87, 945–950.PubMed
38.
Zurück zum Zitat Gross, S. M., Caulfield, L. E., Bentley, M. E., et al. (1998). Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. Journal of American Diet Association, 98, 143–148.CrossRef Gross, S. M., Caulfield, L. E., Bentley, M. E., et al. (1998). Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. Journal of American Diet Association, 98, 143–148.CrossRef
39.
Zurück zum Zitat Ryan, A., & Martinez, G. (1989). Breast-feeding and the working mother: a profile. Pediatrics, 83, 524–531.PubMed Ryan, A., & Martinez, G. (1989). Breast-feeding and the working mother: a profile. Pediatrics, 83, 524–531.PubMed
40.
Zurück zum Zitat Gielen, A., Faden, R., O’Campo, P., Brown, C., & Paige, D. (1991). Maternal employment during the early postpartum period: effects on initiation and continuation of breast-feeding. Pediatrics, 87, 298–305.PubMed Gielen, A., Faden, R., O’Campo, P., Brown, C., & Paige, D. (1991). Maternal employment during the early postpartum period: effects on initiation and continuation of breast-feeding. Pediatrics, 87, 298–305.PubMed
41.
Zurück zum Zitat Kimbro, R. T. (2006). On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women. Maternal and Child Health Journal, 10, 19–26.PubMedCrossRef Kimbro, R. T. (2006). On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women. Maternal and Child Health Journal, 10, 19–26.PubMedCrossRef
42.
Zurück zum Zitat Mozingo, J. N., Davis, M. W., Droppleman, P. G., & Merideth, A. (2000). “It wasn’t working”: Women’s experiences with short-term breastfeeding”. American Journal of Maternal Child Nursing, 25, 120–126.PubMedCrossRef Mozingo, J. N., Davis, M. W., Droppleman, P. G., & Merideth, A. (2000). “It wasn’t working”: Women’s experiences with short-term breastfeeding”. American Journal of Maternal Child Nursing, 25, 120–126.PubMedCrossRef
43.
Zurück zum Zitat Raisler, J. (2000). Against the odds: breastfeeding experiences of low income mothers. Journal of Midwifery & Women’s Health, 45, 253–263.CrossRef Raisler, J. (2000). Against the odds: breastfeeding experiences of low income mothers. Journal of Midwifery & Women’s Health, 45, 253–263.CrossRef
44.
Zurück zum Zitat Shaw, E., & Kaczorowski, J. (1999). The effect of a peer counseling program on breastfeeding initiation and longevity in a low-income rural population. Journal of Human Lactation, 15, 19–25.PubMedCrossRef Shaw, E., & Kaczorowski, J. (1999). The effect of a peer counseling program on breastfeeding initiation and longevity in a low-income rural population. Journal of Human Lactation, 15, 19–25.PubMedCrossRef
Metadaten
Titel
Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach
verfasst von
Kori B. Flower
Michael Willoughby
R. Jean Cadigan
Eliana M. Perrin
Greg Randolph
The Family Life Project Investigative Team
Publikationsdatum
01.05.2008
Verlag
Springer US
Erschienen in
Maternal and Child Health Journal / Ausgabe 3/2008
Print ISSN: 1092-7875
Elektronische ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-007-0248-6

Weitere Artikel der Ausgabe 3/2008

Maternal and Child Health Journal 3/2008 Zur Ausgabe