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

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Original Research

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

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

References

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Data Analyses

Completed surveys were entered into a computerized database using SPSS/PC (SPSS/PC+, SPSS Inc., Chicago, Ill, 1990) and Epi Info (Epi Info version 5.01, Centers for Disease Control, Epidemiology Program Office, Atlanta, Ga, 1990). We used cross-tabulations and contingency table analyses to examine potential predictors of, as well as barriers to, breastfeeding. Independent variables included subject demographics, reproductive history, previous experiences with breastfeeding, and responses to attitudinal items on breastfeeding. We used odds ratios as one measure of association to assess the relationship between selected independent variables and anticipated infant breastfeeding practices. Ninety-five percent confidence intervals for the odds ratio provided an indication of both the precision and significance of these point estimates of risk. We used multiple logistic regression to calculate adjusted odds ratios and confidence intervals. Selected demographic, historical, and attitudinal variables found to be associated with breastfeeding through univariate analyses (P <.10) were entered into the logistic model.

Respondents were stratified into 2 groups on the basis of their responses to survey items on anticipated infant feeding practices. Subjects who reported plans to either exclusively breastfeed or plans to use any combination of breastfeeding and bottle-feeding were classified as the “breastfeed” group, while respondents planning to only bottle-feed their infants were classified as the “bottle-feed” group.

Results

Our results are based on interviews completed with 66 postpartum patients. The majority of participants were African American (95%) and single (95%), with a median age of 24 years. They completed a median of 12 years of schooling, had a median of 3 pregnancies, and a median 2 previous births. Selected demographic and reproductive characteristics are presented in Table 1.

Only 3 participants (4.5%) indicated that they planned to breastfeed exclusively, while an additional 11 (16.7%) noted plans to use a combination of bottle-feeding and breastfeeding. Breastfeeding plans were not found to be associated with maternal demographics features or with reproductive characteristics. A history of breastfeeding was reported by 28% of those planning to breastfeed their new infant, compared with 8% of those planning to bottle-feed; however, this difference failed to achieve significance (odds ratio [OR]=4.80; 95% confidence interval [CI], 0.74-29.7).

Analyses of attitudes about infant feeding are summarized in Table 2. Women planning to breastfeed their infants were more likely to agree that breastfeeding helped reduce their own weight after pregnancy and that they were encouraged to breastfeed by the baby’s father and by their mothers. Respondents planning to bottle-feed reported that breastfeeding was too complicated.

Multiple logistic regression yielded a model that accounted for 50% of the variance in anticipated breastfeeding practice. The adjusted model identified significant odds ratios for the association between low levels of maternal education and anticipated breastfeeding (OR=0.13; 95% CI, 0.05-0.35) and for encouragement from the baby’s father or the participant’s mother to breastfeed and anticipated breastfeeding (OR=12.4; 95% CI, 4.92-31.4). This logistic model also correctly classified 86.5% of the respondents, including 46% of the breastfeed group and 100% of the bottle-feed group. (Univariate odds ratios for these independent variables were 0.18 (0.02-0.95) for limited education and 8.60 (1.71-43.7) for encouragement.)

Discussion

The benefits of infant breastfeeding-including improved maternal-infant bonding, nutritional completeness and enhanced immunologic effects-are well documented and result in decreased infant morbidity during the first year of life.^2,3 This study contributes valuable data on anticipated infant feeding practices among predominantly African American patients from a low-income, urban community. While the goal of Healthy People 2000 is to attain a level of 75% of mothers who breastfeed in the immediate postpartum period, only 21% of study subjects indicated plans to breastfeed their infants. It should be noted that this figure likely represents an overestimate of actual infant feeding practices, since only 3 subjects (4.5%) reported plans to exclusively breastfeed their infants. Moreover, respondents planning to breastfeed noted intentions to nurse their infants for periods ranging from 4 to 52 weeks (median = 8 weeks) and for 30% to 100% of all feedings (median = 75% of feedings). The plans described by these mothers suggest a weak commitment to breastfeeding. For breastfeeding to be successful in the immediate postpartum period it is important that breast milk be the exclusive nutritional source. In addition, the plans for the limited duration of breastfeeding lag behind the public health goal to maintain a level of 50% breastfeeding at 6 months of age.

This study examined anticipated feeding, rather than actual feeding practices, to allow for data collection without the need for further follow-up after delivery. Previous research suggests that intention to breastfeed is related to both initiation^8,9 and duration¹⁰ of breastfeeding. Because, in part, of the limited numbers of study subjects planning to breastfeed their infants (n=14), many of our comparisons failed to achieve statistical significance. Using the chi-square test of independence, the observed sample sizes, and a 2-sided test with a level of significance of 5%, there was approximately 80% power to detect absolute differences of 30% to 35% in the self-reported infant feeding plans by demographic group or attitudinal response. This study design might be replicated among a larger number of postpartum patients at other family medicine centers.