Breastfeeding knowledge, attitudes, and behaviors among low-income African-American and West Indian women

abstract

statement of problem:

Although low-income African-American women have consistently been shown to have some of the lowest breastfeeding rates in the US, few studies have specifically investigated the knowledge, attitudes and behaviors regarding breastfeeding (BKAB) of this group of women. Furthermore, most previous studies have grouped African-American women with those of West Indian descent, assuming that these two groups are culturally similar, although limited evidence shows that there are differences. The purpose of this paper will be to examine the BKAB of low-income West Indian women as compared to those of low-income African-American women.

Methods:

Participants and Procedures: Study participants consisted of 25 African-American and 25 West Indian low-income pregnant women at a community hospital and community health center in a small city north of New York City. Participants were recruited in the waiting room of these facilities prior to either their prenatal care appointments or their WIC appointments and were given a short anonymous questionnaire to complete.

Measures: A questionnaire inquiring about breastfeeding knowledge, attitudes, and behaviors as well as demographic characteristics and past experience of and exposure to breastfeeding was developed. Particular effort was made to include attitudes and barriers to breastfeeding previously reported in the literature.

Results/Conclusion:

Preliminary findings indicate that the BKAB of the West Indian participants differ from those of the African-American participants. This study is expected to highlight the need for future studies to consider cultural differences that may exist and influence attitudes and behaviors among different population subgroups.

(student session two-page summary)

Introduction:

Breastfeeding is the preferred infant feeding method recommended by the World Health Organization, the American Academy of Pediatrics, and the American Dietetic Association, as it provides a variety of medical, economic, and environmental benefits that can be enjoyed not only by infants and mothers but also by society (Gibson-Davis & Brooks-Gunn, 2006; ADA, 2001). Some of the benefits that breastfeeding provides to infants include protection against infection (Labbok, Clark, & Goldman, 2004), a reduced risk of post-neonatal mortality (Gartner & Eidelman, 2005), improved cognitive development (Mettner, 2006; Labbok et. al, 2004), as well as possible protection against sudden-infant death syndrome, diabetes, asthma, and obesity (Gartner & Eidelman, 2005; CDC, 2006). The benefits which breastfeeding can provide for a mother include a reduced risk of postpartum bleeding and improved postpartum bone re-mineralization (Fooladi, 2001; Condon, 2005). In addition, these positive health outcomes that result from breastfeeding translate into reduced health care spending for society (CDC, 2006). An increasing awareness of these benefits has made breastfeeding promotion a national health priority in the U.S., however, despite these efforts there are still many women who are choosing not to breastfeed their infants.

Statement of problem:

Low-income African-American women have consistently been shown to have some of the lowest breastfeeding rates in the US. Statistics show that only 45% of African-American women breastfeed, often discontinuing a few days after birth (Bentley, Dee, & Jensen, 2003). Although less than optimal breastfeeding rates among any population is an issue requiring attention, the low rates of breastfeeding seen within the low-income African-American community are particularly concerning because of the high rates of morbidity and mortality experienced by mothers and infants within this community. Maternal and infant mortality rates are much higher among the African American population as compared to non-Hispanic whites, as well as rates of sudden infant death syndrome and respiratory illness (Meyerink & Marquis, 2002; Forste, Weiss, & Lippincott, 2001). Breastfeeding has been shown to prevent or significantly reduce these adverse health outcomes, underlining the importance of improving breastfeeding rates within this community (Meyerink & Marquis, 2002; Forste et. al, 2001) In addition, high rates of pre-mature birth and low birth weight are also seen among African-American infants (Reagan & Salsberry, 2005) and the health promoting effects of breastfeeding have been found to be especially beneficial to infants born with these conditions (Schanler, 2001; Smith, Kuhn, Durkin, Hinton, & Bellinger, 2003).

Studies that have investigated breastfeeding among low-income African-American women have concluded socio-cultural factors such as early introduction of solid foods (Corbett, 2000), the breastfeeding opinions and experiences of kin (Corbett, 2000; Bentley et. al, 2003), and the impact of poverty (Cricco-Lizza, 2004; Bentley et. al, 2003) contribute to the low rates of breastfeeding seen among this population. However, few of these studies have specifically investigated the knowledge, attitudes and behaviors regarding breastfeeding (BKAB) of this group of women. Furthermore, most previous studies that have investigated breastfeeding among low-income African-American women have grouped these women along with women of West Indian descent, assuming that these two groups are culturally similar, although limited evidence has shown that there are differences. However, investigation into the cultural differences that may exist in the BKAB of these two groups may be important to know when developing breastfeeding promotion efforts targeted at these populations. The purpose of this paper is to examine the BKAB of low-income West Indian women as compared to those of low-income African-American women

Methods:

Participants and Procedures: Study participants consisted of 25 African-American and 25 West Indian low-income pregnant women at a community hospital and community health center in a small city north of New York City. Participants were recruited in the waiting room of these facilities prior to either their WIC or prenatal care appointments and were given a short anonymous questionnaire to complete. Criteria for participation in this study included 1) currently pregnant women 2) eighteen years of age or older and 3) self-identifying as either of African-American or West Indian descent. Data collection occurred during the months of December 2006 and January 2007. Approval for this study was obtained from the Institutional Review Board at New York Medical College.

Measures: A questionnaire inquiring about breastfeeding knowledge, attitudes, and behaviors as well as demographic characteristics and past experience of and exposure to breastfeeding was developed. Particular effort was made to include attitudes and barriers to breastfeeding previously reported in the literature. The questionnaire consisted of a total of 41 questions, the majority of which were adapted from questionnaires available in published studies that examined breastfeeding. Those questions that were not adapted from the literature were developed by the student author and carefully reviewed by her advisor.

Results/Conclusion:

Preliminary findings indicate that the BKAB of the West Indian participants differ from those of the African-American participants. This study is expected to highlight the need for future studies to consider cultural differences that may exist and influence attitudes and behaviors among different population subgroups