Low income women: How they do, or do not, sustain breastfeeding

Rates of breastfeeding (BF) initiation among low income women while historically low are slowing increasing. Duration and exclusivity rates are not experiencing similar increases. Understanding the experiences of these women provides guidance to programs, funders and policy makers.

A longitudinal qualitative study of 13 low income low risk BF mothers (singleton term births), included interviews prenatally and post partum (two weeks, three and six months (39 interviews total)). Participants were mostly primiparous, ages 18-33 and nearly all planned to BF for a year. A social ecological model provided the analytic framework.

Participants were highly motivated to BF and knowledgeable about the benefits. Less universally known: time involved in breastfeeding and how to pump/store breastmilk. All returned to work/school; several had done less anticipatory planning for childcare.

All initiated BF and most continued any BF until at least 12 weeks (most not exclusive). At the inter-personal level, social support from family varied with several living under very difficult circumstances with unreliable support systems. Community level barriers were universal, regardless of interpersonal circumstances. These included returning to work/school without reliable, affordable childcare; lack of reliable breast-pumps; inadequate access to lactation professionals after discharge; and lack of public transportation.

Individual support to overcome inter/intra personal barriers is necessary but not sufficient to sustain BF even among motivated low income women. Policies are warranted to make reliable breast pumps available to all nursing mothers; work place policies that support BF mothers; safe, affordable childcare; and maternity leave.