Just in Case: A Qualitative Study of Requests for Hospital Formula Among Low-Income Women

While hospital policies and medical issues are important factors in determining exclusive breastfeeding (EBF) rates, medically unnecessary supplementation of infants is likely to be due, in part, to maternal request for formula. The goal of this project was to gain an understanding of the facilitating factors and decision making processes surrounding maternal request for formula in the early postpartum period. A series of 14 focus groups were conducted among 97 English and Spanish-speaking low-income participants in the Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers were asked to share their infant-feeding experiences in the hospital. Separate questions were asked about mothers' decision to take formula home. Sessions were recorded, transcribed, and coded independently by 3 members of the research team. Facilitating factors for in-hospital feeding of formula differed from those leading to mothers' requests for formula to take home. Common themes related to in-hospital feeding of formula included “lack of preparation,” “breastfeeding is hard work,” and concerns about infant behavior. Mothers who requested formula to take home nearly universally cited that they needed the formula “just in case” something went wrong with breastfeeding. This powerful theme was present even among groups with high rates of EBF. Interventions to promote in-hospital exclusive breastfeeding must address mothers' real and perceived barriers, specifically addressing mothers' fears related to breastfeeding challenges and infant hunger.