Reality or Ready Excuse? Why Mothers Don't Breastfeed

Introduction: Many mothers face pressure to breastfeed from health professionals. Maryland WIC promotes breastfeeding, employing Breastfeeding Peer Counselors (PCs) to provide education and support. However, many Maryland WIC participants don't initiate breastfeeding or breastfeed only briefly. Mothers may feel obligated to offer “acceptable” reasons for not breastfeeding, masking true barriers. Our qualitative study explored and analyzed the complexities of mothers' decisions. Design: Eight Breastfeeding PCs and a convenience sample of 81 WIC PC clients with infants were interviewed at 3 representative agencies. Mothers reported their infant feeding experiences and practices. PCs reported what mothers related and their own observations. Results: All mothers said breastfeeding was healthiest for the baby. Mothers who did not initiate breastfeeding or terminated early often gave multiple reasons including medication use, smoking, pain, inadequate milk, returning to work, and needing others to feed the baby. PCs reported that reasons did not always align with mothers' practices. Discussion: Mothers sometimes offered contradictory or implausible reasons for introduction of formula, such as needing to return to work when they were not working. Some reasons seemed to be “ready excuses” relaying socially acceptable justifications that did not reflect reality. Factors that mothers did not identify as barriers, such as family and community norms or hospital policies, appeared to influence feeding choices. Our results indicate that simply asking mothers why they did not breastfeed may not be sufficient for developing policy addressing barriers to breastfeeding. Research triangulation and interview probes may more effectively reveal information leading to effective health interventions.