226338 Reality or Ready Excuse? Why Mothers Don't Breastfeed

Monday, November 8, 2010 : 12:30 PM - 12:45 PM

Caitlin Cross-Barnet, PhD , Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Marycatherine Augustyn, PhD , Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Amy Resnik, MS, RD, CSP, LDN , Maryland WIC Program, Maryland State Department of Health and Mental Hygiene, Balitmore, MD
Susan Gross, PhD, MPH, RD , Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Joy P. Nanda, DSc, MS, MHS, MBA , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
David M. Paige, MD MPH , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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.

Learning Areas:
Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related education

Learning Objectives:
Describe a barrier to honest communication between mothers and health care providers. Explore mothers' stated and unstated reasons for their infant feeding choices. Identify research and planning issues for implementing public health policy surrounding infant feeding.

Keywords: Breastfeeding, Communication

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked as a researcher for the Maryland WIC Breastfeeding Peer Counselor Evaluation for three years. All of my research considers issues related to gender and poverty.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.