Smoking and breastfeeding: Practices of low-income mothers

Low-income U.S mothers have high smoking and low breastfeeding rates. Smoking is most prevalent among non-Hispanic white and black mothers. Although breastfeeding's benefits for infants whose mothers smoke outweigh risks of tobacco exposure through breast milk, these mothers may believe that breastfeeding is unsafe. Maryland WIC's 2007 database provided information for 14687 non-Hispanic black and white mothers with household incomes below 180% of the poverty line who registered that year. Multinomial logistic regression assessed the likelihood of mothers who reported cigarette smoking registering as exclusively breastfeeding, partially breastfeeding, or formula feeding versus those who did not smoke. The analysis controlled for public assistance program participation and cesarean birth. Mothers who reported smoking were 5 times more likely to register as entirely formula feeding rather than exclusively breastfeeding (OR 5.03; CI 3.81, 6.66). There was no difference in smoking status between partially and exclusively breastfeeding women. Being African American and having a cesarean reduced the likelihood of exclusively breastfeeding, and increased the likelihood of partially breastfeeding and formula feeding. Participating in multiple public assistance programs had no effect on entirely formula feeding. Maryland WIC participants who reported smoking were more likely to formula feed, but no more likely to supplement breastfeeding with formula, potentially indicating a belief that smoking and breastfeeding are incompatible. Reducing smoking in this population must be addressed; however, these findings suggest that increasing knowledge of breastfeeding's safety and benefits among mothers who smoke is critical to public health efforts to increase breastfeeding rates.