In the latest issue of Pediatrics:
Clinician Support and Psychosocial Risk Factors Associated With Breastfeeding
Discontinuation
Elsie M. Taveras, MD, MPH*,||, Angela M. Capra, MA, Paula A. Braveman, MD,
MPH, Nancy G. Jensvold, MPH, Gabriel J. Escobar, MD and Tracy A. Lieu, MD, MPH||
* Harvard Pediatric Health Services Research Fellowship Program, Boston,
Massachusetts
Division of Research, Kaiser Permanente, Oakland, California
Department of Family and Community Medicine, University of California, San
Francisco, San Francisco, California
|| Center for Child Health Care Studies, Department of Ambulatory Care and
Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston,
Massachusetts
PEDIATRICS Vol. 112 No. 1 July 2003, pp. 108-115
Objective. Breastfeeding rates fall short of goals set in Healthy People 2010
and other national recommendations. The current, national breastfeeding
continuation rate of 29% at 6 months lags behind the Healthy People 2010 goal of
50%. The objective of this study was to evaluate associations between
breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support,
maternal physical and mental health status, workplace issues, and other factors
amenable to intervention.
Methods. A prospective cohort study was conducted of low-risk mothers and
infants who were in a health maintenance organization and enrolled in a
randomized, controlled trial of home visits. Mothers were interviewed in person at 1 to
2 days postpartum and by telephone at 2 and 12 weeks. Logistic regression
modeling was performed to assess the independent effects of the predictors of
interest, adjusting for sociodemographic and other confounding variables.
Results. Of the 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated
breastfeeding, 872 (75%) were breastfeeding at the 2-week interview, and 646
(55%) were breastfeeding at the 12-week interview. In the final multivariate
models, breastfeeding discontinuation at 2 weeks was associated with lack of
confidence in ability to breastfeed at the 1- to 2-day interview (odds ratio
[OR]: 2.8; 95% confidence interval [CI]: 1.02–7.6), early breastfeeding problems
(OR: 1.5; 95% CI: 1.1–1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1–5.7),
and lower maternal education (OR: 1.5; 95% CI: 1.2–1.9). Mothers were much
less likely to discontinue breastfeeding at 12 weeks postpartum if they reported
(during the 12-week interview) having received encouragement from their
clinician to breastfeed (OR: 0.6; 95% CI: 0.4–0.8). Breastfeeding discontinuation
at 12 weeks was also associated with demographic factors and maternal
depressive symptoms (OR: 1.18; 95% CI: 1.01–1.37) and returning to work or school by 12
weeks postpartum (OR: 2.4; 95% CI: 1.8–3.3). Conclusions. Our results
indicate that support from clinicians and maternal depressive symptoms are associated
with breastfeeding duration. Attention to these issues may help to promote
breastfeeding continuation among mothers who initiate. Policies to enhance
scheduling flexibility and privacy for breastfeeding mothers at work or school may
also be important, given the elevated risk of discontinuation associated with
return to work or school.
Key Words: breastfeeding • neonatal • health services • clinician support •
maternal depression
Abbreviations: KPMCP, Kaiser Permanente Medical Care Program • CES-D, Center
for Epidemiologic Studies Depression Scale • OR, odds ratio • CI, confidence
interval • HMO, health maintenance organization
Received for publication Apr 24, 2002; accepted Oct 23, 2002
Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services
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