Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women

Authors: Thomson, Jessica; TUSSING-HUMPHREYS, LISA - University Of Illinois; Goodman, Melissa; LANDRY, ALICIA - University Of Central Arkansas; OLENDER, SARAH - University Of Illinois

Submitted to: International Breastfeeding Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/18/2017
Publication Date: 4/8/2017
Publication URL: https://handle.nal.usda.gov/10113/5678132
Citation: Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H., Landry, A.S., Olender, S.E. 2017. Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women. International Breastfeeding Journal. 12:15. doi:10.1186/s13006-017-0108-y.

Interpretive Summary: Breastfeeding for both infant and maternal health benefits is well established and advocated for by many professional and public health organizations. Despite these known benefits, breastfeeding rates in the United States remain below the Healthy People 2020 objectives, particularly in Mississippi. This paper describes and compares breastfeeding outcomes of the Delta Healthy Sprouts participants during early and late pregnancy. Of specific interest was whether breastfeeding intent, knowledge, and beliefs changed from early to late pregnancy. Additionally, breastfeeding initiation and duration were compared between the two treatment arms and relationships between breastfeeding initiation and breastfeeding intent and beliefs were explored. Eighty-two pregnant women were enrolled in this project spanning three Lower Mississippi Delta counties. These women were randomly assigned to receive either standard treatment, Parents as Teachers curriculum, or intervention treatment, Parents as Teachers Enhanced curriculum which included additional diet and exercise information and lessons. Breastfeeding knowledge increased significantly from early to late pregnancy for both treatment arms. However, neither breastfeeding intent nor beliefs increased during this period for either treatment arm. Further, only 30% (standard treatment) and 50% (intervention) of participants initiated breastfeeding, and only one participant (intervention) breastfed for at least six months. These study findings indicate that increasing knowledge about and addressing barriers for breastfeeding were insufficient to empower rural, Southern, primarily African American women to initiate or continue breastfeeding their infants. Improving breastfeeding outcomes for all socioeconomic groups will require consistent, engaging, culturally relevant education that positively influences beliefs as well as social and environmental supports that make breastfeeding the more accepted, convenient, and economical choice for infant feeding.

Technical Abstract: Background: This paper describes and compares breastfeeding outcomes of the Delta Healthy Sprouts participants during gestational and postnatal periods. Of specific interest was whether breastfeeding intent, knowledge, and beliefs changed from early to late gestational period. Additionally, breastfeeding initiation and duration were compared between the two treatment arms and associations between breastfeeding initiation and breastfeeding intent and beliefs were explored. Methods: Eighty-two pregnant women were enrolled in this project spanning three Lower Mississippi Delta counties. Women were randomly assigned to either standard treatment (PAT) or intervention treatment (PATE). Generalized linear mixed models were used to test for significant treatment, time, and treatment by time effects on breastfeeding outcomes. Results: Breastfeeding knowledge scores increased significantly from baseline to late gestational period for both treatment arms, although no time by treatment effect was apparent. Conversely, significant effects were not found for time, treatment, or time by treatment for breastfeeding intent or beliefs. Only 30% of PAT and 50% of PATE participants initiated breastfeeding. Further, only one (PATE) participant breastfed her infant for at least 6 months. Breastfeeding intent and beliefs significantly predicted breastfeeding initiation. Conclusions: Our findings indicate that increasing knowledge about and addressing barriers for breastfeeding were insufficient to empower rural, Southern, primarily African American women to initiate or continue breastfeeding their infants. Improving breastfeeding outcomes for all socioeconomic groups will require consistent, engaging, culturally relevant education that positively influences beliefs as well as social and environmental supports that make breastfeeding the more accepted, convenient, and economical choice for infant feeding.