Location: Obesity and Metabolism Research Unit
Title: BARRIERS TO COMPLIANCE WITH INFANT-FEEDING RECOMMENDATIONS AMONG LOW-INCOME WOMEN Authors
|Heinig, M - UC DAVIS LACTATION CENTER|
|Ishii, Kara - UC DAVIS LACTATION CENTER|
|Kavanagh-Prochaska, Katherine - UC DAVIS LACTATION CENTER|
|Cohen, Roberta - UC DAVIS LACTATION CENTER|
|Panchula, Jeanette - WIC, SOLANO CTY. HEALTH|
Submitted to: Journal of Human Lactation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: September 9, 2005
Publication Date: January 1, 2006
Repository URL: http://jhl.sagepub.com/content/22/1/27.full.pdf+html
Citation: Heinig, M.J., Follett, J.R., Ishii, K.D., Kavanagh-Prochaska, K., Cohen, R., Panchula, J. 2006. Barriers to compliance with infant-feeding recommendations among low-income women. Journal of Human Lactation. 22(1):27-38, 2006. Interpretive Summary: Targeted education interventions are needed to combat inappropriate infant-feeding behaviors. These efforts should acknowledge the circumstances faced by families of newborn infants and provide specific tools to address participants’ concerns about infant crying and sleeping and their fears that their child is not getting enough to eat. Parents are frequently counseled to look for developmental milestones when determining their infants’readiness for solid foods. However, overemphasis of these often subjective milestones may result in parents starting solid foods too early, particularly among families who view their children as precocious and thus ready for foods earlier than is recommended.Educational efforts should include more information about the importance of introducing complementary foods for the nutritional status of infants, not merely as accompaniment with their motor development. Given the differing attitudes about health care providers’ advice between the English-speaking and Spanish-speaking groups, culturally sensitive approaches must be used, with particular attention paid to how infantfeeding messages are received. For both English-speaking and Spanish-speaking families, it is important that health care providers understand the cues that their patients use to identify hunger in their infants so that they may educate parents about normal infant behavior and provide guidance that is seen as relevant. It is also important that mothers be educated to understand that inappropriate feeding behaviors do not necessarily lead to permanent change and that it is possible for mothers to return to optimal feeding despite the actions of others.
Technical Abstract: Early infant nutrition plays a vital role in the health of a person throughout life. In recognition of this knowledge, the Supplementary Nutrition Program for Women, Infants and Children (WIC) was established in the United States to ensure that low-income women, infants, and children with nutritional risks have access to nutritious foods, nutrition education, links to medical care, and community services. WIC staff members provide extensive counseling and education regarding infant feeding. They are particularly challenged in their efforts because formula feeding, excessive use of juices and sugary drinks, and early introduction of solid foods are common in this population.1 Unchecked, these practices may increase the incidence of a number of serious health concerns such as allergy, dental caries, and obesity among infants and young children.2-5 Understanding the determinants of nonoptimal feeding behaviors is thus essential for the development of targeted interventions to improve infant-feeding practices in this population. The theory of planned behavior (TPB) has been used in several surveys of breastfeeding intentions and practices among pregnant and postpartum women. The TPB is based on the construct that most behaviors of social relevance are under volitional control; specifically,the behavioral intention, or intention to perform the behavior, is considered the most important and immediate determinant of a behavior. According to the TPB, behavioral intention is a direct function of (1) attitudes toward the behavior, (2) subjective norms toward performing the behavior, and (3) perceived behavioral control. The goal of this study was to better understand why nonoptimal infant-feeding practices occur among low-income women despite extensive education and counseling provided by WIC agencies. The specific aim of this project was to convene focus groups among culturally diverseWIC participants to identify specific factors that affect infant-feeding intentions and behavior in the first 6 months postpartum, so that interventions can be developed that increase optimal infant-feeding behaviors. Focus groups were used to examine relationships among maternal beliefs, feeding intentions, and infant-feeding behaviors among 65 Women, Infants and Children–eligible (28 English-speaking and 37 Spanish-speaking) mothers. Participants shared common beliefs that breastfeeding was beneficial; nevertheless, many believed that early introduction of formula and solid foods was unavoidable in certain situations. Medical providers andWomen, Infants and Children staff were sources of infant-feeding information, and the Spanish-speaking mothers attempted to adhere to the guidance. However, the English-speaking mothers often ignored this advice if it was not perceived as working for the family’s circumstances. Mothers, believing that providers would not understand that they were compelled to reject infant-feeding recommendations, would not ask for assistance when facing difficulties. Instead, mothers relied on relatives and others for infant-feeding guidance. Educational efforts should acknowledge mothers’ true circumstances, target support to each situation, and emphasize the health value of complementary foods rather than their association with infant motor development. Interventions are needed to provide parents with specific tools that they may use to cope with infant behavior despite stressful circumstances. The availability of these tools and a better understanding of the compelling reasons to follow infant-feeding guidelines may reduce the acceptance of inappropriate feeding behaviors in this vulnerable population.