Breastfeeding attitudes and intentions in an innercity Northeastern

Breastfeeding attitudes and intentions in an inner-city Northeastern Philadelphia Community 1 Herrine Gail Laura Romcevich 2 3 Claudia Valeggia 1 Temple Abstract Study population promoting breastfeeding among a low-income population in NE Philadelphia by providing educational audiovisual material and establishing a breastfeeding club at a Women’s Center. In this cross-sectional, descriptive study, a convenience sample of pregnant and postpartum women attending the Women’s Care Practice at Northeastern (NE) Hospital was taken via recruitment by Dr. Gail Herrine to participate. Data collection of surveys and questionnaires began in the summer of 2007, and the study was completed, including interviews, by the end of the year. All data was collected at the Women’s Care Center at the time of each woman’s visit. Objective: The goal of this study was to describe breastfeeding attitudes and intentions and identify demographic and behavioral variables as predictors of these attitudes and intentions. Methods: In this cross-sectional, descriptive study we administered a survey and questionnaire to a convenience sample of 117 pregnant and 87 postpartum women. Additionally, we conducted in -depth interviews with 15 pregnant women and 3 of their partners. Quantitative data was analyzed using SPSS and interviews using Grounded Theory. Methods Results: No socio-demographic variables significantly impacted intention, nor did measures of heritage and acculturation indicate ties to intention, exposure, or attitude. Even though the survey showed 90% of women believed they would have their partner’s support, questionnaires demonstrated most women had a positive attitude toward breastfeeding, and the vast majority of interview participants knew that breastfeeding was generally healthy, the various barriers they cited trumped their knowledge, attitude, and perceived support. The main barriers cited were the woman’s fear of pain, inconvenience, and lack of time due to return to work or school. • A survey and a questionnaire were administered to n = 117 pregnant women in their last month of pregnancy (Prenatal) and to n = 87 of the women attending their 6 -week postpartum visit (Postpartum). • In-depth semi-structured interviews of 15 pregnant women and 3 of their partners were conducted following the questionnaires. • The data from the Prenatal survey provided information on basic demographics and intention to breastfeed, previous breastfeeding experience, and current breastfeeding support. • The data from the Postpartum survey provided information on prevalence of exclusive and semi-exclusive breastfeeding, support (or lack of it), and general experience with breastfeeding. Conclusions: In-depth analysis of the data demonstrated the malleability of women’s attitudes towards breastfeeding and the power of circumstance—regardless of previous attitude or behavior —and a need of controlling one’s body. • Introduction • • Despite the significant and undeniable health benefits for both mother and child, many women still make the decision not to breastfeed exclusively. In order to critically analyze this dilemma, the decision to breastfeed must be seen as a complex negotiation of the interests of at least three separate humans—the mother and the infant as well as the child’s father or the mother’s partner. This perspective can demonstrate that making the decision to breastfeed includes much more insight than just knowing how medically beneficial it is for the mother and child. This choice can be better understood according to the different social, economic, and cultural trade-offs with breastfeeding. Preliminary observations on infant feeding practices in the Northeastern region of Philadelphia indicated an extremely low prevalence of breastfeeding at the 6 -week postpartum visit (less than 5%). This discouraging finding prompted the foundation of Programa Lactar, a multidisciplinary, collaborative initiative aimed at promoting breastfeeding among families living in Northeastern Philadelphia. Objectives of Programa Lactar: 1. To gather qualitative and quantitative information for a better understanding of the biocultural determinants of infant feeding practices. 2. To promote breastfeeding education in this population. Educational support is provided through audiovisual material, breastfeeding clubs, nursing postgraduate education, and peer counseling. 3. To assess the challenges and support regarding the establishment of baby-friendly practices right after birth at the Hospital and at home during the early postpartum period. This study was aimed at addressing the first objective through the generation and analysis of baseline data that can be used to generate further research and action. Results The target population for this study consisted of Latina women and families from Colombia, Mexico, Puerto Rico, and some Central American countries living in Northeastern Philadelphia. Seventy-seven percent of our sample was of Puerto Rican origin. Background: This study is part of a long-term project, Programa LACTAR, which aims at The questionnaire provided data on attitudes towards breastfeeding through responses to a series of real life vignettes (see insert). The interviews were implemented when some analysis of the surveys and questionnaires had been started in order to generate relevant question lines. Data analysis: All survey variables were calculated for descriptive statistics, and each questionnaire vignette was scored with a total possible score which could range from 14 to 70, the lower score representing more positive breastfeeding attitudes. Forty-two was the median of the possible score range and was used as the division between overall negative and overall positive attitudes. Individual vignette scores could range from one to five and the median of possible scores was, therefore, three. Analysis of the data set was done using SPSS. Interviews were transcribed by the interviewer, coded with idiosyncratic codes, and analyzed using Grounded Theory (Bernard, 2002). Sample of vignettes in University Hospital, 2 University of Colorado School of Medicine, 3 University of Pennsylvania questionnaire 1 1. Juanita, who just gave birth a while ago, is breastfeeding in the living room. Her neighbor woman friend has come to visit. Juanita covers her chest and baby’s head with a shawl and finishes breastfeeding her child while the two adults chat. Do you think Juanita did the right thing when she continued breastfeeding? 1 2 3 4 5 I strongly agree I somewhat agree I disagree I strongly disagree 2. Estela is breastfeeding her baby in the living room. The neighbors, a man and a woman, arrive to visit. Estela covers her breast and baby’s head with a shawl and finishes nursing while they chat. Do you agree that it was right that Estela continued to nurse? 1 2 3 4 5 I strongly agree I somewhat agree I disagree I strongly disagree 3. Marta is eating lunch with her friends at Mc. Donald’s. When the baby wakes up and seemed hungry, Marta decides to breastfeed the baby under her blouse. Do you agree that Marta should have taken her baby from the public area to nurse? 1 2 3 4 5 I strongly agree I somewhat agree I disagree I strongly disagree • The average of the patients at the time of their 36 weeks prenatal visit was 23. 2 4. 8 years old. Table 1 shows other relevant sociodemographic data. Table 2 shows breastfeeding exposure and attitudes towards breastfeeding during the prenatal visit. • No sociodemographic variables were shown to significantly impact the probability of intending to breastfeeding (all p’s > 0. 05). However, the relationship between intention to breastfeed and previous breastfeeding experience approached significance (p = 0. 055). • The majority of participants cited healthcare professionals and their offices as the main distributers of breastfeeding information. • 90% of women surveyed felt they would have the support of their partner if they decided to breastfeed, but that perception had no significant bearing on intention to breastfeed (χ2 = 0. 489, p = 0. 626; χ2 = 2. 739, p = 0. 098). • Most women’s discourse regarding breastfeeding indicated that it is a very personal decision, which relates with her body, and her time. One-third of the women interviewed—married, single, or in a relationship—did not even discuss the decision with the father of the baby • The main themes that emerged from the interviews included: • Women’s fears of physical issues such as pain. • Women’s fears of not having enough milk • Lack of time or of support for breastfeeding, particularly in relation with return to the workforce. • Unforeseen costs of breastfeeding. • Previous bad experience with breastfeeding % of total sample Sociodemographic data Currently attending school 14. 4 Currently employed 26. 7 Married or in a stable union 54 Birthplace outside U. S. (Puert Rico included) 8. 1 Mother's birthplace outside U. S. (P. R. included) 20. 7 Bilingual (Spanish & English) 26. 1 Breastfeeding exposure and behavior % of total Past breastfeeding experience 17. 1 Intends to breastfeed 46. 8 Knows someone who breastfed 79. 3 Seen breastfeeding at home 55 Seen breastfeeding in public 74. 8 Was breastfed as infant 17. 1 Would have mother's support for breastfeeding 94. 6 Would have partner's support for breastfeeding 90. 1 Best milk for the baby: -breast -bottle -both 55. 9 5. 4 38. 7 Table 1 Table 2 Conclusions • The collected data underscore the malleability of women’s attitudes towards breastfeeding and the power of circumstance. The insignificant correlation between previous experience and total attitude score buttresses this conclusion. • Interview data suggest that agency over one’s body and situational changes can be powerful factors in the decision to breastfeed—regardless of previous attitude or behavior. Acknowledgements UNIVERSITY HOSPITAL Our sincere thanks to all the women and men who participated in this study. This study was funded in part by the University of Pennsylvania Research Funds to CRV. [1] Adapted from Libbus, M. K. (2000) Breastfeeding Attitudes in a Sample of Spanish-Speaking Hispanic American Women. J Hum Lact 16(3): 216 -220. Reprint requests: valeggia@sas. upenn. edu Department of Anthropology

Breastfeeding exposure and behavior % of total Past breastfeeding experience 17. 1 Intends to breastfeed 46. 8 Knows someone who breastfed 79. 3 Seen breastfeeding at home 55 Seen breastfeeding in public 74. 8 Was breastfed as infant 17. 1 Would have mother's support for breastfeeding 94. 6 Would have partner's support for breastfeeding 90. 1 Best milk for the baby: -breast -bottle -both 55. 9 5. 4 38. 7