Why mothers in underserved populations stop breastfeeding

April 24, 2001

New Haven, Conn. - Most women in underserved populations do not continue breastfeeding after four months because they lack the confidence they will do so, and they think their infants prefer formula, a study by Yale researchers shows.

Of the 64 women who participated in the study, 27 percent had discontinued breastfeeding after one week; 37 percent after two weeks; 70 percent after two months, and by four months, 89 percent of the mothers had stopped breastfeeding their infants.

All of the mothers were eligible for the Women, Infants and Children (WIC) nutrition program, and most had already enrolled. WIC provides special supplemental foods, nutritional counseling, and breastfeeding support and education to low income women and their children, up to five years old.

The American Academy of Pediatrics recommends breastfeeding through the first year of life.

John Leventhal, M.D., professor of pediatrics at Yale School of Medicine, is senior author of the study published in a recent issue of the journal Pediatrics. The principal investigator on the study was Ilgi Ertem, M.D., who at the time was a developmental-behavioral fellow at Yale working with Leventhal.

Leventhal said the women who stopped breastfeeding did not do so because they lacked knowledge about breastfeeding or because they experienced difficulty doing so.

"When asked about their confidence that they would continue breastfeeding until the infant was two months of age, almost half of the women stated that the chances that they would still be breastfeeding were low," he said.

Yet most of the women also said they wanted to breastfeed for up to six months to help protect their babies against illness, to provide them with the best natural food and nutrition, and for the psychological benefits to the children.

Based on these results, Leventhal said, mothers should be encouraged to talk about their doubts and the reasons for the discrepancy between what they want for their children's nutrition and what they believe they will actually do.

The majority of the mothers also said the babies preferred breast milk, but nearly 40 percent said the infants enjoyed formula milk more.

The issue of whether the infants prefer formula more than breast milk was unrelated to the mother's confidence about continuing to breastfeed. "It may be that a newborn's early behavior at the breast may shape a mother's perception of whether her baby enjoys breastfeeding," Leventhal said. "The infant's cues and what the infant wants need to be discussed to dispel the myth that infants like formula better."

He said the results of the study demonstrate that interventions aimed at prolonging the duration of breastfeeding will need to shift focus from increasing knowledge and managing problems of lactation to enhancing the mother's confidence regarding breastfeeding, while also addressing beliefs regarding an infant's preferences.
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The other researcher on the study in addition to Leventhal and Ertem was Nancy Votto, R.N., clinical researcher in internal medicine and endocrinology.

Yale University

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