Breastfeeding practices, program efficacy, and reasons for breastfeeding discontinuation for low-income women enrolled in a peer counseling breastfeeding support program
BACKGROUND: Breastfeeding reduces risk for a myriad of health conditions in both infant and mother. Risk of many adverse health outcomes is higher and breastfeeding rates are lower in the low-income population compared to the general population. Peer counseling breastfeeding support programs have demonstrated efficacy in improving breastfeeding initiation, duration, and exclusive duration among low-income women. However, there is little information on how program factors are associated with participant characteristics, breastfeeding outcomes and reasons women in these programs discontinue breastfeeding.OBJECTIVE: To understand factors inherently affecting breastfeeding outcomes; to identify program components associated with improved breastfeeding outcomes; and to identify reasons for breastfeeding discontinuation in a population of low-income women enrolled in a peer counseling breastfeeding support program; in order to identify effective strategies for improving breastfeeding outcomes in these programs.METHODS: Demographic, breastfeeding, and program information was prospectively collected for 12,923 women enrolled in Michigan State University Extension's Breastfeeding Initiative Program from 2005 until 2011. Participants were described according to breastfeeding status at program entry and exit using chi-square tests, one way ANOVA and logistic regression. Cox Proportional Hazard Regression model was utilized to examine the association between program components and breastfeeding outcomes in 5,886 prenatal enrollees. Chi-square tests and Kruskall-Wallis ANOVA were utilized to explore the associations between reason for breastfeeding discontinuation and infant age at weaning and participant characteristics for 7,942 participants who discontinued breastfeeding while enrolled in the program. RESULTS: Postnatal enrollees had longer breastfeeding duration than prenatal enrollees (F<0.001). Women who withdrew from the program while breastfeeding were demographically similar to those who discontinued breastfeeding prior to one year, although they breastfed for significantly longer at exit (mean± SD: 27.8± 14.8 weeks and 15.7± 13.3 weeks respectively; p< 0.001). For each additional home, phone, and other peer counselor contact there was a significant reduction in the hazard of discontinuing any breastfeeding by six months [HR (95% CI): 0.90 (0.88, 0.92); 0.89 (0.87, 0.90); and 0.93 (0.90, 0.96) respectively] and exclusive breastfeeding by three months [HR (95% CI): 0.92 (0.89, 0.95); 0.90 (0.88, 0.91); and 0.93 (0.89, 0.97) respectively]. Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breastfeeding discontinuation compared to those who were considered to have an optimum quantity of contacts [HR (95% CI): 0.17 (0.14, 0.20) and 0.28 (0.23, 0.35) respectively]. The most common reasons reported for discontinuing breastfeeding were "Mother's Preference" (39%) and "Low Milk Supply" (21%), and reasons differed by age of infant weaning (p< 0.001). CONCLUSIONS: When delivering program protocols, it is important to recognize the varying needs of individual participants. Identifying participants who are at higher risk of undesirable breastfeeding outcomes, reaching participants using the most effective methods, and delivering curriculum that addresses common reasons for discontinuation may serve to improve breastfeeding outcomes for low-income women enrolled in peer counseling programs.
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- In Collections
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Electronic Theses & Dissertations
- Copyright Status
- In Copyright
- Material Type
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Theses
- Authors
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Rozga, Mary Rebekah
- Thesis Advisors
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Olson, Beth H.
- Committee Members
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Alaimo, Katherine
Kerver, Jean
Hamm, Michael
- Date
- 2014
- Subjects
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Peer counseling
Breastfeeding
Decision making
Low-income mothers
Scheduled tribes in India--Attitudes
Michigan
- Program of Study
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Human Nutrition - Doctor of Philosophy
- Degree Level
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Doctoral
- Language
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English
- Pages
- xiii, 136 pages
- ISBN
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9781321152555
1321152558
- Permalink
- https://doi.org/doi:10.25335/fdeh-8d59