Temporal Changes in the Determinants of Breastfeeding Initiation

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Abstract
Regular identification of factors that predict a woman's infant feeding choice is important so that breastfeeding promotion interventions can be targeted at those women least likely to breastfeed. The objective of this study was to compare determinants of breastfeeding at discharge from hospital in 2002/2003 with those reported for 1992/1993. Women participating in two longitudinal infant feeding studies in Perth, Australia, completed a baseline questionnaire just before, or shortly after, discharge from hospital. Data collected included infant feeding method and socio-demographic, biomedical, and psychosocial factors known, or suspected, to be related to the initiation of breastfeeding. Multivariate logistic regression was used to identify independent predictors of "any" and "exclusive" breastfeeding at hospital discharge in both studies. Although maternal age, level of education, and family income were independent predictors of breastfeeding at hospital discharge in the first study, no association was found between these factors and breastfeeding at hospital discharge in the second study. In both studies, a woman who perceived her husband to prefer breastfeeding was significantly more likely to leave hospital breastfeeding, and to be exclusively breastfeeding, than a woman who perceived her husband to prefer formula feeding. The strongest predictor in both studies for a woman to not be exclusively breastfeeding at hospital discharge was having an infant who had been admitted to the special care nursery after delivery. Given the importance of psychosocial factors to breastfeeding initiation, interventions that aim to increase breastfeeding initiation rates should be targeted on the basis of parental attitudes to breastfeeding rather than on sociodemographic factors. Similarly, interventions that aim to increase exclusive breastfeeding should address biomedical factors that hinder a woman's ability to establish exclusive breastfeeding.