Breastfeeding Recommended for Low-Income Mothers

From Medscape Medical News

Crina Frincu-Mallos, PhD

October 28, 2009 (Washington, DC) — Despite the recommendation from the World Health Organization that all women exclusively breastfeed for the first 6 months for optimal infant growth and development, data from 198 primiparous women in Tennessee show that even women intending to nurse give up after the first 2 months. The findings were reported here at the American Academy of Pediatrics 2009 National Conference and Exhibition.

More than half of low-income first-time mothers start breastfeeding, but only 13% continue up to 6 months, partly because of the availability of free infant formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, known as the WIC program, researchers told meeting attendees.

Mother's Milk Is Best . . . and Free

"We did our research in first-time mothers in the South, which has the lowest rates of breastfeeding," said Stephanie M. Reich, PhD, assistant professor in the Department of Education at University of California at Irvine.

"We found that if they were getting free formula from their pediatrician, they were more than twice as likely to quit breastfeeding," Dr. Reich said in an interview with Medscape Pediatrics.

The 198 women in the study were interviewed at home during the third trimester of their pregnancy. Of these, 168 women were interviewed after they gave birth, and again at 2, 4, 6, 9, 12, and 18 months postpartum. Study participants were African American (n = 125), white (n = 62), Hispanic (n = 16), and Asian (n = 2). Most women in study were single mothers (n = 154). Pregnancy was planned in only 40 cases (20%).

In terms of education, 58 first-time mothers were high-school graduates, 57 attended college, 52 attended high school, 21 had associate and/or bachelors degrees, and 10 were in graduate school. In terms of annual income, 31 first-time mothers had incomes higher than $26,000, 29 had incomes lower than $8000, and the rest fell within this range.

Good Intentions but Negative Impact of Free Infant Formula

"Giving new mothers formula gives them the idea that formula, in some way, might be preferable to breast milk, which it is not," noted Paula Brinkley, MD, a pediatrician in private practice in Berkeley, California, who was attending the meeting. "In order to maximize breastfeeding, it's preferable not to make formula too easy to obtain," Dr. Brinkley, who was not involved with the study, told Medscape Pediatrics in an interview.

"Keep formula companies from giving free formula to hospitals, which they often do, suggested Dr. Brinkley, "and, as a pediatrician, don't give formula to mothers, don't offer it as a perk, unless it's necessary," she advised.

There are other factors that contribute to a new mother's decision to stop breastfeeding, yet all mothers "were more likely to give it up if they were given free formula," explained Dr. Reich. "If you are frustrated with breastfeeding, it's 1 more step to have to go and buy formula and decide, but if you can open a cabinet and do that, it's easier. Formula is expensive, but if you get it for free, you don't have the cost barrier that a lot of other women face," she said.

Breastfeeding Decision Is Influenced by Parents, Physicians

Most women in the study (71%) planned to breastfeed their infants and even more (99%) knew about the health benefits of mother's milk. Those not intending to breastfeed felt it would be a hassle and were more likely to be receiving WIC, said Dr. Reich.

The study results indicate that the obstetrician's influence regarding a new mother's decision to breastfeed is relatively high, compared with the pediatrician's influence (23% vs 9%). However, "family members were very influential in their decision to breastfeed," noted Dr. Reich, "so if their parents were against breastfeeding (46%), they didn't at all, but if their parents were supportive, they were more likely to try it."

Interestingly, looking at postnatal practices, the results show that of the first-time mothers who said during the initial interview that they intend to breastfeed, 89% actually did. However, of those who intended to use free formula, none breastfed.

Dr. Reich added that "a lot of them did not intend to breastfeed for very long, only planned to breastfeed for 1 month, which doesn't give as many of the benefits, but gives all the discomforts — the discouragement, the soreness, . . . the rest of it, but they don't have enough education about breastfeeding to know that it's easier downstream."

"Women who know more about breastfeeding," she remarked, "know more about the benefits of breastfeeding, the protective factor, and do continue breastfeeding."

"This is part of a larger study in which we are trying to educate women by providing educational information through baby books, so as women read to their children, they learn more about child development and intervention," explained Dr. Reich. "We are studying these infants for the first 18 months of their lives and [by now] we know that books work, we know that moms know more after reading them. Then we look at whether that changes any of their behaviors, if it increases their interaction with their babies, and do they provide nutritional benefits."

"We started with breastfeeding," Dr. Reich said, "but we look at other feeding practices, safety in their home, the quality of their interactions, [and] language and cognitive development in the babies."

Knowing the benefits of breast milk is not sufficient for inducing low-income first-time mothers to breastfeed their babies for at least 6 months. Understanding the reasons for never starting or discontinuing early and the role that family and doctors play in this decision could help with implementing breastfeeding practices, concluded Dr. Reich.

Dr. Reich and Dr. Brinkley have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2009 National Conference and Exhibition: Abstract 7890. Presented October 18, 2009.