Breast-feeding education and support: association with the decision to breast-feed

Rates of breast-feeding in the United States are well below the Healthy People 2000 objective of 75% and do not meet recent American Academy of Pediatrics guidelines.

To identify factors associated with the initiation and duration of breast-feeding in managed care enrollees who had had a normal vaginal delivery.

Telephone survey of 5213 new mothers (4 to 6 months postpartum) enrolled in commercial managed care plans (response rate 72%).

Starting breast-feeding (ever vs never) and duration of breast-feeding (< or = 6 weeks vs > 6 weeks).

Logistic regression models controlling for sociodemographic variables. Given the prevalence of the outcome, odds ratios were converted to relative risks (RRs).

Seventy-five percent of respondents reported ever breast-feeding, and of those women, 75% reported breast-feeding for more than 6 weeks. In adjusted multivariate analyses, breast-feeding was affected by education, employment, and marital status. Women who were more likely to breast-feed were those who attended childbirth classes (RR, 1.16; 95% CI, 1.11 to 1.20), those who received prenatal breast-feeding advice (RR, 1.24; CI, 1.19 to 1.27), and those who received postpartum breast-feeding assistance (RR, 1.31; CI, 1.15 to 1.34). Breast-feeding for more than 6 weeks postpartum was associated with education, employment status, and the adequacy of postpartum information.

These findings suggest that health plans and employees may promote breast-feeding by providing breast-feeding education and support.