U.S. obstetrician-gynecologists' estimates of their patients' breastfeeding rates

To estimate obstetrician-gynecologists' promotion and support of breastfeeding and their perception of patient breastfeeding practices to examine whether variation in physician practice contributes to low breastfeeding rates.

We conducted a survey study of 290 members of the Collaborative Ambulatory Research Network, a sample of college fellows (response rate 48.3%). We compared the results with the Centers for Disease Control and Prevention state-by-state Breastfeeding Report Card data: 75% or more initiating breastfeeding termed high, 65-74% termed medium, and 64% or lower termed low. The survey consisted of questions regarding physician and patient demographics, physician satisfaction regarding breastfeeding practices, opinions and knowledge of breastfeeding, opinions of breastfeeding duration, and physicians' effort toward encouraging breastfeeding. An "effort" score was created from these questions.

Physicians' perceptions of breastfeeding initiation rates were consistent with Centers for Disease Control and Prevention data for high (77.3%±1.5%), medium (70.9%±2.7%), and low states (59.4%±3.4%). Physicians with a high proportion of African American or Medicaid-eligible patients reported lower rates of initiating breastfeeding; a high proportion of Medicaid-eligible patients was associated with lower breastfeeding at 3, 6, and 12 months. More physicians were satisfied in high breastfeeding states (72.7%) than in medium (60%) or low states (34.3%). We found no association between the effort score and physician age or patient demographics; however, women (10.2±0.2) scored higher than men (8.6±0.3, P=.001). Effort score did not differ among high, medium, or low breastfeeding states.

Physician satisfaction reflected perceived patient behavior. Physician effort scores were similar across patient breastfeeding behavior. Patient demographics rather than physician practice predicted low breastfeeding rates.

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