Impact of Breastfeeding Self-Efficacy and Sociocultural Factors on Early Breastfeeding in an Urban, Predominantly Dominican Community

Abstract

Background:
Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4–6 weeks postpartum in our community.


Subjects and Methods:

Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4–6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from “1” (exclusive formula feeding) to “5” (exclusive breastfeeding) characterized feeding practices. Paired-sample
t
tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4–6 weeks.



Results:

We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4;
p
<0.05) and then decreased by 4–6 weeks (2.9±1.4 to 2.5±1.44;
p
<0.05), without significant change between WBN and 4–6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)].



Conclusions:
Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.