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Strategies to Promote Breast-feeding Among Adolescent Mothers
Constance M. Wiemann, PhD;
Jacqueline C. DuBois, MD;
Abbey B. Berenson, MD
Arch Pediatr Adolesc Med. 1998;152:862-869.
Objective To identify characteristics of adolescent mothers who bottle-feed who considered breast-feeding their infants and strategies to promote breast-feeding within this special group.
Design Adolescents completed an hour-long interview within 48 hours of delivery that elicited factors considered important to the mother's feeding decision and indices of mental health.
Setting Postpartum ward of university hospital.
Subjects A total of 693 adolescents 18 years old or younger (mean age, 16.7 years) from African American, Mexican American, or white race or ethnicity; 27% of Mexican American participants spoke little or no English.
Main Outcome Measures Factors associated with breast-feeding decision.
Results Those who chose bottle-feeding (hereafter, bottle-feeders) who had considered breast-feeding were first compared with bottle-feeders who had not considered breast-feeding and then with adolescents who breast-fed. After controlling for ethnicity, bottle-feeders who had considered breast-feeding were more likely than those who had not considered breast-feeding to be impoverished (adjusted odds ratio [AOR]=4.8), to have delayed their feeding decision until the later stages of pregnancy (AOR=4.6), to have been encouraged to breast-feed (AOR=4.5), to have friends who breast-fed (AOR=2.3), and to have experienced low financial, tangible, emotional, or informational support from their families (AOR=1.6). They were more likely to cite barriers associated with breast-feeding while returning to school or work (AOR=2.0) and less likely to state that bottle-feeding was healthier (AOR=0.3) as reasons for bottle-feeding. Compared with those who chose breast-feeding (hereafter, breast-feeders), this group was more likely to have made the feeding decision alone rather than relying on advice (AOR=4.6), to have made this decision in the later stages of pregnancy (AOR=4.4), to report fewer breast-feeding role models (AOR=1.8) and fewer significant others who encouraged breast-feeding (AOR=2.8), and to report at least 2 significant others who encouraged bottle-feeding (AOR=3.2). They were also less likely to have attempted to breast-feed a previous child (AOR=3.3).
Conclusions A subgroup of adolescent mothers who had considered breast-feeding but ultimately chose to bottle-feed may be identified in the late stages of gestation by collecting information on financial status, family support, perceived barriers to breast-feeding and attending school or working, timing of the feeding decision, prior breast-feeding experience, breast-feeding role models, and encouragement to breast-feed. We speculate that strategies to promote breast-feeding should focus on role modeling and facilitation.
From the Departments of Obstetrics & Gynecology (Drs Wiemann and Berenson) and Pediatrics (Drs DuBois and Berenson), The University of Texas Medical Branch, Galveston. Dr Wiemann is now with the Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
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