Influences on Breast-Feeding by Lower-Income Women: An Incentive-Based, Partner-Supported Educational Program

doi:10.1016/S0002-8223(95)00083-6

Journal of the American Dietetic Association

Volume 95, Issue 3, March 1995, Pages 323-328

https://doi.org/10.1016/S0002-8223(95)00083-6 Get rights and content

Abstract

Objective To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women.

Design Women who expressed a willingness to participate in the breast-feeding educational program were randomly assigned to one of two groups: an intervention group and a control group who received usual breast-feeding education.

Setting Clinics of the Special Supplemental Food Program for Women, Infants, and Children in Flagstaff, Ariz.

Subjects Sixty-eight primiparous pregnant women with expected due dates between May 1992 and December 1992 were willing to participate in the study. Of these, 34 were randomly assigned to the intervention group and 34 to the control group. Approximately 81% of the women completed the study: 29 in the control group and 26 in the intervention group.

Intervention The intervention consisted of special incentives (prizes) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth. Women were also encouraged to use a breast-feeding support program in which peers serve as role models.

Main outcome measures The primary outcome measure was infant feeding method. Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks, 6 weeks, and 3 months postpartum.

Statistical analyses performed Binomial proportional analyses of the feeding data were performed.

Results Women in the intervention group reported a higher percentage of breast-feeding at all measurement times.

Applications These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breastfeeding promotion activities can dramatically increase the rate and duration of breast-feeding. J Am Diet Assoc. 1995; 95:323-328.

Section snippets

Study Population

The sample consisted of primiparous pregnant women who attended the two WIC clinic sites in Flagstaff, Ariz. Multiparous women were excluded from the study in an attempt to control for the considerable influence that feeding of previous children has on feeding decisions (34).

Subjects

Women were recruited from March through December 1992. The two WIC clinics in Flagstaff served as recruitment sites. All primiparous, pregnant women attending the two clinics were given an infant feeding questionnaire that

Demographic Findings

The demographic data revealed that the control and intervention groups were not significantly different with respect to age, ethnicity, or level of formal education. The first demographic hypothesis was that the control group's ethnic composition was not different from that of the intervention group. That is, when the women of the study were separated into the two categories of white vs all minority groups combined, the treatment and control groups were similar as measured using a 2×2

Discussion

Breast-feeding educational interventions can be effective in promoting breast-feeding. Misperceptions about breast-feeding are common (35). Furthermore, for women to continue breastfeeding, they may need knowledge, skills, and help to overcome breast-feeding problems (36). Breast-feeding interventions should address common misperceptioris about breast-feeding and should provide women with the abilities to overcome problems themselves. Educational interventions seem to be even more likely to

Applications

The benefits of breast-feeding are especially important to the health of children from lower socioeconomic groups. Interventions to promote breast-feeding, especially those that include both women and their partners, can have a positive effect on breastfeeding among those who participate. Prizes donated by the local community can help attract low-income women and their partners to participate in breast-feeding educational interventions. ■

This study was supported through contract no.

References (51)

A.S Cunningham et al.
Breast-feeding and health in the 1980sa global epidemiologic review
J Pediatr.
(1991)
A.S Cunningham
Morbidity in breast-fed and artificially fed infants, II
J Pediatr.
(1979)
R.M Applebaum
The modern management of successful breastfeeding
Pediatr Clin North Aw.
(1970)
L.B Dusdieker et al.
Investigation of a model for the initiation of breastfeeding in primiparous women
Soc Sci Med.
(1985)
D.A Jones et al.
Maternal characteristics associated with the duration of breast-feeding
Midwifery.
(1986)
M.L Bevan et al.
Factors influencing breast-feeding in an urban WIG program
J Am Diet Assoc.
(1984)
S.P Barron et al.
Factors influencing duration of breast-feeding among low-income women
J Am Diet Assoc.
(1988)
J Robinson et al.
Attitudes toward infant feeding among adolescent mothers from a WIG population in northern Louisiana
J Am Diet Assoc.
(1993)
L.S Wiles
The effects of prenatal breastfeeding education on breastfeeding success and maternal perception of the infant
J Obstet Gynecol Neonatal Nurs.
(1984)
N Whitley
Preparation for breastfeedinga one-year followup of 34 mothers
J Obstet Gynecol Neonatal Nurs.
(1978)

D.D Kaplowitz et al.

The effect of an education program on the decision to breastfeed

J Nutr Educ.

(1983)

R Mazen et al.

The influence of communicator-recipient similarity upon the beliefs and behavior of pregnant women

J Exp Soc Psychol.

(1972)

R Novotny et al.

Health of infant is the main reason for breast-feeding in a WIG population in Hawaii

J Am Diet Assoc.

(1994)

D James et al.

Factors associated with breastfeeding prevalence and duration among international students

J Am Diet Assoc.

(1994)

Breast feedinga commentary in celebration of the International Year of the Child 1979

Pediatrics.

(1978)

Promotion of breast feedingrecommendations of the Councils of the Society for Pediatric Research and American Pediatric Society, and of the American Academy of Pediatrics

Pediatr Res.

(1982)

Pediatrics.

(1980)

Healthy People 2000 National Health Promotion and Disease Prevention Objectives

(1990)

P.C.H Anholm

Breastfeedinga preventive approach to health care in infancy

Issues Compr Pediatr Nurs.

(1986)

D.B Jelliffe et al.

“Breast is best”modern meanings

N Engl J Med.

(1977)

J.M Leventhal et al.

Does breast-feeding protect against infections in infants less than 3 months of age?

Pediatrics.

(1986)

M.G Kovar et al.

Review of the epidemiologic evidence for an association between infant feeding and infant health

Pediatrics.

(1984)

A.S Ryan et al.

The recent decline in breastfeeding. 1984-1989

Pediatrics.

(1991)

G Martinez et al.

1984 Milk-feeding patterns in the United States

Pediatrics.

(1985)

G.A Martinez

Trends in breast feeding in the United States

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Influences on Breast-Feeding by Lower-Income Women: An Incentive-Based, Partner-Supported Educational Program

Abstract

Section snippets

Study Population

Subjects

Demographic Findings

Discussion

Applications

J Pediatr.

J Pediatr.

Pediatr Clin North Aw.

Soc Sci Med.

Midwifery.

J Am Diet Assoc.

J Am Diet Assoc.

J Am Diet Assoc.

J Obstet Gynecol Neonatal Nurs.

J Obstet Gynecol Neonatal Nurs.

J Nutr Educ.

J Exp Soc Psychol.

J Am Diet Assoc.

J Am Diet Assoc.

Breast feedinga commentary in celebration of the International Year of the Child 1979

Pediatrics.

Promotion of breast feedingrecommendations of the Councils of the Society for Pediatric Research and American Pediatric Society, and of the American Academy of Pediatrics

Pediatr Res.

Pediatrics.

Healthy People 2000 National Health Promotion and Disease Prevention Objectives

Breastfeedinga preventive approach to health care in infancy

Issues Compr Pediatr Nurs.

“Breast is best”modern meanings

N Engl J Med.

Does breast-feeding protect against infections in infants less than 3 months of age?

Pediatrics.

Review of the epidemiologic evidence for an association between infant feeding and infant health

Pediatrics.

The recent decline in breastfeeding. 1984-1989

Pediatrics.

1984 Milk-feeding patterns in the United States

Pediatrics.

Trends in breast feeding in the United States