Factors Affecting Breastfeeding Initiation and Duration Among WIC Recipients in Washington, D

Breastfeeding provides a critical start to a healthy childhood, as it is known to afford immunity and a wide range of health benefits to the infant as well as the mother. The American Academy of Pediatrics and World Health Organization recommend that women breastfeed exclusively for at least the first 6-months of life, but very few women meet this recommendation. Further, women receiving supplemental nutrition benefits from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) have historically low breastfeeding rates, indicating an even greater need among this population. There are a number of deterrents to continued breastfeeding, including maternal factors such as low breastfeeding confidence, lack of support from peers or professionals, smoking, and norms or restraints within the social environment. Therefore, the goal of this research was to better understand the maternal factors affecting WIC recipients' breastfeeding initiation and duration, focusing specifically on social support resources as well as previously identified factors that research has indicated may increase or decrease sustained breastfeeding, including smoking. A mixed methods approach was undertaken to better understand the determinants of breastfeeding initiation and duration. First, a content analysis described the landscape of mobile breastfeeding support services, identified appropriate interventions and made recommendations for needed maternal resources. Next, a quantitative study examined the extent to which smoking and other variables affected breastfeeding among WIC recipients. Finally, a follow-up qualitative study elucidated other barriers or facilitators to breastfeeding, such as psychological determinants, self-regulation and observational learning, that were not captured in the WIC dataset. Together, these three approaches aimed to identify which factors influence breastfeeding in order to understand how to improve breastfeeding rates among WIC participants. The content analysis identified 50 mobile applications on the GooglePlay and iTunes stores and an additional 15 text-messaging programs and applications were found in a comprehensive literature search, that largely served to provide informational breastfeeding support to pregnant and/or postpartum women through a variety of different tools, features, and content-areas. The quantitative analysis found that the 416 postpartum women who smoked in the sample had significantly lower breastfeeding initiation and duration than women who did not smoke, both when examining this relationship alone and when holding other potentially confounding variables constant. The qualitative analysis in line with the Social Cognitive Theory helped explain the breastfeeding barriers and facilitators of African American WIC recipients, including the influence of others, the understanding of the benefits breastfeeding confers, the pervasiveness of breastfeeding obstacles and how social support helped women overcome these obstacles and additional individual and environmental challenges. Altogether, these results suggest that breastfeeding is multifaceted, and certain risk factors consistent with the literature (smoking status, African American race) are also seen in the DC WIC population. Available sources of support, including those from mhealth tools may help women overcome disparities and enhance breastfeeding initiation and duration.