Infant feeding decisions and behaviours among low-income smoke-exposed women: timing and change during pregnancy

Objective: The present study aimed to describe change in feeding intentions and predictors of breast-feeding intentions during the course of pregnancy. Design: Analysis of prospectively collected data from a larger randomized controlled trial of a health education intervention to reduce environmental smoke exposure among women during and after pregnancy. Setting: Participants were recruited from prenatal clinics, but all further communication occurred with participating women living in the community. Subjects: Low-income, adult women (n 399) were interviewed during the 16th and 32nd week of pregnancy to ascertain prenatal feeding intentions and breast-feeding knowledge, attitudes and self-efficacy. Characteristics of women by infant feeding intention were assessed along with differences in intention from 16 to 32 weeks of pregnancy and feeding behaviours after delivery. Differences in psychosocial variables between women of different intention for infant feeding were measured. Women in each category of feeding intention were assessed for changes in psychosocial factors by eventual infant feeding behaviour. Results: Feeding intention early in pregnancy was strongly, but not consistently, associated with feeding intention late in pregnancy, feeding initiation and later feeding patterns. Over one-third of women who were undecided at 16 weeks' gestation or earlier initiated breast-feeding. Increases in knowledge and improvement in time, social factors and social support barriers were found among those who exclusively breast-fed. Conclusions: Results indicate that feeding decisions may change during pregnancy. Determining when women make feeding decisions during their pregnancy warrants more research. Interventions to increase breast-feeding intentions should target knowledge, self-efficacy and barriers.