Las Dos Cosas: An Analysis of Attitudes of Latina Women on Non-Exclusive Breastfeeding

Background: Non-exclusive breastfeeding among Latina women is commonly seen in the newborn period. The reasons behind las dos cosas ("both things'') are not well understood but have included the beliefs that formula has vitamins and that adding formula will result in a chubbier baby, which is desirable. Many previous studies involved Mexican and Puerto Rican women living in the mainland United States. Methods: We performed detailed semistructured interviews with 17 Latina mothers in late pregnancy or the newborn period at a community hospital and an affiliated clinic in Massachusetts, serving a large Dominican population. Women were asked about their beliefs about breastfeeding, colostrum, and infant formula. Transcripts were analyzed using Nvivo 9 software (QSR International Pty. Ltd., Melbourne, Australia) to identify the frequencies of common trends. Results: The most common reasons for introducing formula were treatment for insufficient milk, to keep the baby fuller longer, and planning for return to work. None of the women understood the potential risks of introducing formula on the establishment of breastfeeding, particularly on milk supply. Many thought that even limited amounts of breastfeeding were sufficient to produce a healthier child, failing to understand a negative dose-response effect of formula on health and milk production. While every woman saw breastfeeding as healthier, only one saw formula as unhealthy, an important distinction. None of the women expressed familiarity with medical recommendations around breastfeeding duration or exclusivity, with many believing that breastmilk alone would be insufficient to satisfy the hunger or nutritional needs of a growing child after as little as 3 months. Women consistently demonstrated a willingness to learn from health professionals. Conclusions: In counseling Latina women, it may be important to discuss the risks of formula to infant health, breastfeeding, and milk supply and to include the medical recommendations for breastfeeding exclusivity. Educational opportunities exist in the prenatal setting and when postpartum women request formula.