What Do Pregnant Low-Income Women Say About Breastfeeding?

Background: Although low socioeconomic status and African-American race have been shown to be risk factors for low rates of breastfeeding, maternal reasons for selection of infant feeding method are not well understood in these populations. Methods: Healthy women >= 15 years of age receiving routine obstetrical care from nurses and nurse midwives at the outpatient clinic of MacDonald Women's Hospital, Case Medical Center, Cleveland, OH were surveyed using a questionnaire interview including Likert-scaled and open-ended questions. All responses to the six open-ended queries were transcribed. Content analysis was used to categorize these responses into three to seven descriptive themes for each question. The authors and two other clinically experienced reviewers participated in theme development, which involved categorization by individual reviewers and then by the group; a full consensus was achieved at each stage. University Hospitals Institutional Review Board approved the study. Results: Of 186 eligible women, 179 (96%) consented, and 176 (95%) were interviewed. Median age was 22 years (range, 15-41 years), 68 (41%) had greater than a high school education, 167 (95%) were African-American, 167 (non-identical 95%) were unmarried, and 87 (49%) were multiparous. When interviewees were asked, "What is the biggest reason you want to breastfeed?,'' responses included maternal reasons, infant-related reasons, and advice of others. When women were asked, "What would stop you from breastfeeding?,'' responses included lifestyle reasons, pain-related reasons, lactation process issues, hypothetical medical reasons, and maternal reluctance. Conclusions: Expectant low-income African-American inner-city women appear well informed about the benefits of breastfeeding. Obstacles to breastfeeding that may be susceptible to intervention include fear of pain, lifestyle issues, and lactation process concerns. "I want to breastfeed because I don't want to get up in the middle of the night.'' "I wouldn't breastfeed if it hurt.'' "He [the father of my baby] does not want me to breastfeed because the baby might want to suck on his nipples.''