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Contextual Influences on Breastfeeding Decision-Making Processes

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July 27, 2010


Demographic and Behavioral Sciences (DBS) Branch, Center for Population Research (CPR), NICHD


6100 Executive Blvd, 5th floor conference room, Rockville, Maryland


Breastfeeding is the final biological link in the reproductive process between mother and child. The success of this biological process depends upon the interaction of two individuals, and the frequency and nature of this interaction depends on the broader social context in which the individuals are embedded.

Despite the American Academy of Pediatrics’ recommendation that all biological mothers breastfeed for the infant’s first year of life and that parents never use formula, the Centers for Disease Control and Prevention (CDC) estimates that only three-quarters of mothers are breastfeeding during the early postpartum period and that this percentage drops considerably within the first months after the birth. Furthermore, breastfeeding rates vary tremendously across racial and ethnic groups; for the 2005 birth cohort, the CDC estimates "ever breastfed" rates from a low of 59% for non-Hispanic African Americans to a high of 84% among Asian/Pacific Islanders.

Anecdotal evidence provides many reasons why mothers discontinue breastfeeding: physical difficulties related to breastfeeding (including low production), lack of support from medical and related professionals, lack of support from the mother's social network and the broader community, structural barriers related to work and child care, and lack of supportive public policies. But no scientific evidence exists as to the relative contributions of these factors to women's decision-making processes, and whether and how these contributions may vary across racial, ethnic, or occupational groups.

This workshop is designed to encourage research at a broader level than that of individual-level interventions targeted at specific populations. It is unknown whether the racial/ethnic disparities in breastfeeding in the U.S. are generated by cultural differences or by structural factors that disproportionately impact members of those groups. Potential structural factors include education (both in terms of specific knowledge and associated self-efficacy), occupational distribution (including associated occupational characteristics such as income and workplace conditions), and vulnerability to public policy variations (such as the provision of funding for formula under WIC but the lack of provision of funding for breast pumps and lactation consultants under Medicaid). It is only by understanding the relevant structural factors that researchers can begin to tease apart modifiable factors facilitating or hindering the effectiveness of interventions meant to increase breastfeeding. Modifications to structural factors may have as great an effect as individual-level interventions, or may interact with those interventions to produce a greater or lesser impact.


Dr. Roz King, DBS Branch, CPR, NICHD
Tel: (301) 435-6986

Last Reviewed: 11/30/2012
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