Impact of Breastfeeding Self-Efficacy and Sociocultural Factors on Early Breastfeeding in an Urban, Predominantly Dominican Community

Background: Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community. Subjects and Methods: Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from 1 (exclusive formula feeding) to 5 (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks. Results: We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6 +/- 1.2 to 2.9 +/- 1.4; p<0.05) and then decreased by 4-6 weeks (2.9 +/- 1.4 to 2.5 +/- 1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [beta = 0.21 (0.08, 0.56)], breastfeeding a previous child for >= 6 months [beta = 0.35 (0.57, 1.8)], foreign birth [beta = 0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [beta = 0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio = 1.18 (1.05, 1.32)]. Conclusions: Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.