Breastfeeding Experiences of Low Income Women in Three Settings

ABSTRACT BREASTFEEDING EXPERIENCES OF LOW INCOME WOMEN IN THREE SETTINGS Joan Doyle Paddock Cornell University, 2017 The fact that the majority (53%) of infants in the US are born to women living at 185% of poverty or less who participate in the WIC program raises the stakes on any discussion of maternal and infant care for low income women. The importance of breastfeeding for infant development and the prevention of chronic diseases in later life underscores the significance of this opportunity to positively influence the health and wellbeing of a large and growing portion of the US population. However, in the US, low income and minority women are less likely to breastfeed. The papers in this dissertation examine aspects of breastfeeding support that are available for low income women in three different program settings: an urban, Baby Friendly Hospital, a nutrition education program, and a worksite where breastfeeding support policies had just been introduced. In each setting, the changes made to support breastfeeding had a positive impact. For women delivering at a Baby Friendly Hospital, the supportive policies of the Baby Friendly Hospital Initiative (BFHI) resulted in breastfeeding discharge rate of 73%. Based on interviews, many women would not have initiated breastfeeding, or would have given up before discharge without the assistance of hospital based lactation consultants as required by the BFHI. WIC peer counselors were the only community breastfeeding support reported. A broader system of community supports would be a benefit to low income women delivering in this setting. For women participating in the Expanded Food and Nutrition Education Program (EFNEP), peer support provided by EFNEP educators at home visits had an impact on breastfeeding duration. Women receiving home visits, on average, doubled the breastfeeding duration goals they had set at enrollment. Lastly, the implementation of employee policies in support of breastfeeding resulted in an increase in the overall breastfeeding rates from pre to post implementation (+9.35%), and an increase in breastfeeding after employees returned to work (+2%). Job position (academic vs hourly) remained a critical factor for women breastfeeding after return to work. Job position and associated privileges such as a private office or autonomy over one’s schedule are not easily mitigated. Given the overwhelming benefits of breastfeeding in providing optimal nutrition for infants, the changes in each program have the potential to contribute to long term health of the infants they serve