The multiple contexts of infant feeding decisions: Breastfeeding intention, behaviors, and beliefs among low -income, inner -city mothers

In recent years, breastfeeding has been promoted as the optimal infant feeding method, highlighted for the protective health benefits it confers to infants. Although a seemingly simple choice, the decision to breastfeed is multi-faceted, resulting in considerable variation among U.S. mothers. This dissertation consists of three empirical chapters related by their focus on the decision to breastfeed among socio-economically disadvantaged women. Chapter 2 examines differences in prepartum women\u27s breastfeeding intentions, assessed at the time of their first prenatal care visit to Philadelphia public health centers (Philadelphia Longitudinal Study of Low-income Women, Wave 1). I find that many of the same factors that are known correlates of breastfeeding behavior are similarly associated with breastfeeding intentions and that breastfeeding promotional programs should focus additional outreach efforts to prepartum, low-income women who are less educated, unmarried, smoke, and are native-born. Chapter 3 then presents a detailed examination of breastfeeding behavior, focusing on racial/ethnic and nativity differences, using data from the first three waves of the Philadelphia Longitudinal Study. The analyses in Chapters 2 and 3 reveal striking immigrant versus native-born differences: foreign-born women are significantly more likely to intend to breastfeed and to initiate breastfeeding than U.S.-born women. These differences are robust to controls for socioeconomic characteristics and numerous other factors, suggesting that breastfeeding is a socially embedded, normative behavior among immigrant women. Finally, Chapter 4 provides an in-depth examination of infant feeding decisions and beliefs among low-income mothers, drawing from 29 qualitative interviews and a focus group discussion. I find that while both formula feeding and breastfeeding mothers are cognizant that “breastfeeding is best,” breastfeeding mothers (N = 7) internalize this belief more so than formula feeding mothers (N = 22). Formula feeding mothers often rationalize their decision not to breastfeed based on observations that the marginal benefits of breastfeeding may be minimal. This chapter illustrates how socio-cultural ideologies of breasts as objects of sexual gratification and feminine beauty have a powerful presence in low-income mothers\u27 beliefs and that these ideologies are an important aspect of understanding their infant feeding decisions