Of the 883 women in our study population, the majority self-identified as Hispanic (59.9%) or non-Hispanic black (31.6%). One-third were born outside the United States (50 states), and 46.3% were enrolled in WIC. Three-quarters planned to return to work in the infant's first year. Among parous women, 21.7% had never breastfed. Compared with the IFPS II population, our population was considerably more diverse (). BINGO and PAIRINGS participants were less likely to have graduated from high school, more likely to be enrolled in WIC, and more likely to be returning to work in the first year. Parous participants in our study were less likely to have ever breastfed.
Characteristics of the BINGO and PAIRINGS Patient Populations, Compared with the Infant Feeding Practices Study II Population
Of our study group, 405 (45.9%) intended exclusive breastfeeding, 407 (46.1%) intended mixed feeding, and 71 (8.0%) intended to formula feed. Compared with our study group, a significantly greater proportions of IFPS II participants intended to exclusively breastfeed (59.3%) and exclusively formula feed (15.1%), while significantly fewer intended to mixed feed (25.7%, p
0.001 for all comparisons).
Despite multiple risk factors predisposing our sample to less favorable attitudes and knowledge about breastfeeding compared with the IFPS II, results were surprising. Women in our study were significantly more likely than women in the IFPS II sample to report feeling “Comfortable” breastfeeding in front of close woman friends or in public and were similarly comfortable in front of men and women who are close to them (). Regarding the statement “infant formula is as good as breastmilk,” 65.0% of our sample disagreed compared with 59.3% of the IFPS sample (p
0.001). Compared with the IFPS II sample, our study group was also significantly more likely to agree with statements that breastfed infants are less vulnerable to ear infections (68.0% vs. 63.8%), respiratory infections (66.7% vs. 64.4%), diarrhea (53.9% vs. 50.2%), and obesity (45.2% vs. 36.9%) and that babies should only get breastmilk in the first 6 months (52.4% vs. 36.9%) ().
Maternal Comfort with Feeding in Social Settings for the BINGO and PAIRINGS Versus Infant Feeding Practices Study II Populations
Maternal Knowledge About the Health Effects of Breastfeeding for the BINGO and PAIRINGS Versus Infant Feeding Practices Study II Populations
There were strong correlations among the six items pertaining to maternal knowledge about the health effects of breastfeeding in our study group (Spearman correlation coefficients 0.08–0.65, all p
values ≤0.01). We similarly found strong correlations among the three items pertaining to mothers' degree of comfort in breastfeeding in social situations (Spearman correlation coefficients 0.52–0.71, all p
Maternal knowledge of breastfeeding's health effects was significantly associated with prenatal feeding intentions in a dose-dependent manner (all p
values for trend <
0.05) (). In multivariate-adjusted models, women who disagreed with the statement about formula's equivalence with breastmilk were 3.44 times more likely to intend to exclusively breastfeed than exclusively formula feed (95% confidence interval 1.80–6.59) than women who agreed. Moreover, women who disagreed were 2.13 times as likely to plan to mixed feed rather than exclusively formula feed (95% confidence interval 1.13–4.02), compared with women who agreed with this statement. We similarly found marked differences in breastfeeding intention by degree of agreement with statements about breastfeeding and infant risk of ear infections, respiratory infections, diarrhea, and obesity, as well as with the statement “Babies should be fed only breastmilk for the first 6 months.”
Among BINGO and PAIRINGS Participants, Maternal Opinions About the Health Effects of Breastfeeding and Intention to Breastfeed Exclusively or Mixed Feed Versus Formula Feed by Multinomial Logistic Regression Model
Maternal agreement with statements about health effects also predicted exclusive breastfeeding versus mixed feeding intention, as well as duration of intended exclusive breastfeeding (). Mothers who agreed that babies should be fed only breastmilk for the first 6 months were 3.16 times as likely to intend to exclusively breastfeed versus mixed feed than women who held the opposite opinion (95% confidence interval 2.28-4.37, ). This statement was also strongly associated with intended duration: Women who agreed that babies should be fed only breastmilk for the first 6 months had exclusive breastfeeding intentions 1.65 months longer (95% confidence interval 1.27–2.04) than women who disagreed. Women who agreed that breastfed babies were less likely to get ear infections, respiratory infections, or diarrhea or become obese were 1.98–2.73 times as likely to intend to exclusively breastfeed, and they intended to exclusively breastfeed for 0.62–1.26 months longer, than those who disagreed with these statements.
We also found associations between maternal comfort in breastfeeding in social situations and intent to exclusively breastfeed. Women who were comfortable in breastfeeding in front of close women friends, men and women they were close to, and in public were 1.77, 1.72, and 1.63 times as likely to plan exclusive breastfeeding versus mixed feeding as women who were uncomfortable in these settings in multivariate-adjusted models (). Increasing comfort was also associated with longer intended exclusive duration: Women who were comfortable breastfeeding in public planned to breastfeed exclusively 0.84 month longer (95% confidence interval 0.41–1.28 months) than women who were uncomfortable breastfeeding in public.
Among BINGO and PAIRINGS Participants, Maternal Comfort with Breastfeeding in Social Settings and Intention to Exclusively Breastfeed Versus Mixed Feed
When we tested for interactions among nulliparity, maternal knowledge and comfort, and intended exclusive duration, we found no evidence that parity altered the observed associations (all interaction p