title: Clinician support and psychosocial risk factors associated with breastfeeding discontinuation.
abstract: OBJECTIVE
  Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations. The current, national breastfeeding continuation rate of 29% at 6 months lags behind the Healthy People 2010 goal of 50%. The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support, maternal physical and mental health status, workplace issues, and other factors amenable to intervention.
  
  
  METHODS
  A prospective cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a randomized, controlled trial of home visits. Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks. Logistic regression modeling was performed to assess the independent effects of the predictors of interest, adjusting for sociodemographic and other confounding variables.
  
  
  RESULTS
  Of the 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated breastfeeding, 872 (75%) were breastfeeding at the 2-week interview, and 646 (55%) were breastfeeding at the 12-week interview. In the final multivariate models, breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.02-7.6), early breastfeeding problems (OR: 1.5; 95% CI: 1.1-1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1-5.7), and lower maternal education (OR: 1.5; 95% CI: 1.2-1.9). Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported (during the 12-week interview) having received encouragement from their clinician to breastfeed (OR: 0.6; 95% CI: 0.4-0.8). Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms (OR: 1.18; 95% CI: 1.01-1.37) and returning to work or school by 12 weeks postpartum (OR: 2.4; 95% CI: 1.8-3.3).
  
  
  CONCLUSIONS
  Our results indicate that support from clinicians and maternal depressive symptoms are associated with breastfeeding duration. Attention to these issues may help to promote breastfeeding continuation among mothers who initiate. Policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may also be important, given the elevated risk of discontinuation associated with return to work or school.
authors.affiliation: Harvard Pediatric Health Services Research Fellowship Program, Children's Hospital of Boston, Boston, Massachusetts 02115, USA. elsie.taveras@tch.harvard.edu
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Angela M
authors.initials: AM
authors.lastname: Capra
authors.forename: Paula A
authors.initials: PA
authors.lastname: Braveman
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Jensvold
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D002140:California; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000523:psychology; D004493:Education; D004651:Employment; D005006:Ethnicity; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008423:Maternal Age; D009035:Mothers / Q000523:psychology*; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D049590:Postpartum Period / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D014886:Weaning