title: Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach.
abstract: OBJECTIVE
  To determine factors associated with breastfeeding in rural communities.
  
  
  METHODS
  We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N=1292) of infants born September 2003-2004 and (2) a parallel ethnographic study (N=30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding.
  
  
  RESULTS
  Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance.
  
  
  CONCLUSIONS
  Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.
authors.affiliation: Charles Drew Community Health Center, Piedmont Health Services, 221 North Graham-Hopedale Road, Burlington, NC, USA. kflower@nc.rr.com
authors.forename: Kori B
authors.initials: KB
authors.lastname: Flower
authors.forename: Michael
authors.initials: M
authors.lastname: Willoughby
authors.forename: R Jean
authors.initials: RJ
authors.lastname: Cadigan
authors.forename: Eliana M
authors.initials: EM
authors.lastname: Perrin
authors.forename: Greg
authors.initials: G
authors.lastname: Randolph
mesh_terms: D000293:Adolescent; D000328:Adult; D000884:Anthropology, Cultural; D001942:Breast Feeding / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D009657:North Carolina; D010414:Pennsylvania; D011203:Poverty; D011247:Pregnancy; D036301:Qualitative Research; D012424:Rural Population; D012959:Socioeconomic Factors