title: Are starting and continuing breastfeeding related to educational background? The generation R study.
abstract: OBJECTIVE
  To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association.
  
  
  METHODS
  We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously.
  
  
  RESULTS
  Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics.
  
  
  CONCLUSIONS
  Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women.
authors.affiliation: Generation R Study Group, Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands. l.vanrossem@erasmusmc.nl
authors.forename: Lenie
authors.initials: L
authors.lastname: van Rossem
authors.forename: Anke
authors.initials: A
authors.lastname: Oenema
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.forename: Vincent W V
authors.initials: VW
authors.lastname: Jaddoe
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008019:Life Style; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires