Las dos cosas: an analysis of attitudes of latina women on non-exclusive breastfeeding.
BACKGROUND
Non-exclusive breastfeeding among Latina women is commonly seen in the newborn period. The reasons behind las dos cosas ("both things") are not well understood but have included the beliefs that formula has vitamins and that adding formula will result in a chubbier baby, which is desirable. Many previous studies involved Mexican and Puerto Rican women living in the mainland United States.


METHODS
We performed detailed semistructured interviews with 17 Latina mothers in late pregnancy or the newborn period at a community hospital and an affiliated clinic in Massachusetts, serving a large Dominican population. Women were asked about their beliefs about breastfeeding, colostrum, and infant formula. Transcripts were analyzed using Nvivo 9 software (QSR International Pty. Ltd., Melbourne, Australia) to identify the frequencies of common trends.


RESULTS
The most common reasons for introducing formula were treatment for insufficient milk, to keep the baby fuller longer, and planning for return to work. None of the women understood the potential risks of introducing formula on the establishment of breastfeeding, particularly on milk supply. Many thought that even limited amounts of breastfeeding were sufficient to produce a healthier child, failing to understand a negative dose-response effect of formula on health and milk production. While every woman saw breastfeeding as healthier, only one saw formula as unhealthy, an important distinction. None of the women expressed familiarity with medical recommendations around breastfeeding duration or exclusivity, with many believing that breastmilk alone would be insufficient to satisfy the hunger or nutritional needs of a growing child after as little as 3 months. Women consistently demonstrated a willingness to learn from health professionals.


CONCLUSIONS
In counseling Latina women, it may be important to discuss the risks of formula to infant health, breastfeeding, and milk supply and to include the medical recommendations for breastfeeding exclusivity. Educational opportunities exist in the prenatal setting and when postpartum women request formula.
Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts 02139, USA. melissabartick@gmail.com
Melissa
M
Bartick
Catherine
C
Reyes
D000328:Adult; D001903:Bottle Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D008800:Mexico / Q000208:ethnology; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D010379:Peer Group; D011247:Pregnancy; D011647:Puerto Rico / Q000208:ethnology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology