Mothers' attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa.
BACKGROUND
In American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration.


OBJECTIVE
(1) To examine American Samoan mothers' feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding.


METHODS
Eighteen semi-structured interviews were conducted with American Samoan mothers at 16-32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data.


RESULTS
Intention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous "back-up option" where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design.


CONCLUSIONS
This study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.
Department of Chronic Disease Epidemiology, School of Public Health, Yale University, United States. Electronic address: nicola.hawley@yale.edu.
Nicola L
NL
Hawley
Centers for Behavioral and Preventative Medicine, The Miriam Hospital, United States; Department of Behavioral and Social Sciences, Warren Alpert Medical School, Brown University, United States.
Rochelle K
RK
Rosen
International Health Institute, School of Public Health, Brown University, United States.
E Ashton
EA
Strait
Department of Behavioral and Social Sciences, Warren Alpert Medical School, Brown University, United States.
Gabriela
G
Raffucci
International Health Institute, School of Public Health, Brown University, United States.
Inga
I
Holmdahl
International Health Institute, School of Public Health, Brown University, United States.
Joshua R
JR
Freeman
Lyndon B Johnson Tropical Medical Center, American Samoa.
Bethel T
BT
Muasau-Howard
International Health Institute, School of Public Health, Brown University, United States.
Stephen T
ST
McGarvey
D000328:Adult; D018948:American Samoa; D001942:Breast Feeding / Q000208:ethnology*; D002755:Choice Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007223:Infant; D008425:Maternal Behavior / Q000208:ethnology*; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D012938:Social Perception; D055815:Young Adult
American Samoa; Breastfeeding; Formula; Infant feeding; Mothers