title: Barriers and Contributors to Breastfeeding in WIC Mothers: A Social Ecological Perspective.
abstract: BACKGROUND
  In response to the Surgeon General's Call to Action to Support Breastfeeding, the goal of this research was to assess the barriers and positive contributors to breastfeeding initiation and duration in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants using the social ecological model (SEM).
  
  
  METHODS
  A cross-sectional design was used to survey WIC mothers (n = 283) in southern New Hampshire. Analysis of breastfeeding initiation and duration revealed statistically significant results primarily at the individual level of the SEM. Findings also showed influences at the interpersonal, community, and organizational levels. There were significant differences in beliefs toward breastfeeding between women who ever breastfed and women who never breastfed. Women who ever breastfed were more likely to agree that breastfeeding assists with losing baby weight (89% versus 77%; p = 0.03), babies fed breastmilk are less likely to get sick (86% versus 74%; p = 0.04), and breastfeeding helps mothers bond with their babies more quickly than formula feeding (88% versus 72%; p < 0.01). Breastfeeding duration was significantly related to employment status; among women who breastfed for 6 months or longer, 15% were employed full-time, 30% worked part-time, and 55% indicated "other" such as unemployed or stay-at-home mother (p = 0.01). Logistic regression revealed that maternal age was the most significant predictor of breastfeeding duration (odds ratio = 1.11; 95% confidence interval, 1.03, 1.19; p < 0.004).
  
  
  CONCLUSIONS
  Results indicate opportunities to inform and support women in the prenatal and postpartum period, improve the social and built environment, and develop and advocate for policies in an effort to support breastfeeding.
authors.affiliation: 1 Department of Health Science, Keene State College , Keene, New Hampshire.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Dunn
authors.affiliation: 1 Department of Health Science, Keene State College , Keene, New Hampshire.
authors.forename: Karrie A
authors.initials: KA
authors.lastname: Kalich
authors.affiliation: 2 Community Health Clinical Integration, Cheshire Medical Center/Dartmouth-Hitchcock Keene , Keene, New Hampshire.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Fedrizzi
authors.affiliation: 3 Consultant , Peterborough, New Hampshire.
authors.forename: Sarah
authors.initials: S
authors.lastname: Phillips
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology*; D009513:New Hampshire / Q000453:epidemiology; D011632:Public Assistance; D012931:Social Environment; D012944:Social Support