title: Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women.
abstract: BACKGROUND
  Despite the benefits of breastfeeding for both infant and mother, rates in the United States remain below Healthy People 2020 breastfeeding objectives. This paper describes breastfeeding outcomes of the Delta Healthy Sprouts participants during gestational and postnatal periods. Of specific interest was whether breastfeeding intent, knowledge, and beliefs changed from the early to late gestational period. Additionally, analyses were conducted to test for associations between breastfeeding initiation and breastfeeding intent, knowledge and beliefs as well as sociodemographic characteristics and other health measures.
  
  
  METHODS
  Eighty-two pregnant women were enrolled in this project spanning three Mississippi counties. Participants were randomly assigned to one of two treatment groups. Because both groups received information about breastfeeding, breastfeeding outcomes were analyzed without regard to treatment assignment. Hence participants were classified into two groups, those that initiated breastfeeding and those that did not initiate breastfeeding. Generalized linear mixed models were used to test for significant group, time, and group by time effects on breastfeeding outcomes.
  
  
  RESULTS
  Breastfeeding knowledge scores increased significantly from baseline to late gestational period for both groups. Across time, breastfeeding belief scores were higher for the group that initiated breastfeeding as compared to the group that did not breastfeed. Only 39% (21 of 54) of participants initiated breastfeeding. Further, only one participant breastfed her infant for at least six months. Breastfeeding intent and beliefs as well as pre-pregnancy weight class significantly predicted breastfeeding initiation.
  
  
  CONCLUSIONS
  Our findings indicate that increasing knowledge about and addressing barriers for breastfeeding were insufficient to empower rural, Southern, primarily African American women to initiate or continue breastfeeding their infants. Improving breastfeeding outcomes for all socioeconomic groups will require consistent, engaging, culturally relevant education that positively influences beliefs as well as social and environmental supports that make breastfeeding the more accepted, convenient, and economical choice for infant feeding.
  
  
  BACKGROUND
  clinicaltrials.gov NCT01746394. Registered 5 December 2012.
authors.affiliation: United States Department of Agriculture, Agricultural Research Service, 141 Experiment Station Road, Stoneville, MS 38776 USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Thomson
authors.affiliation: Department of Medicine and Cancer Center, University of Illinois at Chicago, 416 Westside Research Office Building, 1747 West Roosevelt Road, Chicago, IL 60608 USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Tussing-Humphreys
authors.affiliation: United States Department of Agriculture, Agricultural Research Service, 141 Experiment Station Road, Stoneville, MS 38776 USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Goodman
authors.affiliation: Department of Family and Consumer Sciences, University of Central Arkansas, 201 Donaghey, 113 McAlister Hall, Conway, AR 72035 USA.
authors.forename: Alicia S
authors.initials: AS
authors.lastname: Landry
authors.affiliation: Department of Medicine and Cancer Center, University of Illinois at Chicago, 416 Westside Research Office Building, 1747 West Roosevelt Road, Chicago, IL 60608 USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Olender
keywords: African American; Breastfeeding beliefs; Breastfeeding duration; Breastfeeding initiation; Rural