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OBJECTIVES: This study aimed to understand why breastfeeding and exclusive breastfeeding rates substantially decrease shortly after birth among mothers in the USA. Specifically, we aimed to illuminate the impact of stressful life events and racial discrimination on mothers' breastfeeding behaviors and duration. METHODS: We conducted a qualitative analysis of semi-structured telephone interviews with women (N = 66; 47 White, 16 Black, and 3 Hispanic) who gave birth between 2019 and 2021 in Ohio. Interviews were conducted between March 2022 and May 2022. Interviews were digitally recorded, transcribed verbatim, analyzed, coded, and organized into themes. RESULTS: After thematic analysis of the data, five key themes were identified: (1) stress, (2) breastfeeding barriers, (3) policy and system change to support breastfeeding mothers, (4) racial discrimination, and (5) breastfeeding motivators. Our study found that the breastfeeding experience was both a positive bonding experience and a challenging practice, characterized by physical, mental, and sociocultural struggles. CONCLUSION FOR PRACTICE: Addressing stress during pregnancy, equitable access to culturally sensitive lactation support, improved parental leave, and enhanced workplace breastfeeding regulations are essential to increasing breastfeeding duration among racially marginalized women.
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Breastfeeding is invaluable for postpartum physical healing and mental wellbeing, but psychosocial stress and depression impede such recovery processes. To inform future interventions and policies, associations between breastfeeding, maternal stress, and depression were examined. Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed (2016-2019). Logistic regression models were used to calculate adjusted odds ratios with 95% confidence intervals. Of the total sample (n = 95,820), approximately 88% of participants attempted breastfeeding. Our findings indicate that participants who experienced any form of stress had a slightly higher likelihood of breastfeeding compared to those without stress. Specifically, partner-related and financial-related stressors were significantly associated with increased odds of breastfeeding. However, no significant associations were observed trauma-related or emotional-related stressors and breastfeeding. Additionally, no significant association was found between depression at different stages (preconception, prenatal, and postpartum) and breastfeeding. A significant interaction effect was noted between having experienced any of the 13 stressors and Black race/ethnicity on breastfeeding odds. Similarly, significant interaction effects were observed between partner-related, trauma, financial, or emotional stressors and Black race/ethnicity. These findings emphasize the importance of considering various factors when promoting breastfeeding in diverse populations, and screening for psychosocial stress during postpartum visits. Our study recommends tailoring breastfeeding interventions to address the needs of Black mothers which could significantly improve maternal health and breastfeeding outcomes.
RESUMO
Background: Despite the known benefits of breastfeeding, many women in the United States do not exclusively breastfeed for the recommended 6 months due to various factors. Limited studies have examined the association between prenatal stressful life events and exclusive breastfeeding duration. The aim of this study was to examine the association between prenatal stressful life events and exclusive breastfeeding duration for 3 months among mothers in the United States. Materials and Methods: We analyzed data from 2009 to 2011 (Phase 6) Pregnancy Risk Assessment and Monitoring System (PRAMS; n = 43,934). Multivariable logistic regression analyses were performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: Overall, 43% of the study participants exclusively breastfed for 3 months and 52.1% reported having no stressful life events during pregnancy. In the multivariable model, there was a statistically significant interaction between maternal age and number of stressful life events on 3-month exclusive breastfeeding, the odds of exclusive breastfeeding for 3 months were lower among women ≤24 years old who experienced at least ≥2 stressful life events compared with women who did not experience any stressful life events: OR 95% CI 0.80 (0.66-0.98) for 1-2 stressful life events, 0.67 (0.54-0.82) for 3-5 stressful life events, and 0.58 (0.43-0.80) for ≥6 stressful life events, respectively. Conclusions: Identification of stressful life event exposure among young mothers is important for extending support toward this population to increase exclusive breastfeeding duration.
