Barriers to Breastfeeding Reported by Exclusively Formula Feeding Mothers

Monday, October 4, 2010: 3:00 PM
Yerba Buena Salons 1-3 (San Francisco Marriott Marquis)
Amudha Palaniappan, Lori Feldman-Winter and Sandra Knapp, Pediatrics, Cooper University Hospital, Camden, NJ


The objective of this study is to determine various barriers reported by exclusively formula feeding mothers from different racial groups among an urban population associated with a large teaching hospital. We expect African-American/Black mothers to report different barriers to breastfeeding than non-African-American/Black mothers. This research will help identify potential barriers that contribute to the disparities in breastfeeding.


While exclusive formula feeding is becoming rarer in the US, African American/blacks (AA/B) continue to have the highest rates of exclusive formula feeding and their breastfeeding rates continue to be far from Healthy People 2010 objectives. New Jersey has an overall breastfeeding rate of 81%, yet the breastfeeding rate among mothers in racially and ethnically diverse urban populations, specifically African-American/Blacks, is much lower.


Data was collected from a subset of a larger ongoing prospective cohort study. This subset included only mothers who were exclusively formula feeding during postnatal period. An open ended question was posed, "Is there any particular reason why you chose not to breastfeed?” Responses were recorded verbatim and coded into categories: easily modifiable barriers (fear of pain, latching problems, milk supply issues, misinformation); and not easily modifiable barriers (lack of self efficacy, lack of desire, previous formula feeding history, return to work/school, true contraindications). Pearson Chi Square and Fisher Exact Test were used to test proportion differences with Bonferroni correction for multiple testing.


There were 62 (43%) African-American/Blacks (AA/B) and 83 (57%) non-AA/B, who participated in the study. 23% of AA/B vs. 42% of non-AA/B had easily modifiable barriers (p=0.01). 89% of AA/B vs. 74% non-AA/B had not easily modifiable barriers (p=0.02). “Lack of desire to breastfeed” was the most commonly reported barrier with 55% AA/B vs. 27% non-AA/B (P < 0.01). “Misinformation” (General, Tobacco, Medications) was significantly more commonly reported among non AA/B (p=0.02).


African-American/Blacks reported more not easily modifiable barriers and lack of desire to breastfeed. Nommenson-Rivers recently reported that formula feeding comfort strongly predicted and substantially mediated ethnic disparities in breastfeeding initiation and comfort with formula feeding was the most influential reason for not breastfeeding among blacks(1). Structured and coordinated efforts to educate mothers and their families about breastfeeding and clarification of misinformation and myths about breastfeeding both prenatally and during the immediate postnatal period may lead to higher rates of breastfeeding among a diverse urban population. This education should include a rationale for why exclusive formula feeding should not provide comfort but rather poses risks.


1. Nommsen-Rivers LA, Chantry CJ, Cohen RJ, Dewey KG. Comfort with the idea of formula feeding helps explain ethnic disparity in breastfeeding intensions among expectant first-time mothers. Breastfeed Med. 2010 Feb; 5:25-33.

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