Risk Factors for Cessation of Breastfeeding Prior to Six Months Postpartum among a Community Sample of Women in Calgary, Alberta

By Kehler, Heather L.; Chaput, Katie H. et al. | Canadian Journal of Public Health, September/October 2009 | Go to article overview

Risk Factors for Cessation of Breastfeeding Prior to Six Months Postpartum among a Community Sample of Women in Calgary, Alberta


Kehler, Heather L., Chaput, Katie H., Tough, Suzanne C., Canadian Journal of Public Health


ABSTRACT

Objectives: To describe the rates of breastfeeding initiation and breastfeeding for at least six months and identify risk factors for failing to breastfeed for six months among a community sample of mothers in Calgary, Alberta.

Methods: A cohort of women (n=1737) who participated in a longitudinal study of prenatal support and who could be contacted when their child was three years old (n=1147) were invited to participate in a follow-up telephone questionnaire. Of these 1147 women, 780 (69% participating rate) participated and provided breastfeeding data. Risk factors for early cessation of breastfeeding prior to six months were identified using bivariate and multivariable strategies.

Results: Of the 780 women, 95.6% initiated breastfeeding and 71.6% continued to breastfeed for at least six months. Risk factors identified for early cessation included younger maternal age, obesity prior to pregnancy, lower maternal education, working full-time or intending to within the first year, history of depression, depression or anxiety during pregnancy, poor social support, and smoking during pregnancy (all p<0.05). Multivariable analysis revealed that working full-time or intending to within the first year, lower maternal education, obesity prior to pregnancy and anxiety during pregnancy most increased a woman's risk of early cessation (all p<0.05).

Conclusion: Nearly all mothers initiated breastfeeding and 70% continued to breastfeed for six months, although subgroups of women remained at an elevated risk of early cessation. Research to better understand breastfeeding decisions among women with the risk factors identified is needed to facilitate the development of more effective breastfeeding promotion strategies.

Key words: Breastfeeding; cessation; risk factors; epidemiology

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2009;100(4):376-80.

The benefits of breastfeeding for children and mothers are well established.1 Children who are breastfed have a reduced risk of gastrointestinal infections,2,3 respiratory tract infections,4 asthma1,5 and obesity and diabetes later in life.6 Mothers who breastfeed lower their risk of breast and ovarian cancers and type 2 diabetes.1 The strength of this evidence has led to global recommendations developed by the World Health Organization, and adopted by Health Canada for exclusive breastfeeding until six months of age and continued breastfeeding for up to two years.7,8 Data from the Canadian Community Health Survey conducted in 2003 found 84.5% of mothers in Canada initiate breastfeeding and 38.7% continue to breastfeed for at least six months.9

Studies conducted in developed countries have consistently reported younger maternal age,10-21 lower education,11,13,14,17,22 lower income,18,23,24 smoking,14,17,21-23,25 returning to work fulltime, 19,20 and higher body mass index25-27 as negatively associated with breastfeeding duration. In Canada, women are entitled to a 12-month maternity leave policy which ensures they can return to their job or an equal position and receipt of 55% of their salary up to a maximum of $435 per week for those who have worked at least 600 insurable hours in the year prior to birth.28 This policy may make it more feasible for women to breastfeed during the first postpartum year and the universal health care system may improve access to breastfeeding support services for lower-income women. Therefore, this study was undertaken to determine what factors contribute to the majority of women failing to breastfeed for at least six months in Canada.

The purpose of this study was to describe current rates of breastfeeding initiation and continuation for six months among mothers in Calgary, Alberta and to identify risk factors for early cessation of breastfeeding, defined as breastfeeding cessation prior to six months postpartum.

METHODS

Women who participated in the Community Perinatal Care study (CPC), a trial of increasing support during pregnancy, were contacted by telephone and asked to participate in a follow-up study when their child was three years of age. …

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