Strategies to promote breast-feeding among adolescent mothers

Objective: To identify characteristics of adolescent mothers who bottle- feed who considered breast-feeding their infants and strategies to promote breast-feeding within this special group. Design: Adolescents completed an hour-long interview within 48 hours of delivery that elicited factors considered important to the mother's feeding decision and indices of mental health. Setting: Postpartum ward of university hospital. Subjects: A total of 693 adolescents 18 years old or younger (mean age, 16.7 years) from African American, Mexican American, or white race or ethnicity; 27% of Mexican American participants spoke little or no English. Main Outcome Measures: Factors associated with breast-feeding decision. Results: Those who chose bottle-feeding (hereafter, bottle-feeders) who had considered breast-feeding were first compared with bottle-feeders who had not considered breast- feeding and then with adolescents who breast-fed. After controlling for ethnicity, bottle-feeders who had considered breast-feeding were more likely than those who had not considered breast-feeding to be impoverished (adjusted odds ratio [AOR] = 4.8), to have delayed their feeding decision until the later stages of pregnancy (AOR = 4.6), to have been encouraged to breast- feed (AOR= 4.5), to have friends who breast-fed (AOR = 2.3), and to have experienced low financial, tangible, emotional, or informational support from their families (AOR = 1.6). They were more likely to cite barriers associated with breast-feeding while returning to school or work (AOR = 2.0) and less likely to state that bottle-feeding was healthier (AOR = 0.3) as reasons for bottle-feeding. Compared with those who chose breast-feeding (hereafter, breast-feeders), this group was more likely to have made the feeding decision alone rather than relying on advice (AOR = 4.6), to have made this decision in the later stages of pregnancy (AOR = 4.4), to report fewer breast-feeding role models (AOR = 1.8) and fewer significant others who encouraged breast- feeding (AOR = 2.8), and to report at least 2 significant others who encouraged bottle-feeding (AOR = 3.2). They were also less likely to have attempted to breast-feed a previous child (AOR = 3.3). Conclusions: A subgroup of adolescent mothers who had considered breast-feeding but ultimately chose to bottle-feed may be identified in the late stages of gestation by collecting information on financial status, family support, perceived barriers to breast-feeding and attending school or working, timing of the feeding decision, prior breast-feeding experience, breast-feeding role models, and encouragement to breast-feed. We speculate that strategies to promote breast-feeding should focus on role modeling and facilitation.