Barriers and Contributors to Breastfeeding in WIC Mothers: A Social Ecological Perspective

Background: In response to the Surgeon General's Call to Action to Support Breastfeeding, the goal of this research was to assess the barriers and positive contributors to breastfeeding initiation and duration in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants using the social ecological model (SEM). Materials and Methods: A cross-sectional design was used to survey WIC mothers (n=283) in southern New Hampshire. Analysis of breastfeeding initiation and duration revealed statistically significant results primarily at the individual level of the SEM. Findings also showed influences at the interpersonal, community, and organizational levels. There were significant differences in beliefs toward breastfeeding between women who ever breastfed and women who never breastfed. Women who ever breastfed were more likely to agree that breastfeeding assists with losing baby weight (89% versus 77%; p=0.03), babies fed breastmilk are less likely to get sick (86% versus 74%; p=0.04), and breastfeeding helps mothers bond with their babies more quickly than formula feeding (88% versus 72%; p<0.01). Breastfeeding duration was significantly related to employment status; among women who breastfed for 6 months or longer, 15% were employed full-time, 30% worked part-time, and 55% indicated other such as unemployed or stay-at-home mother (p=0.01). Logistic regression revealed that maternal age was the most significant predictor of breastfeeding duration (odds ratio=1.11; 95% confidence interval, 1.03, 1.19; p<0.004). Conclusions: Results indicate opportunities to inform and support women in the prenatal and postpartum period, improve the social and built environment, and develop and advocate for policies in an effort to support breastfeeding.