1. Breastfeeding supports and challenges: Report Highlights Minnesota Breastfeeding Coalition meeting (St. Paul, MN) October 25, 2010 Laura Schauben Wilder Research

2. Background

3. Purpose of study To learn more about how to promote a supportive environment for breastfeeding Primary foci was healthcare and employment settings Collected some information about influence of childcare and family and friends as well. Wilder Research

4. Methodology Given limited resources, emphasized learning about women who are underrepresented in current literature ─ Rural women ─ Low-income women (level of education used as proxy) ─ Somali women ─ Native American women ─ Hmong and Latina focus groups also added Wilder Research Evaluation Workshop

5. Methodology 12 focus groups (95 participants) ─ Focus of questions was environmental conditions ─ Participants generally readily discussed personal experience 82 interviews ─ Focus of questions was personal experience Wilder Research Evaluation Workshop

6. Participants Primarily 18-34 years old (focus group: 85%, interview participants: 86%) College degree or higher (focus group: 20%, interview participants: 36%) Wilder Research Evaluation Workshop

7. Participants Most common race/ethnicity: ─ White (focus group: 33%, interview participants: 59%) ─ Hispanic/Latina (focus group: 21%, interview participants 5%:) ─ African American/African (focus group: 20%, interview participants 18%) ─ Native American (focus group: 18%, interview participants 19%) Wilder Research Evaluation Workshop

8. Participants Employment status ─ Stay-at-home parent (focus group: 41%, interview participants: 43%) ─ Employed PT or FT (focus group: 37%, interview participants: 35%:) Geography: Twin Cities (focus group: 49%, interview participants: 68%) Number of children ─ Mean=2 ─ Mode=1 ─ Range: 1 - 11 Wilder Research Evaluation Workshop

9. Findings

10. Infant feeding: Plan before birth Before their babies were born: ─ 75% of women planned to breastfeed exclusively ─ 8% planned to breastfeed in combination with formula ─ Largest influence (besides their own previous experience) was family and friends Almost all who planned to breastfeed, initiated it Wilder Research Evaluation Workshop

11. Infant feeding: Current method ≤6 mos. (N=77) 7-12 mos. (N=90) Total (N=167) Breastfeeding39%48%44% Formula feeding47%38%42% Both breastfeeding and formula 14%10%12% Other (solids, milk)0%4%2% Wilder Research Evaluation Workshop

12. Perceived benefits BreastfeedingFormula feeding Healthier for baby (more vitamins, better immunity) and mom (better weight loss and lower cancer risk) Convenient (less embarrassing, more independence for Mom, More bonding time for Dad, keeps baby full longer) Important bonding opportunityMore comfortable for mom ConvenientHealthier for baby (more vitamins in formula) Inexpensive/less expensiveEasier to monitor how much baby is eating Wilder Research Evaluation Workshop

13. Health care: Sources of information Literature most common Verbal advice and hands on help also common Many women received formula at hospital A few women took classes and/or noted hospitals encouraging skin-to-skin contact Most information provided at hospital (rather than during prenatal appointments) Wilder Research Evaluation Workshop

14. Health care: Influence on infant feeding Overall, participants did not feel their health care provider influenced their decision, as generally their decision was already made Participants did want and appreciate providers support for their infant feeding decision Wilder Research Evaluation Workshop

15. Health care: Participants’ recommendations Provide more information on ─ Logistics of breastfeeding ─ Formula ─ Combining breastfeeding and formula feeding Provide mothers with a mentor/“breast buddy” Include infant feeding as part of birth plan Wilder Research Evaluation Workshop

16. Work site: Sources of support Formal policies: existence and enforcement Space: Privacy and availability Time: Availability and impact on others Storage: Privacy and proximity Emotional support: Supervisors and co-workers Wilder Research Evaluation Workshop

17. Work site: Influence of infant feeding For many stay-at-home moms, wanting to breastfeed influenced decision not to work. Most participants who returned to work didn’t feel doing so influenced their feeding plans However, small group of women said going back to work was catalyst for using formula Wilder Research Evaluation Workshop

18. Social support: Women most influenced by family and friends beliefs and experiences. Partners most common source of support Mothers, other family members, and friends provide advice and support WIC program also mentioned as source of information and resources Wilder Research Evaluation Workshop

19. Population-specific findings Substantial more similarities than differences Native American participants ─ Breastfeeding is seen at traditional for Native American mothers and having benefit for mother and baby ─ Small proportion than participants overall planned to breastfeed Wilder Research Evaluation Workshop

20. Population-specific findings Latina participants ─ Believed breastfeeding natural and common in their culture ─ Some feared losing their job if they requested too many accommodations for pumping Somali participants ─ Breastfeeding supported by Qur’an ─ Most stayed at home in order to breastfeed Wilder Research Evaluation Workshop

21. Population-specific findings Hmong participants ─ See breastfeeding as cheaper and good for bonding. Few mentioned health benefits ─ Described hearing others opinions about how they feed their baby as stressful Women with a HS education or lower ─ See breastfeeding as more convenient and healthier ─ Formula led to faster weight gain for babies, allowed family members to help, and was less embarrassing Wilder Research Evaluation Workshop

22. Recommendations

23. Recommendations: Health care system Use multiple methods and mediums to share information Ensure information is culturally-appropriate Talk about breastfeeding early Include feeding as part of the birth plan Wilder Research Evaluation Workshop

24. Recommendations: Work site Provide facilities for breast milk pumping and storage Dedicate a staff member to support women Wilder Research Evaluation Workshop

25. Recommendations: Government Develop a public awareness campaign Increase awareness of the benefits of breastfeeding in cultural communities Develop or expand peer support networks for breastfeeding Educate worksites on existing state breastfeeding policies and how to implement them Wilder Research Evaluation Workshop