Previous Breastfeeding Practices and Duration of Exclusive Breastfeeding in the United States

Ghasi Phillips; Kate Brett; Pauline Mendola

Disclosures

Matern Child Health J. 2011;15(8):1210-1216. 

In This Article

Results

Of the 5,095 first-, second-, and third-born children born to multiparous mothers in our sample, 39% were never breastfed, whereas 39% were exclusively breastfed for <4 months, and 22% were exclusively breastfed for ≥4 months (Table 1). The median number (95% confidence limits) of months of exclusive breastfeeding was 0.7 (0.6, 0.9) among those exclusively breastfed for <4 months and was 5.0 (4.6, 5.1) among those exclusively breastfed for ≥4 months. Children born to mothers who were B25 years of age, unmarried, or NH black were less likely to be exclusively breastfed for ≥4 months compared to other children.

All subsequent results are based on the mother as the unit of analysis. Approximately 70% of 2,149 multiparous women repeated the duration of exclusive breastfeeding of the first child for the second (Table 2). Fourteen percent of mothers exclusively breastfed their first two children for ≥4 months and about 2% (n = 45) switched from not breastfeeding their first child to exclusively breastfeeding their second child for ≥4 months. While approximately 60% of women with three or more children repeated the duration of exclusive breastfeeding of the first child for the second and third, only 13% exclusively breastfed all three children for ≥4 months. Among women with three or more children, about 20% repeated duration of breastfeeding for the second and third child only and 11% repeated duration for the first and second child only.

Table 3 presents adjusted odds ratios and 95% confidence intervals for duration of exclusive breastfeeding for the second child in relation to duration of exclusive breastfeeding of the first child and maternal demographic characteristics of the second child. Relative to mothers who never breastfed their first child, mothers who exclusively breastfed their first child for ≥4 months had significantly greater odds (OR = 90.7, 95% CI: 45.4–181.4) of breastfeeding the second child exclusively for ≥4 months after adjustment for maternal characteristics. This large estimate is a reflection of the odds overestimating the relative risk due to the high prevalence of mothers repeating breastfeeding practices for her children. In the same model, we observed married women and older mothers were more likely to exclusively breastfeed second children than their counterparts even after adjustment for the duration of exclusive breastfeeding of their first child.

Duration of exclusive breastfeeding of third children was also highly influenced by the mother's practice with earlier children (Table 4). Relative to mothers who never breastfed their second child, mothers who exclusively breastfed their second child for ≥4 months had substantially greater odds of exclusively breastfeeding their third child for ≥4 months, adjusting for the duration of exclusive breastfeeding for the first child and maternal characteristics of the third child (OR = 93.2, 95% CI = 30.8–281.8). The impact on exclusive breastfeeding for ≥4 months for third children was weaker for duration of exclusive breastfeeding of first children in adjusted models that included the duration of exclusive breastfeeding of second children along with maternal characteristics (OR = 6.5, 95% CI = 2.5–16.8).

Although we had little statistical power to evaluate characteristics of mothers who changed breastfeeding practices between the first and second child, we did observe that among mothers who never breastfed their first child (n = 883), mothers married at their second birth had significantly greater odds of exclusively breastfeeding their second child ≥ 4 months, relative to unmarried mothers at second birth (OR = 3.5, 95% CI: 2.0–6.2). This association strengthened after additional adjustment for marital status at first birth (OR = 6.2, 95% CI: 2.7–14.2). Among mothers who exclusively breastfed their first child for <4 months (n = 788), married women at second birth had approximately half the odds of never breastfeeding their second child, compared with unmarried women. This association, however, lost statistical significance after adjusting for marital status at first birth (OR = 0.4, 95% CI: 0.2–1.1). Among mothers who exclusively breastfed their first child for ≥4 months (n = 478), we observed no significant differences by marital status in the odds of switching from exclusively breastfeeding the first child for ≥4 months to never breastfeeding the second child or exclusively breastfeeding the second child for <4 months. Furthermore, we found no statistically significant evidence of maternal age at second birth or race/ethnicity as predictors of changing practices between the first two children, regardless of the exclusive breastfeeding duration of the first child.

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