Abstract and Introduction
Abstract
We examined the influence of duration of exclusive breastfeeding (DEBF) for a mother's earlier children on the DEBF for her later children among multiparous women from the 2002 National Survey of Family Growth. DEBF was categorized as: never breastfed (NBF) (referent); not exclusively breastfed or exclusively breastfed for<4 months (EBF < 4); and exclusively breastfed for ≥4 months (EBF ≥ 4). We examined DEBF using weighted percentages and odds ratios (OR) with 95% confidence intervals (CI) from multinomial logistic regression models, adjusting for maternal factors. About 70% of multiparous women (n = 2,149) repeated the duration of exclusive breastfeeding of their first child for their second child; 14% of women repeated EBF ≥ 4. Among multiparous women, the adjusted odds ratio for EBF ≥ 4 for second children was 7.2 (95% CI = 4.0–12.9) when first children were EBF <4 and 90.7 (95% CI = 45.4–181.4) when first children were EBF ≥ 4, relative to NBF first children. In analyses where DEBF of third children was the outcome, odds of EBF ≥ 4 were more strongly influenced by DEBF of second children while the impact of DEBF of first children was not as strong. Older maternal age and being married were related to an increased DEBF. Being married at second birth predicted a change from NBF for first children to EBF ≥ 4 for second children (OR = 6.2, 95% CI = 2.7–14.2). In conclusion, mothers generally repeated the DEBF of their previous child. For third children, DEBF of the second child was more likely to be repeated than that of the first child.
Introduction
Exclusive breastfeeding reduces the risk of adverse health outcomes such as breast and ovarian cancers in mothers and diarrhea, respiratory tract infections, and atopic diseases in children. For a number of years, women were encouraged to exclusively breastfeed their infants for 4–6 months. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding through the first 6 months of life. Approximately 14% of women in the United States breastfed their infant exclusively for 6 months in 2006, less than the 17% target for Healthy People 2010.
To improve the duration of exclusive breastfeeding, it is important to first understand how multiple factors influence breastfeeding practices. Studies have consistently shown positive associations between increased duration of breastfeeding and demographic (e.g. older age, married, and higher education), biological (e.g. sufficient milk supply), and social (e.g. familial and peer support) factors. Previous breastfeeding practices, however, have been examined less frequently. Recent reports have shown that mothers tend to repeat the breastfeeding practices of previous children with later children but these studies, with the exception of one, were conducted outside the United States or were not nationally representative.
Taylor et al. used data from the 2002 National Survey of Family Growth (NSFG) to examine the impact of birth order on breastfeeding initiation. The authors speculated that compared with children of lower birth order, the likelihood of breastfeeding children of higher birth order would decrease as family size and demands increased. Instead, they found that women who breastfed their first child were likely to also breastfeed subsequent children, irrespective of the number of children they had.
Our study builds on the work of Taylor et al. by using the 2002 NSFG to examine the influence of duration of exclusive breastfeeding for a mother's earlier children on the duration of exclusive breastfeeding for her later children. We also investigated whether maternal demographic factors influenced the duration of exclusive breastfeeding of second children, given the duration of exclusive breastfeeding of first children.