Best of Intentions: Influential Factors in Infant Feeding Intent among Marshallese Pregnant Women

Breastfeeding Intentions among Pregnant Women Enrolled in a Healthy Start Program in Arkansas

INTRODUCTION

Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program.

METHODS

The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program.

RESULTS

The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding.

DISCUSSION

This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods.

Assessing the acceptability and implementation feasibility of a culturally adapted parenting intervention for Marshallese mothers: A study protocol

Background

Pacific Islanders, including the Marshallese, face higher rates of obesity and obesity-related chronic conditions. Early-life interventions targeting eating patterns during the first 1000 days of life are essential to promote proper nutrition and growth. Marshallese mothers and caregivers are important decision-makers for feeding practices that could affect childhood obesity rates in Marshallese children. However, little is known about dietary patterns and practices of Marshallese families from birth to 12 months. Culturally-adapted approaches using community-based assets and Pacific Islander cultural values/practices have demonstrated effectiveness in reducing obesity but have not been developed for children.

Methods

This article describes the protocol for a study to culturally adapt the Centering Parenting intervention for Marshallese mothers in Arkansas.

Conclusion

This will be the first study to culturally adapt and implement Centering Parenting with Marshallese women in the United States. This study will be an important first step to assess the feasibility and acceptability of an abbreviated parenting intervention to reduce childhood obesity in Marshallese communities.

Breastfeeding Outcomes Associated With the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) promotes and supports breastfeeding for low-income women and children. A prior review reported negative associations of WIC with breastfeeding outcomes. WIC food package changes in 2009 increased breastfeeding support.

OBJECTIVE

The objectives of this systematic review were to 1) evaluate evidence on WIC participation and breastfeeding outcomes and 2) evaluate breastfeeding outcomes of WIC participants before versus after the 2009 food package.

DATA SOURCES

PubMed, Embase®, CINAHL, ERIC, SCOPUS, PsycINFO, and the Cochrane Central Register of Controlled Trials for papers published January 2009 to April 2022.

ELIGIBILITY CRITERIA

Included studies compared breastfeeding outcomes (initiation, duration, exclusivity, early introduction of solid foods) of WIC participants with WIC-eligible nonparticipants, or among WIC participants before versus after the 2009 package change.

STUDY APPRAISAL METHODS

Two independent reviewers evaluated each study and assessed risk of bias using EHPHP assessment.

RESULTS

From 13 observational studies we found: 1) moderate strength of evidence (SOE) of no difference in initiation associated with WIC participation; 2) insufficient evidence regarding WIC participation and breastfeeding duration or exclusivity; 3) low SOE that the 2009 food package change is associated with greater breastfeeding exclusivity; 4) low SOE that WIC breastfeeding support services are positively associated with initiation and duration.

LIMITATIONS

Only observational studies, with substantial risk of bias and heterogeneity in outcomes and exposures.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

WIC participation is not associated with a difference in breastfeeding initiation compared to WIC-eligible nonparticipants, but the 2009 food package change may have improved breastfeeding exclusivity among WIC participants and receipt of breastfeeding support services may have improved breastfeeding initiation and duration.

"It's Okay With Our Culture but We're in a Different Place and We Have to Show Respect": Marshallese Migrants and Exclusive Breastfeeding Initiation

BACKGROUND

Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups.

RESEARCH AIM

To describe infant feeding beliefs and experiences of Marshallese living in the United States.

METHODS

We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants (N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6-8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques.

RESULTS

Participants' mean age was 27.1 years (SD = 6.1), and 88.9% (n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership (n = 28, 77.8%). Most participants had a high school education or lower (n = 30, 83.3%). Mean household size was 7.2 (SD = 2.8). Fewer than half of participants had no health insurance (n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants' infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public.

CONCLUSIONS

Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6-8 weeks postpartum. Findings will inform future health education programs.

Sociodemographic and Personal Predictors of Exclusive Breastfeeding in Pregnant Mexican Women Using Public Health Services

Exclusive breastfeeding (EBF) is a cost-effective healthy behavior for the mother–child dyad. Globally, rates of EBF are low. Little research has been conducted on the joint role of modifiable and nonmodifiable variables in pregnant women’s decision-making. The aim was to develop and test a model that used personal and sociodemographic factors to predict whether pregnant women who use public healthcare services plan to breastfeed. In a nonprobabilistic sample of 728 pregnant Mexican women, self-efficacy, the planned behavior theory constructs, and the intention to breastfeed (BFI) were measured. A total 60% of the sample was randomly chosen to develop a predictive multivariate logistic regression model. The model was validated in the remaining 40%. Women in the highest tertiles of attitudes and self-efficacy had fourfold increased chances of having a high BFI (OR 4.2, 95% CI [2.4, 7.4]). Working was associated with a decreased intention to exclusively breastfeed (OR 0.61, 95% CI [0.37, 0.98]). The model predicted BFI with a sensitivity of 38.3% and specificity of 82.2%. While personal variables predict the BFI, working decreases women’s chances of breastfeeding. The results can be utilized to develop primary prevention strategies to help mothers who use public health services to breastfeed.