ABSTRACT
OBJECTIVE: To examine the association between unintended pregnancy and the initiation and duration of breastfeeding.
STUDY DESIGN: This was a secondary data analysis of the 1995 Cycle 5 of the National Survey of Family Growth.
POPULATION: We studied 6733 first singleton live births to US women aged 15 years to 44 years.
OUTCOMES MEASURED: Using the 1995 Institute of Medicine definitions, pregnancies were classified as intended or unintended; unintended pregnancies were further categorized as either mis-timed or unwanted. We measured initiation of breastfeeding and duration of nonexclusive breastfeeding for at least 16 weeks.
RESULTS: In this study, 51.5% of women never breastfed, 48.5% initiated breastfeeding, and 26.4% of all women continued breastfeeding for at least 16 weeks. US women with unwanted unintended pregnancies were more likely not to initiate breastfeeding (odds ratio [OR] = 1.76; 95% confidence interval [CI], 1.26-2.44) and more likely not to continue breastfeeding (OR =1.69; 95% CI, 1.12-2.55) than women with intended pregnancies. White women with unwanted unintended pregnancies were more likely not to breastfeed than those with intended ones (initiation: OR = 2.50; 95% CI, 1.54-4.05; continuation: OR = 2.56; 95% CI, 1.34-4.87). This finding was not seen for black or Hispanic women.
CONCLUSIONS: In the United States, women with unwanted pregnancies were less likely either to initiate or to continue breastfeeding than women with intended pregnancies. A strong inverse association between unwanted pregnancies and breastfeeding was observed only for white women. Education for women with unintended pregnancies may improve breastfeeding rates and subsequently, the health of women and infants.
KEY POINTS FOR CLINICIANS
- In the United States, women whose pregnancies were unwanted are at a higher risk of not breastfeeding than women whose pregnancies were intended.
- Future research to evaluate the importance of incorporating pregnancy intention status into patient-centered breastfeeding promotion is needed.
- For now, women with unwanted pregnancies, especially white women, should be targeted for breastfeeding counseling.
Unintended pregnancy is a significant public health issue. More than half of all pregnancies are unintended at the time of conception; approximately half of those end as births and half as induced abortions.1 Forty-eight percent of women have at least one unplanned pregnancy, and 28% of women have at least one unplanned birth during their reproductive lifetime.2 Unintended pregnancies and births are associated with numerous harmful behaviors and adverse outcomes.3,4
Breastfeeding is currently promoted as the preferred method of feeding for infants for at least 1 year because of its multiple immediate and long-term benefits for both mother and child.5,6 Yet in 1998 only 64% of US mothers were breastfeeding at the time of hospital discharge and 29% at 6 months postpartum, which is well below the Healthy People 2010 goals of 75% and 50%, respectively, for those intervals.7
We hypothesized that women with unintended pregnancies are less likely to breastfeed their infants than those with intended ones. We quantified the association between the intendedness of pregnancy at the time of conception and breastfeeding behavior, both the initiation of any breastfeeding and the continuation of nonexclusive breastfeeding for at least 16 weeks, for first singleton births to US mothers. We then explored other factors which might affect breastfeeding practices.
Methods
Study design
This study is a secondary data analysis of the 1995 Cycle 5 of the National Survey of Family Growth (NSFG), a periodic population-based survey conducted by the National Center for Health Statistics and the Centers for Disease Control which focuses on women’s health and pregnancy. A national probability sample of 14,000 civilian noninstitutionalized women aged 15 years to 44 years was selected from among households that responded to the 1993 National Health Interview Survey, with an oversampling of minority women. Personal interviews were conducted between January and October of 1995 with 10,847 of these women. The data were then adjusted for a response rate of 79% and weighted so that findings would reflect the US population as a whole. Full details of the NSFG survey methods are described elsewhere.8
The data set contains information on 21,332 pregnancies and 14,958 live births (Figure). After excluding multiple gestations (n=154), subsequent births to the same mother (n=7930), and neonatal adoptions or deaths (n=141), the final sample contained 6733 first singleton live births. To study the initiation of breastfeeding, women who breastfed at all were compared with those who did not. To study duration of breastfeeding, women who breastfed for 16 or more weeks were compared with those who did not. In this second set of analyses, the 1459 women who breastfed for between 0 and 16 weeks and the 33 women who were breastfeeding at the time of the interview and whose children had been born within 16 weeks of that date were excluded.