Individual net-benefit maximization: A model for understanding breastfeeding cessation among low-income women

Objectives: We use economic theory of individual net benefit maximization to motivate a comprehensive look at 32 social, economic, and psychological disincentives that potentially influence breastfeeding cessation. Methods: The sample consists of 1,595 low-income families participating in the Healthy Steps for Young Children National Evaluation. Participants were recruited from 24 pediatric sites across the United States. Infants were enrolled at birth and followed through age 30-33 months. Survival analysis was used to assess the relation of social, economic and psychosocial factors with duration of breastfeeding. Results: Disincentives significantly associated with cessation in multivariate hazard analysis were: WIC participation at 2-4 months (HR = 1.50; 95% CI: 1.29, 1.74), mother's returning to work for 20-40 h per week (HR = 1.47; 95% CI: 1.26, 1.71), mother's not attending a postpartum doctor's visit (HR = 1.39; 95% CI: 1.18, 1.63), father's not being in the home (HR = 1.38; 95% CI: 1.21, 1.57), a smoker in the household (HR = 1.34; 95% CI: 1.17, 1.52), no receipt of breastfeeding instruction at the pediatric office (HR = 1.20; 95% CI:1.06, 1.37), the doctor's not encouraging breastfeeding (HR = 1.19; 95% CI: 1.01, 1.39) and the mother experiencing depressive symptoms (HR = 1.16; 95% CI: 1.02, 1.33). Conclusions: The decision to stop breastfeeding is often complex. Research on breastfeeding cessation has been limited with regard to the social and economic issues that may influence the behavior of low-income women. The results support the need to develop interventions and policies to minimize disincentives associated with breastfeeding cessation.