Breast feeding self-efficacy and other determinants of the duration of breast feeding in a cohort of first-time mothers in Adelaide, Australia
Introduction
In Australia, the importance of breast-feeding is officially recognised in the National Health and Medical Research Council's Dietary Guidelines for Children and Adolescents, with the advice to ‘encourage and support breast-feeding’ (NHMRC, 2003). The last national survey of breast-feeding in Australia was contained in the 1995 Australian Health Survey, which found that 46% of women were breast-feeding at least partially (only 19% fully) at 6 months postpartum (Donath and Amir, 2000). This figure fell well short of the Australian target, for the year 2000, of 50% fully breast-feeding and 80% at least partially breast-feeding their babies at 6 months (Nutbeam et al., 1993).
Those wishing to encourage breast-feeding are confronted with a constellation of factors associated with the initiation, duration and exclusivity of breast-feeding. However, many of them are broad social determinants, such as maternal age, education and socio-economic status. Although they provide valuable indicators of sub-populations where interventions to promote breast-feeding might best be targeted, they provide little insight into the underlying mechanisms, and they are not especially amenable to interventions in themselves. Recently, however, Dennis and Faux (1999) developed a self-report instrument, the Breast-feeding Self-Efficacy Scale (BSES), which assesses a woman's confidence in her perceived ability to breast feed, and may provide new insights into interventions to promote breast-feeding in future. The instrument attempts to operationalise, within the context of breast-feeding, a self-efficacy concept of Bandura (1977) containing (1) an outcome expectancy (the belief that a given behaviour will produce a particular outcome) and (2) a self-efficacy expectancy (an individual's conviction that one can successfully perform certain tasks or behaviours to produce the desired outcome).
The extent to which the BSES adds new predictive information on breast-feeding, and the extent to which it ‘captures’ elements of the seemingly less mutable socio-cultural and socio-economic factors, has not been explored in much detail. Dennis (2003) reported no relationship between scores for an abbreviated version of the BSES and maternal age, marital status, education or income (but lower BSES scores in women who had a caesarean delivery). Blyth et al. (2002) reported higher BSES scores in multiparous compared with primaparous women, but no significant differences in ethnic, marital or education status.
In this study of first-time mothers, we examine the relationship between the actual duration of breast-feeding and (1) the intended duration; (2) the BSES Score at around 1 week postpartum; and (3) socio-demographic characteristics of both women and their partners. The use of survival analysis techniques, which make full use of the continuous nature of the duration of breast-feeding (compared with simply looking at who had stopped breast-feeding at, say, 3 or 6 months), enabled us to derive a minimal set of predictors that can then be used to explore the efficacy of other strategies (e.g. the WHO/UNICEF ‘Ten Steps to Successful Breast-feeding’), with minimal risk of confounding (see companion paper, Pincombe et al., 2006).
Section snippets
Participants
The study was conducted in a large teaching hospital in Adelaide, South Australia, in which around 4000 births take place each year. To be eligible for the study, women were required to be 18 years of age or older; primiparous; 37 weeks gestation or more; intending to breast feed; able to understand and communicate in both written and spoken English; and have given informed consent. Women with multiple pregnancies, or whose baby subsequently required prolonged care in a Special Care Nursery,
Findings
Recruitment took 6 months to complete, with 482 women approached in our antenatal clinic and invited to participate. A total of 85 women were either ineligible or declined to participate. After exclusions for prolonged stays in the Special Care Nursery, not attempting breast-feeding, delivering at a different hospital, being missed at the postpartum period and a neonatal death, 378 (78.4%) women remained eligible. On administration of the BSES (1 week postpartum), 41 women had already stopped
Discussion
Our work confirms that the BSES score for first-time mothers who managed to breast feed for the first week of their baby's life is a useful predictor of how long they will continue to breast feed. Furthermore, this instrument captures information that is not contained in the demographic factors that are so repeatably associated with intention and duration of breast-feeding. The BSES is, therefore, a valuable tool for identifying women who might benefit considerably from postnatal interventions
Acknowledgement
The authors wish to thank the WCH Research Foundation for funding this research.
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