Factors influencing the reasons why mothers stop breastfeeding.
Brown, Catherine R.L. ; Dodds, Linda ; Legge, Alexandra 等
Breast milk is the best food source for optimal infant growth and
development. (1,2) Despite compelling evidence that exclusive
breastfeeding provides long-term health benefits to both infant and
mother, less than one-quarter of Canadian mothers meet the World Health
Organization and the Canadian Infant Feeding Joint Working Group's
recommendation that infants should exclusively breastfeed for the first
six months of life. (3-5) Breastfeeding is a complex health behaviour
influenced by interactions among biological, psychosocial, demographic
and social factors. Given the gap between exclusive breastfeeding
practices and recommendations, understanding not only why a mother
chooses to initiate breastfeeding, but also why she may choose to
discontinue any breastfeeding before the recommended six months is
important for health care providers and policy-makers to better support
mothers and their newborns.
The 2009-2010 Canadian Community Health Survey reports that the top
three reasons why Canadian mothers stop breastfeeding are insufficient
milk supply (26.1%), infant being ready for solid food (18.9%) and
infant having self-weaned (13.1%). (6) In the same survey, about 9% of
mothers also indicated that they stopped breastfeeding to return to
school or work. (6) Evidence suggests that the reason why a mother stops
breastfeeding varies with the age of the child at breastfeeding
cessation. (7,8) Williams et al. found that the primary reason mothers
chose to wean before three months was concern for the baby's
nutrition, whereas the primary reason they gave for weaning after six
months was a decision to return to work. (9) Similarly, Li et al.
reported that mothers' concerns about lactation and nutrition
issues were the most cited reasons for stopping breastfeeding during the
first two months of life, whereas self-weaning reasons became most
important after three months. (10)
While there is a growing literature regarding the reasons why
mothers cease breastfeeding earlier than recommended, there is a paucity
of information about how those reasons are influenced by factors such as
mother's education and income levels, her parity, lifestyle
characteristics such as smoking, as well as obstetrical and neonatal
factors. This hypothesis-generating study used a sample of Canadian
mothers to identify reasons why women ceased breastfeeding completely
before six months. Specifically, we highlight the influence of
demographic, behavioural, and clinical characteristics on reasons for
discontinuing all breastfeeding before six months.
METHODS
This longitudinal cohort study used data obtained through a record
linkage between the Nova Scotia Atlee Perinatal Database (NSAPD) and the
Healthy Beginnings public health database. The NSAPD collects
information from all hospitals and all registered midwives in Nova
Scotia. Data are captured electronically through the information coded
for the Canadian Institute for Health Information (CIHI) as well as
abstraction of variables coded specifically for the NSAPD (i.e.,
variables that are not captured for CIHI). Therefore, because the
Database uses CIHI information, we are assured that all hospital births
are captured, as are all births attended by a regulated maternity care
provider, regardless of the location.
The province-wide Healthy Beginnings public health database was
designed to enable Nova Scotia Public Health Services to identify
families facing challenges and to offer these families home visiting. At
the time of this study, seven out of nine Nova Scotia district health
authorities did not include population-based information on
breastfeeding patterns; however, public health nurses in two district
health authorities, Cape Breton District Health Authority (CBDHA) and
Guysborough Antigonish Straight Health Authority (GASHA), collected
additional information on the breastfeeding patterns of all mothers in
these two district health authorities as part of the Healthy Beginnings
database. Public health nurses collected the breastfeeding data through
telephone or face-to-face interviews. The information included
mothers' self-reported breastfeeding status collected at the time
of hospital discharge and at one week, six weeks, two months, four
months, and six months after discharge. Information on breastfeeding
duration and reasons for cessation were extracted from the Healthy
Beginnings database and linked with the NSAPD in order to obtain
information on client-specific maternal socio-demographic, prenatal,
labour, delivery and neonatal factors.
The study included mothers of all live singleton newborns in Nova
Scotia who resided in CBDHA or GASHA between January 1, 2008 and
December 31, 2009. Mothers who did not initiate breastfeeding or who
continued to breastfeed, either exclusively or with supplementation,
beyond the first six months of life were excluded. Also excluded were
mothers who did not state a reason for breastfeeding cessation or were
lost to follow-up before six months.
When a mother stopped all breastfeeding before her child was six
months old, she could indicate one of four forced-choice reasons: lack
of support at home, lack of support in hospital, return to work, and
other. Mothers were also able to provide a more detailed open-ended
response for each reason. Public health nurses either paraphrased the
mother's reason for stopping breastfeeding or quoted it directly.
Eleven categories were created from the responses mothers provided: 1)
"Supply" included any reference related to decreased milk
supply (real or perceived), insufficient infant weight gain, or baby not
satisfied with breastfeeding. 2) "Baby was ready for or preferred
formula or solid foods" included any reference to preference for
bottle or formula feeding. 3) "Inconvenience/fatigue due to
breastfeeding" was related to breastfeeding being tiring or
demanding for the mother as well as lack of time to breastfeed while
caring for other children. 4) "Difficulty with breastfeeding"
included poor latch, sore nipples, engorged breasts or mastitis. 5)
"Medical condition in either baby or mother" included
references to medical conditions not related to breastfeeding (e.g.,
Caesarean incision infection or congenital heart disease) as well as the
advice of a doctor or health care professional. 6) "Planned to stop
BF at this time" included references to mother feeling ready or
deciding to stop. 7) "Child weaned him/herself' was related to
baby biting or refusing mother's breast. 8) "Returned to
work/school" included mother returning to work or school or
planning to do so. 9) "Personal decision" referred to
parent's decision with no further explanation. 10) "Lack of
support in hospital or at home" included lack of support in these
locations, as well as the mother's partner working away from home.
11) Finally, "other" included all other reasons not captured
within the previous categories, such as baby in foster care or mother
uncomfortable breastfeeding in public. More than one reason could be
coded for mothers who reported several reasons for stopping.
Breastfeeding duration was the time, measured in weeks/months,
between the infant's birth and when the infant stopped
breastfeeding. Breastfeeding duration was categorized into breastfeeding
duration of less than one week, one week to six weeks inclusive, and
greater than six weeks. Maternal and newborn characteristics were all
derived from the NSAPD and defined and categorized as follows.
Mother's location of residence was dichotomized using Canada
Post's forward sortation areas into urban (for forward sortation
areas 1-9) and rural (for forward sortation area 0). Mother's
postal code linked to Canadian census data was used as an approximation
for income level, as has been done in previous studies. (11,12) As it
has been suggested that this method provides a valid approximation of
individual-level household income when large categories of neighbourhood
income are used, we grouped mothers in the lowest and lower-middle
income quintiles as low income. (13) Mother's highest level of
education was dichotomized into low education level (no post-secondary
education) and post-secondary education (inclusive of college and
university). Maternal age was categorized as less than 25 years, 25-29
years, 30-34 years, and 35 years or older. Marital status was
dichotomized into mothers with a partner (women who were married or in a
common-law relationship) and single motherhood (women who were single,
divorced, widowed, or separated). Mother's self-reported
pre-pregnancy body mass index (BMI) was categorized as normal (<25
kg/[m.sup.2]), overweight (25-29.99 kg/[m.sup.2]), or obese (BMI >30
kg/[m.sup.2]). Mothers who reported smoking at least one cigarette at a
prenatal visit or at hospital admission for labour/birth were considered
smokers. Mode of birth was dichotomized into vaginal birth or Caesarean
birth. Preterm birth was defined as delivery at less than 37 weeks'
gestational age. Low birth weight was defined as a birth weight of less
than 2500 grams. Mother's intention to breastfeed was collected
during a prenatal visit. If the mother reported diabetes, hypertension,
or hyperemesis gravidarum during her pregnancy, she was considered to
have a health condition during pregnancy.
The reasons mothers stopped breastfeeding completely were analyzed
using descriptive statistics and are reported as percentages with 95%
confidence intervals. A chi-square test was used to compare reasons for
breastfeeding cessation according to breastfeeding duration and to
compare demographic and clinical characteristics according to
breastfeeding duration. For each reason noted for breastfeeding
cessation, logistic regression models were used to estimate unadjusted
odds ratios (OR) and 95% confidence intervals (CI) for each covariate
category. For instance, when analyzing the covariates associated with
"insufficient supply", analyses were conducted with
"insufficient supply", yes or no, as the dependent variable.
All analyses were conducted using SPSS 17.0.
This study received data access approval from the Joint Data Access
Committee of the Reproductive Care Program as well as the research ethic
boards for the IWK Health Centre, McGill University, University of PEI,
CBDHA, and GASHA. As per agreement with the Research Ethics Board, all
cell sizes of under five were suppressed.
RESULTS
Of all women residing in CBDHA or GASHA who gave birth to a live
singleton infant between January 1, 2008 and December 31, 2009, there
were 1,500 women who initiated breastfeeding and were breastfeeding at
discharge from hospital, and 1,207 women who stopped breastfeeding
completely before their infant reached six months of age. Among those
who were known to have weaned by six months, 500 mothers provided a
reason for their cessation of breastfeeding and were included in this
study. Of these 500 women, 127 (25.4%) women stopped breastfeeding
within the first week postpartum, 241 (48.2%) women breastfed their
infant for one to six weeks, and 132 (26.4%) breastfed their infant for
at least six weeks (Table 1).
Table 1 shows the duration of breastfeeding according to a number
of demographic, behavioural, and clinical characteristics. Only a few of
the maternal and infant characteristics included in the analysis were
associated with breastfeeding duration. The mothers of infants who
required admission to a special care nursery were more likely to
discontinue breastfeeding within the infant's first week of life
(36.3%) when compared with mothers of infants who did not require such
an admission (23.3%). Women 35 years of age or older were more likely to
stop breastfeeding within their infant's first week of life (34.4%)
than women who were 30-34 years of age (24.2%).
As shown in Table 2, the most frequent reasons cited for early
cessation of breastfeeding were "inconvenience/fatigue due to
breastfeeding" (22.6%) and "insufficient supply" (21.6%).
Most reasons cited by women were not found to be associated with a
specific duration of breastfeeding (Table 2). However, women were more
likely to cite "difficulty with breastfeeding technique" as a
reason for cessation if they stopped breastfeeding within the first week
postpartum (7.9%) or within one to six weeks (12.9%) than if they
breastfed their infant for six weeks or more before stopping. More women
were likely to cite "return to work/school" as a reason for
breastfeeding cessation if their infant was six weeks of age or greater.
Table 3 shows the relationship between various maternal or infant
characteristics and the odds of providing specific reasons as important
in the decision to stop breastfeeding. The majority of cited reasons
were not found to be significantly associated with any of the
characteristics evaluated. We found, however, that young mothers (<25
years) were more likely to cite "insufficient supply" as a
reason for cessation of breastfeeding when compared with mothers in the
25-29 year age group (OR 2.3, 95% CI: 1.3-4.0). Additionally,
primiparous mothers were more likely than multiparous mothers to cite
"insufficient supply" as an important reason for their
decision to stop breastfeeding (OR 1.7, 95% CI: 1.1-2.6). Women residing
in high-income neighbourhoods were also more likely to cite supply
concerns as a reason for breastfeeding cessation (OR 1.7, 95% CI:
1.1-2.7).
According to Table 3, "medical reasons" was more likely
to be cited as a reason for breastfeeding cessation among obese women
(OR 3.2, 95% CI: 1.6-6.5) and among women who reported a known health
condition during their pregnancy (OR 2.6, 95% CI: 1.1-6.3). Women with
postsecondary education were less likely than those without to cite
medical reasons for discontinuing breastfeeding (OR 0.5, 95% CI:
0.3-1.0). Additionally, single women were less likely than married women
to cite medical reasons for breastfeeding cessation (OR 0.5, 95% CI:
0.2-1.0).
A comparison of socio-demographic factors and infant factors for
the 500 women who provided a reason for breastfeeding cessation and
those who did not provide a reason is shown in Table 4. Women with a
reason for cessation tended to be younger, nulliparous, and unmarried
and to have a lower education than women who did not have a reason for
stopping breastfeeding recorded in the database. As well, the infants of
women who had a reason recorded were more likely to be preterm or low
birth weight.
DISCUSSION
Our data and those of others have suggested that the first six
weeks postpartum are when women are at greatest risk of early
breastfeeding cessation.14-18 Prenatal and postpartum interventions
designed to prolong breastfeeding duration may be particularly
beneficial if they target this particularly vulnerable post-delivery
period. We attempted to identify maternal socio-demographic and
pregnancy factors associated with women who stop breastfeeding early.
Surprisingly few factors were significantly related to the timing of
breastfeeding cessation. Women whose infants required admission to a
special care nursery, however, had higher rates of breastfeeding
cessation in the first week after birth, which is consistent with
findings from a recent national survey of Canadian women. (19) These
findings suggest that additional support may be necessary to
specifically target this subset of women whose infants require special
medical care.
Among mothers who stopped breastfeeding during the first six months
of their infant's life, concerns about milk supply were frequently
cited as an important reason for their decision to stop breastfeeding,
regardless of breastfeeding duration. Supply concerns have been
consistently reported as a key contributor to early breastfeeding
cessation in several previous studies. (7,8,10,17,20) However, studies
examining milk intake and infant weight gain in exclusively breastfed
infants have demonstrated that less than 5% of mothers are actually
unable to produce adequate milk to meet their infant's nutritional
needs in the first four months of life. (18,20-23) Young mothers (<25
years) and primiparous mothers were more likely to cite "not enough
breast milk" as a reason for cessation, suggesting that perceptions
of low milk supply may be linked to a lack of knowledge about
breastfeeding or lack of previous breastfeeding experience. A recent
Cochrane review of support for breastfeeding mothers with healthy term
babies found that support from both professionals and lay supporters
increased the duration; however, support offered reactively, which was
initiated only after women sought out contact instead of on an ongoing,
scheduled basis, was not effective. (24) They concluded that
face-to-face support at scheduled visits was optimal.
As reported elsewhere, (7-10) we found that the reasons provided by
mothers for their decision to stop breastfeeding varied according to the
age of the infants when they were weaned. Women were more likely to stop
breastfeeding because of difficulties with breastfeeding technique
within the first six weeks postpartum. Again, this emphasizes the
importance of early breastfeeding interventions. In an Australian study,
85%-100% of first time mothers indicated that they required lactation
support at two weeks after delivery. (25) Access to lactation
consultants and other types of breastfeeding support early in the
postpartum period may help prevent early breastfeeding cessation among
women experiencing technical difficulties with lactation, although more
research is needed. While technical difficulties were more likely to
occur early in the breastfeeding experience, women were more likely to
cite their return to work or school as a reason for breastfeeding
cessation in the period beyond six weeks. Programs such as flexible
working schedules for breastfeeding mothers and easy access to a private
lactation room have been shown to prolong breastfeeding duration among
mothers returning to school or work. (26)
A Canadian study concluded that in-hospital supplementation
interfered with maternal milk production and infant suckling behaviours,
and it was associated with perceived breastfeeding problems as well as
lower breastfeeding self-efficacy at both baseline and six weeks. (27)
Although the literature generally indicates that supplementation is
negatively associated with breastfeeding duration, (27-29) it is unclear
whether breastfeeding problems occur first, leading to supplementation,
or whether supplementation occurs first, leading to breastfeeding
problems. Unfortunately, we did not have access to data on some key
variables that are known to influence breastfeeding duration, such as
in-hospital formula supplementation.
The strengths of this study include the minimization of recall
bias, as women were queried about their reasons for stopping
breastfeeding shortly after their cessation. Access to a large number of
maternal and infant variables in the NSAPD allowed for the comparison of
breastfeeding duration and reasons for breastfeeding cessation across
various demographic and clinical subgroups.
One limitation is that the Healthy Beginnings database was designed
as a clinical public health database to help public health nurses
enhance their perinatal programs and service through the Nova Scotia
Enhanced Home Visiting Initiative. (30) Breastfeeding was one of many
focuses of these visits, so women were not required to give reasons for
breastfeeding cessation. As a result, we had information on the reasons
for stopping for only 42% of the cohort. This underlines the limitation
of using existing databases for research purposes, and in doing so
increases the risk of selection bias in our study. In comparing
demographic information for women with and without a reason for stopping
breastfeeding, we found that women who did not have a reason associated
with cessation were more likely to be married, more highly educated,
multiparous, and older. This may reflect the public health nurses'
effort to provide more intense follow-up (and, therefore, obtain more
information) for those with a less favourable socio-demographic profile.
Therefore, our findings may not be representative of the breastfeeding
experience of all women who stopped breastfeeding before their infant
was six months of age. Second, the study was limited by the use of the
forced-choice reasons programmed into the public health database, and
these do not align with previous studies that examined reasons why
mothers ceased to exclusively breastfeed before six months, such as the
2009-2010 Canadian Community Health Survey. (6) Also, the categorization
of open-ended responses inevitably involved some degree of subjectivity
in the interpretation of the reasons provided by women. Last, we
conducted a number of analyses, and some of the statistically
significant findings may be due to a type 1 error. We chose not to
adjust for multiple comparisons because this was a hypothesis-generating
exercise, and we did not want to miss potential associations.
CONCLUSIONS AND RECOMMENDATIONS
Despite current World Health Organization recommendations, (1) the
majority of Canadian mothers do not exclusively breastfeed their infants
for the first six months of life. (6,19) Since this study found that
over two-thirds of women stopped breastfeeding by six weeks and this
finding has been noted in other studies, (14-18,31) early postpartum
interventions are likely to be an important factor in improving early
breastfeeding cessation. Our study highlights the most frequently cited
reasons for breastfeeding cessation, how these reasons change with
infant weaning age, as well as how they vary across different maternal
socio-demographic groups and with maternal and newborn medical
conditions. As this study is hypothesis-generating, further research is
needed to test interventions that will help to reduce breastfeeding
cessation for the commonly cited reasons. Our findings, however, may be
helpful in informing health care providers and peer supporters offering
lactation support to breastfeeding women and for researchers planning
studies on breastfeeding cessation.
Received: September 5, 2013
Accepted: March 14, 2014
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Catherine R.L. Brown, MSc, [1] Linda Dodds, PhD, [1,2] Alexandra
Legge, MD, [3] Janet Bryanton, RN, PhD, [4] Sonia Semenic, RN, PhD [5]
Author Affiliations
[1.] Department of Community Health & Epidemiology, Dalhousie
University, Halifax, NS
[2.] Departments of Obstetrics & Gynecology and Pediatrics,
Dalhousie University, Halifax, NS
[3.] Faculty of Medicine, Dalhousie University, Halifax, NS
[4.] School of Nursing, University of Prince Edward Island,
Charlottetown, PE
[5.] School of Nursing, McGill University, Montreal, QC
Correspondence: Dr. Linda Dodds, Perinatal Epidemiological Research
Unit, IWK Health Centre, Room G7108, 5980 University Ave, PO Box 9700,
Halifax, NS B3K 5R8, Tel: 902-470-7191, E-mail: l.dodds@dal.ca
Acknowledgements: We thank the Reproductive Care Program of Nova
Scotia as well as Public Health Services in Cape Breton District Health
Authority and Guysborough Antigonish Straights Health Authority for
access to the data, and Dr. Colleen O'Connell for technical
support.
Conflict of Interest: None to declare.
Table 1. Duration of any breastfeeding according to maternal
and infant characteristics
<1 week 1-6 weeks
% (95% CI) % (95% CI)
Overall (N=500 *) 25.4 (21.6-29.5) 48.2 (43.7-52.7)
Maternal age (years)
<25 (n=161) 22.4 (16.2-29.6) 59.6 (51.6-67.3)
25-29 (n=150) 26.0 (19.2-33.8) 39.3 (31.5-47.6)
30-34 (n=128) 24.2 (17.1-32.6) 44.5 (35.7-53.6)
35+ (n=61) 34.4 (22.7-47.7) 47.5 (34.6-60.7)
Parity
Nulliparous (n=266) 23.7 (18.7-29.3) 48.1 (42.0-54.3)
Multiparous (n=234) 27.4 (21.7-33.5) 48.3 (41.7-54.9)
Pre-pregnancy BMI
Normal (n=217) 23.5 (18.0-29.7) 50.7 (43.8-57.5)
Overweight (n=118) 20.3 (13.5-28.7) 53.4 (44.0-62.6)
Obese (n=98) 30.6 (21.7-40.7) 43.9 (33.9-54.3)
Smoking status
No (n=366) 24.6 (20.3-29.3) 48.1 (42.9-53.3)
Yes (n=125) 28.8 (21.1-37.6) 47.2 (38.2-56.3)
Marital status
Married (n=256) 25.0 (19.8-30.8) 44.5 (38.3-50.8)
Single (n=153) 24.8 (18.2-32.5) 52.3 (44.1-60.4)
Mode of delivery
Vaginal
delivery (n=348) 25.0 (20.5-29.9) 46.8 (41.5-52.2)
C-section (n=152) 26.3 (19.5-34.1) 51.3 (43.1-59.5)
Preterm birth (<37 wks)
No (n=453) 25.8 (21.9-30.1) 48.3 (43.7-53.1)
Yes (n=44) 15.9 (6.6-30.1) 50.0 (34.6-65.4)
Infant sex
Female (n=254) 23.2 (18.2-28.9) 46.9 (40.6-53.2)
Male (n=246) 27.6 (22.2-33.7) 49.6 (43.2-56.0)
Residency
Urban (n=383) 25.3(21.0-30.0) 48.8 (43.7-54.0)
Rural (n=117) 25.6 (18.0-34.5) 46.2 (36.9-55.6)
Neighbourhood income
Low (n=186) 28.0(21.6-35.0) 48.9 (41.5-56.3)
High (n=308) 24.4 (19.7-29.5) 47.1 (41.4-52.8)
Maternal education
level ([dagger])
Low (n=204) 26.0 (20.1-32.6) 50.0 (42.9-57.1)
High (n=246) 22.1 (17.0-27.9) 47.9 (41.4-54.4)
Intention to
breastfeed
No (n=30) 40.0 (22.7-59.4) 43.3 (25.5-62.6)
Yes (n=435) 23.2 (19.3-27.5) 49.0 (44.2-53.8)
SCN admission
No (n=420) 23.3(19.4-27.7) 48.8 (43.9-53.7)
Yes (n=80) 36.3 (25.8-47.8) 45.0 (33.8-56.5)
Low birth weight
(<2500 grams)
No (n=457) 24.9 (21.0-29.2) 48.8 (44.1-53.5)
Yes (n=40) 30.0 (16.6-46.5) 45.0 (29.3-61.5)
>6 weeks p value
% (95% CI)
Overall (N=500 *) 26.4 (22.6-30.5) --
Maternal age (years) 0.002
<25 (n=161) 18.0 (12.4-24.8)
25-29 (n=150) 34.7 (27.1-42.9)
30-34 (n=128) 31.3 (23.4-40.0)
35+ (n=61) 18.0 (9.4-30.0)
Parity 0.508
Nulliparous (n=266) 28.2 (22.9-34.0)
Multiparous (n=234) 24.4 (19.0-30.4)
Pre-pregnancy BMI 0.482
Normal (n=217) 25.8 (20.1-32.2)
Overweight (n=118) 26.3 (18.6-35.2)
Obese (n=98) 25.5 (17.2-35.3)
Smoking status 0.592
No (n=366) 27.3 (22.8-32.2)
Yes (n=125) 24.0 (16.8-32.5)
Marital status 0.201
Married (n=256) 30.5 (24.9-36.5)
Single (n=153) 22.9 (16.5-30.4)
Mode of delivery 0.395
Vaginal
delivery (n=348) 28.2 (23.5-33.2)
C-section (n=152) 22.4 (16.0-29.8)
Preterm birth (<37 wks) 0.268
No (n=453) 25.8 (21.3-30.1)
Yes (n=44) 34.1 (20.5-49.9)
Infant sex 0.167
Female (n=254) 29.9 (24.4-36.0)
Male (n=246) 22.8 (17.7-28.5)
Residency 0.850
Urban (n=383) 25.8 (21.5-30.5)
Rural (n=117) 28.2 (20.3-37.3)
Neighbourhood income 0.374
Low (n=186) 23.1 (17.3-29.8)
High (n=308) 28.6 (23.6-34.0)
Maternal education
level ([dagger]) 0.325
Low (n=204) 24.0 (18.3-30.5)
High (n=246) 30.0 (24.3-36.2)
Intention to
breastfeed 0.094
No (n=30) 16.7 (5.6-34.7)
Yes (n=435) 27.8 (23.7-32.3)
SCN admission 0.035
No (n=420) 27.9 (23.6-32.4)
Yes (n=80) 18.8 (10.9-29.0)
Low birth weight
(<2500 grams) 0.778
No (n=457) 26.3 (22.3-30.5)
Yes (n=40) 25.0 (12.7-41.2)
* Not all total 500 because of missing values for some
variables.
([dagger]) The NSAPD only began collecting data on maternal
education level on April 1, 2008, therefore this information
is missing for all mothers between January 1, 2008 and March
31, 2008.
CI=confidence interval; BMI=body mass index; SCN=special
care nursery.
Table 2. Reasons for stopping breastfeeding completely
according to length of time that infants were breastfed
Reason * Total (N=500) <1 wk (N=127)
% (95% CI) % (95% CI)
Inconvenience/ 22.6 (19.0-26.5) 22.8 (15.9-31.1)
fatigue due to
breastfeeding
Supply--not 21.6 (18.1-25.5) 19.7 (13.2-27.7)
enough breast
milk
Personal 14.8 (11.8-18.2) 19.7 (13.2-27.7)
decision
Returned to 12.6 (9.8-15.8) 7.9 (3.8-14.0)
work/school
Medical 10.4 (7.9-13.4) 9.4 (5.0-15.9)
condition in
baby or mother
Difficulty with 8.8 (6.5-11.6) 7.9 (3.8-14.0)
breastfeeding
technique
Lack of support 7.6 (5.4-10.3) 7.9 (3.8-14.0)
Planned to stop 7.2 (5.1-9.8) 7.9 (3.8-14.0)
breastfeeding
at this time
Ready for 7.0 (4.9-9.6) 8.7 (4.4-15.0)
solids/mother
preference
Other 2.0 (1.0-3.6) --
Child weaned 1.8 (0.8-3.4) --
him/herself
Reason * 1-6 wk (N=241) >6 wk (N=132) p valuet
% (95% CI) % (95% CI)
Inconvenience/ 24.5 (19.2-30.4) 18.9 (12.6-26.7) 0.472
fatigue due to
breastfeeding
Supply--not 23.2 (18.1-29.1) 20.5 (13.9-28.3) 0.684
enough breast
milk
Personal 8.3 (5.1-12.5) 22.0 (15.2-30.0) <0.001
decision
Returned to 11.2 (7.5-15.9) 19.7 (13.3-27.5) 0.011
work/school
Medical 13.3 (9.3-18.2) 6.1 (2.7-11.6) 0.085
condition in
baby or mother
Difficulty with 12.9 (8.9-17.8) -- 0.002
breastfeeding
technique
Lack of support 9.1 (5.8-13.5) 4.5 (1.7-9.6) 0.277
Planned to stop 6.2 (3.5-10.1) 8.3 (4.2-14.4) 0.711
breastfeeding
at this time
Ready for 5.8 (3.2-9.6) 7.6 (3.7-13.5) 0.568
solids/mother
preference
Other 2.1 (0.7-4.8) -- 0.882
Child weaned 2.1 (0.7-4.8) -- 0.905
him/herself
* Women could give more than one reason for
breastfeeding cessation.
([dagger]) Pearson chi square.
-- Numbers suppressed because cell size <5.
Table 3. Socio-demographic and pregnancy factors and their associations
with reasons for stopping breastfeeding completely *
Lack of Personal Planned
support reasons to stop
Characteristic OR (95% CI) OR (95% CI) OR (95% CI)
Maternal age (years)
<25 1.1 (0.5-2.7) 1.0 (0.6-1.9) 0.7 (0.5-1.9)
25-29 Referent Referent Referent
50-54 0.9 (0.4-2.4) 0.9 (0.5-1.8) 1.1 (0.4-2.6)
55+ 2.1 (0.8-5.6) 0.5 (0.2-1.5) 1.4 (0.5-5.9)
Parity
Nulliparous 0.7 (0.4-1.5) 0.9 (0.5-1.4) 0.7 (0.5-1.4)
Multiparous Referent Referent Referent
Maternal BMI
Normal Referent Referent Referent
Overweight 1.5 (0.7-5.4) 0.6 (0.5-1.1) 2.6 (1.1-6.0)
Obese 1.5 (0.6-5.5) 0.7 (0.4-1.4) 1.6 (0.6-4.5)
Smoking
No Referent Referent Referent
Yes 1.1 (0.5-2.2) 1.0 (0.6-1.8) 1.0 (0.4-2.1)
Marital status
Married/partnf Referent Referent Referent
Single 1.9 (0.9-5.8) 1.2 (0.7-2.2) 0.9 (0.4-2.1)
Mode of delivery
Vaginal deliver y Referent Referent Referent
C-section 1.4 (0.7-2.7) 1.1 (0.6-1.8) 1.5 (0.7-5.0)
Gestational age
Full-term ([dagger]) Referent Referent
Pre-term ([dagger]) 0.7 (0.5-1.9) ([dagger])
Education
Low (1-2) Referent Referent Referent
High (5-4) 1.2 (0.6-2.6) 0.9 (0.5-1.5) 0.9 (0.4-1.9)
Intent to BF
No ([dagger]) Referent ([dagger])
Yes ([dagger]) 0.5 (0.2-1.5) ([dagger])
SCN admission
No ([dagger]) Referent Referent
Yes ([dagger]) 0.9 (0.5-1.8) 0.8 (0.5-2.2)
Low birth weight
No ([dagger]) Referent ([dagger])
Yes ([dagger]) 0.8 (0.5-2.2) ([dagger])
Infant sex
Female Referent Referent Referent
Male 1.5 (0.7-2.9) 1.5 (0.8-2.1) 1.2 (0.6-2.5)
Residency
Urban Referent Referent Referent
Rural 1.6 (0.8-5.2) 0.4 (0.2-0.8) 0.6 (0.5-1.6)
Neighbourhood income
Low (1,2) Referent Referent Referent
High (5-5) 1.1 (0.6-2.5) 0.6 (0.4-1.1) 0.7 (0.4-1.5)
Maternal health
condition in
pregnancy
No Referent Referent Referent
Yes 0.8 (0.2-5.5) 0.8 (0.5-2.5) 0.8 (0.2-5.6)
Return Insufficient
to work Supply Difficulty
Characteristic OR (95% Cl) OR (95% Cl) OR (95% Cl)
Maternal age (years)
<25 1.1 (0.6-2.0) 2.5 (1.5-4.0) 0.9 (0.4-2.2)
25-29 Referent Referent Referent
50-54 0.6 (0.5-1.2) 1.5 (0.7-2.5) 1.6 (0.7-5.6)
55+ 0.8 (0.5-2.0) 1.5 (0.7-5.2) 1.9 (0.7-5.0)
Parity
Nulliparous 1.5 (0.8-2.2) 1.7(1.1-2.6) 0.9 (0.5-1.6)
Multiparous Referent Referent Referent
Maternal BMI
Normal Referent Referent Referent
Overweight 1.7 (0.9-5.1) 0.9 (0.5-1.5) 0.6 (0.5-1.5)
Obese 0.6 (0.2-1.5) 0.7 (0.4-1.2) 1.0 (0.5-2.2)
Smoking
No Referent Referent Referent
Yes 1.0 (0.5-1.8) 0.9 (0.6-1.5) 0.5 (0.2-1.5)
Marital status
Married/partnf Referent Referent Referent
Single 1.0 (0.5-1.8) 1.2 (0.8-2.0) 1.5 (0.6-2.6)
Mode of delivery
Vaginal deliver Referent Referent Referent
C-section 0.7 (0.4-1.5) 1.5 (0.8-2.0) 1.1 (0.6-2.1)
Gestational age
Full-term Referent Referent ([dagger])
Pre-term 0.9 (0.5-2.5) 1.4 (0.7-2.8) ([dagger])
Education
Low (1-2) Referent Referent Referent
High (5-4) 1.2 (0.7-2.2) 0.9 (0.5-1.5) 1.5 (0.8-2.9)
Intent to BF
No Referent Referent ([dagger])
Yes 0.7 (0.5-1.9) 0.9 (0.4-2.2) ([dagger])
SCN admission
No Referent Referent ([dagger])
Yes 1.0 (0.5-2.0) 1.2 (0.7-2.0) ([dagger])
Low birth weight
No Referent Referent ([dagger])
Yes 1.2 (0.5-5.1) 1.2 (0.6-2.6) ([dagger])
Infant sex
Female Referent Referent Referent
Male 0.6 (0.4-1.1) 0.8 (0.5-1.2) 0.8 (0.4-1.4)
Residency
Urban Referent Referent Referent
Rural 1.2 (0.7-2.5) 0.98 (0.6-1.6) 1.8 (0.9-5.5)
Neighbourhood income
Low (1,2) Referent Referent Referent
High (5-5) 1.7 (0.9-5.1) 1.7(1.1-2.7) 0.9 (0.5-1.6)
Maternal health
condition in
pregnancy
No Referent Referent Referent
Yes 0.7 (0.2-2.5) 1.0 (0.4-2.5) 1.1 (0.5-5.6)
Medical Solids
reasons Inconvenience introduced
Characteristic OR (95% Cl) OR (95% Cl) OR (95% Cl)
Maternal age (years)
<25 0.5 (0.2-1.2) 0.9 (0.5-1.5) 1.5 (0.5-5.1)
25-29 Referent Referent Referent
50-54 1.5 (0.7-5.0) 1.0 (0.6-1.8) 1.2 (0.5-5.1)
55+ 1.5 (0.5-5.1) 0.7 (0.5-1.5) 1.4 (0.5-4.4)
Parity
Nulliparous 0.7 (0.4-1.5) 0.7 (0.5-1.1) 1.5 (0.7-2.7)
Multiparous Referent Referent Referent
Maternal BMI
Normal Referent Referent Referent
Overweight 0.9 (0.4-2.2) 0.9 (0.5-1.5) 0.6 (0.2-1.7)
Obese 5.2 (1.6-6.5) 1.0 (0.6-1.8) 1.2 (0.5-2.9)
Smoking
No Referent Referent Referent
Yes 1.5 (0.8-2.9) 1.0 (0.6-1.6) 0.9 (0.4-2.0)
Marital status
Married/partnf Referent Referent Referent
Single 0.5 (0.2-1.0) 0.8 (0.5-1.5) 0.5 (0.2-1.2)
Mode of delivery
Vaginal deliver Referent Referent Referent
C-section 1.8 (1.0-5.2) 0.7 (0.5-1.2) 0.9 (0.4-1.9)
Gestational age
Full-term Referent Referent ([dagger])
Pre-term 1.4 (0.6-5.6) 1.5 (0.7-2.9) ([dagger])
Education
Low (1-2) Referent Referent Referent
High (5-4) 0.5 (0.5-1.0) 0.7 (0.5-1.1) 1.0 (0.5-2.2)
Intent to BF
No ([dagger]) Referent ([dagger])
Yes ([dagger]) 0.7 (0.5-1.5) ([dagger])
SCN admission
No Referent Referent Referent
Yes 1.7 (0.8-5.4) 1.5 (0.7-2.2) 1.5 (0.6-5.2)
Low birth weight
No Referent Referent ([dagger])
Yes 2.5 (1.0-5.4) 1.5 (0.8-5.1) ([dagger])
Infant sex
Female Referent Referent Referent
Male 1.5 (0.8-2.4) 1.1 (0.7-1.7) 0.9 (0.4-1.7)
Residency
Urban Referent Referent Referent
Rural 1.0 (0.5-1.9) 1.0 (0.6-1.7) 1.5 (0.6-2.9)
Neighbourhood income
Low (1,2) Referent Referent Referent
High (5-5) 0.9 (0.5-1.6) 0.9 (0.6-1.5) 0.9 (0.4-1.8)
Maternal health
condition in
pregnancy
No Referent Referent Referent
Yes 2.6 (1.1-6.5) 0.5 (0.1-1.1) 2.0 (0.7-6.0)
* Two categories (Child weaned him/herself and Other) not included
because of too few subjects,
([dagger]) Not analyzed because cell size <5.
OR=odds ratio; CI=confidence interval; BMI=body mass index;
BF=breastfeed.
Table 4. Comparison of factors between women with a
reason for stopping breastfeeding completely and
women with no reason, Public Health Database
No reason Reason
N (%) given N (%) p value
Overall (N=1,202 *) n=702 n=500
Maternal age (years)
<25 186 (26.5) 161 (32.2)
25-29 190 (27.1) 150 (30.0)
30-34 211 (30.0) 128 (25.6)
35+ 115 (16.4) 61 (12.2) 0.021
Parity
Nulliparous 303 (43.2) 266 (53.2)
Multiparous 399 (56.8) 234 (46.8) 0.0006
Pre-pregnancy BMI
Normal 240 (50.5) 217 (50.1)
Overweight 117 (24.6) 118 (27.3)
Obese 118 (24.9) 98 (22.6) 0.585
Smoking status
No 543 (78.6) 366 (74.5)
Yes 148 (21.4) 125 (25.5) 0.104
Marital status
Married 387 (71.7) 256 (62.6)
Single 153 (28.3) 153 (37.4) 0.003
Mode of delivery
Vaginal delivery 491 (69.9) 348 (69.6)
C-section 211 (30.1) 152 (30.4) 0.898
Preterm birth (<37 wks)
No 656 (94.4) 453 (91.1)
Yes 39 (5.6) 44 (8.9) 0.03
Infant sex
Female 351 (50.0) 254 (50.8)
Male 351 (50.0) 246 (49.2) 0.785
Residency
Urban 577 (82.2) 383 (76.6)
Rural 125 (17.8) 117 (23.4) 0.017
Neighbourhood income
Low 230 (33.5) 186 (37.6)
High 456 (66.5) 308 (62.4) 0.144
Maternal education level
Low 189 (32.5) 204 (45.9)
High 392 (67.5) 240 (54.1) <0.0001
Intention to breastfeed
No 31 (4.8) 30 (6.5)
Yes 618 (95.2) 435 (93.5) 0.226
SCN admission
No 594 (84.6) 420 (84.0)
Yes 108 (15.4) 80 (16.0) 0.772
Low birth weight
(<2500 grams)
No 674 (96.1) 457 (91.9)
Yes 27 (3.9) 40 (8.1) 0.002
* Includes women who initiated breastfeeding and were
breastfeeding at the time of discharge from hospital,
but did not continue breastfeeding to six months.
BMI=body mass index; SCN=special care nursery.
