Factors Influencing a Woman's Decision to Breastfeed: A Social Ecological Perspective

Problem Statement:  Over the past several years, the breastfeeding rate at Woman's Hospital has fluctuated between 55% and 58%.  An important organizational goal is to increase the proportion of breastfeeding mothers to reflect the national average of 64% and, ultimately, the Healthy People 2010 target of 75%.
Purpose:  The purpose of this study was to examine personal, cultural, social, and environmental factors that influence a woman's decision to breastfeed.
Conceptual Framework:  The Social Ecological Framework developed by McLeroy, Bibeau, Steckler & Glanz (1988) was used to guide this study.  The model conceptualizes overlapping spheres of influence, including media, national legislation, political/economic factors, marketing, hospital policies, health provider practices, community/environmental factors, the role of family, knowledge and beliefs. 
Method: A correlational design was used with a purposive convenience sample of 241mothers who were 18 years of age or older, admitted to the Mother / Baby Unit, one to four days post-delivery and able to read and understand English.  Excluded from the study were mothers who were less than 18 years of age, who were seriously ill or whose baby was seriously ill and placed in Neonatal ICU.  Mothers whose baby was being placed for adoption or whose level of spoken English was insufficient to enable understanding of the questionnaire were also excluded.  The Mother/Baby unit at Woman's Hospital served as the setting.  Woman's Hospital is a private, nonprofit community hospital located in Baton Rouge, Louisiana. The facility specializes in the care of women and infants and delivers approximately 8,000 infants per year.  Mothers meeting the inclusion criteria were invited to participate.  Data was collected from mothers in the privacy of their rooms.
Research Questions:   The following questions were addressed:  (1) What personal, cultural, social, and environmental factors influence a woman's decision to breastfeed or not?  (2) Is there a relationship between selected demographic variables (age, ethnicity, insurance status, marital status) and a woman's decision to breastfeed or not?
Instruments:  The following instruments were used to collect data:   (1) a Demographic Questionnaire which elicited socioeconomic information and childbirth history and (2) The Breastfeeding Questionnaire (Kong & Lee, 2004) with a cronbach's alpha coefficient of  (r=0.71) includes a Likert-type response scale covering personal, social, cultural, and environmental dimensions relevant to the decision to breastfeed.
Data Analysis:  Descriptive statistics, including measures of central tendency and variability, will be used to describe the demographic variables. Various inferential statistical procedures will also be utilized. 
Projected Outcomes:  Currently, data collection is complete and data analysis is in progress.  It is anticipated that findings from this study will allow identification of the factors that have the greatest impact on the infant feeding decisions of our patient population.  This data will be used to develop culturally appropriate, individualized interventions aimed at increasing the breastfeeding rate in the diverse patient population of Woman's Hospital.  The data reflecting a possible relationship between selected demographic variables and the decision to breastfeed will also be used to guide future interventions, patient education, and community offerings related to breastfeeding.