Our intention was to identify factors independently associated with intention to breastfeed. It is important to attempt to identify those women most at risk of choosing not to breastfeed in order to direct promotional efforts appropriately.
The results of the univariate analyses agree with several other studies reporting an association of infant feeding intention with socio-economic status, maternal age, previous breastfeeding experience, maternal smoking [4, 12–14] and living with a partner [15] and a lack of association between parity and feeding intention [13, 14]. Other studies, however, have demonstrated an association between parity and feeding intention [4, 12].
Most previous studies have identified socio-economic deprivation as being strongly associated with feeding choice. In our study, however, multivariate analysis indicated that socio-economic deprivation was not an independent predictor of infant feeding intention. This is consistent with research in the US reporting that breastfeeding was more strongly associated with maternal attitudes rather than deprivation per se [16].
However, some care must be taken in interpreting our results. Only 7% of the women in our study did not reside in a DEPCAT 7 area, and all of these lived in a DEPCAT 4 area. Our analysis may therefore have underestimated the association between deprivation and feeding intention. Different patterns may well have been seen had the study been based on a random sample of women from the full spectrum of deprivation categories.
Multivariate analysis of the impact of milk tokens suggested that previous anxieties about the possible negative effects of milk tokens on breastfeeding may be unfounded [9]. However, our analysis, which demonstrated a borderline result, combined with the lack of published research into the impact of milk tokens on feeding choice suggests that there is a need for further research in this area.
Previous breastfeeding experience and increasing maternal age were both independently associated with feeding choice. The fact that mothers who have previously breastfed are more likely to intend to breastfeed emphasises the need to support and encourage breastfeeding in first time mothers.
The influence of the partner is likely to vary depending on the partner's attitudes to the feeding choice [17] and how influential he is in the relationship. Bryant [11] identified the partner as having a greater influence if he actually lived with the new mother. Our study did not measure the attitudes of the expectant father, but revealed a significantly positive relationship between choice of feeding and living with the partner. This may relate to physical environment and privacy. A study of low-income women in Glasgow [18] noted that the lack of a private place to breastfeed was a contributing factor to the mother's choice of feeding. Hally [15] also reported an association between not breastfeeding and overcrowding or living with the mother's family. This situation is more likely to occur where the mother lives at home with her parents and extended family.
Smoking has also been shown to be associated with feeding choice in a number of other studies [13, 14, 19]. This has been generally attributed to deprivation status in that smoking is more prevalent among more socio-economically disadvantaged individuals. Our study found smoking to be independently predictive of infant feeding choice. An individual who smokes may represent an individual who has resisted health promotion attempts to address high smoking levels among women and particularly among pregnant women. Such an individual may also be resistant to attempts to promote breastfeeding as the healthy option. There is also some evidence to suggest that women who smoke think that they can not or should not breastfeed [20].
