THE IMPACT OF PARITY ON AN ADOLESCENT'S DECISION TO BREASTFEED

Background: Feeding with human milk can minimize morbidities associated with high-risk infants. Adolescent mothers have increased probability of delivering high-risk neonates, yet little is known about the prevalence of breastfeeding, motivators or effects of intervention in this age group. We have previously reported our findings on this subject in nulliparous adolescent females. We now report the effects of parity on the attitudes and perceptions towards breastfeeding in a similar cohort. Methods: A cross-sectional survey was undertaken among 30 post-partum and 29 nulliparous women, aged 13-19 years. The instrument included 39 statements scored on a 5-point Likert scale, followed by 41 open and closed-ended questions administered by the Pl. Statistical analysis, using SAS software, included descriptive statistics and chisquare analysis. Results: Both groups were mostly afro-american, average age 16 years. 46% of babies were to be cared for by the mother's mother or grandmother. The paras differed from the nulliparas in school attendance (63% vs 83%), religious affiliation (70%, vs 93%), decision to formula feed (60% vs 45%), decision to breastfeed (24% vs 14%), and acceptability of breastfeeding in public (63% vs. 24%). Feeding decision was more frequently their own (64% vs 41%), or influenced by health care providers (7% vs 1%). Likert scale questions were divided into the following positive and negative categories: self-image, process perceptions, emotional perceptions, outside influences. Negative attitudes previously reported in the nulliparous group persisted among the parous group, with the additional following negative responses: "Breastfeeding hurts." "My mother wants me to bottlefeed." Positive responses from the parous group, distinct from nulliparous respondents included (among others): "Breastfeeding is the healthiest feeding for my baby" and "Breastfeeding would be good for me and my baby." Less parous women (30% vs 62%) reported they "did not know enough about breastfeeding." Conclusion: Parous adolescents are less likely to be in school or to claim a religious affiliation. Misinformation persists among adolescents regarding the benefits of breastfeeding, and a lack of social support exists after delivery. However, health care providers have some influence on feeding choice. Of note, parous women showed less interest in learning about breastfeeding. This suggests that, to be maximally effective, educational efforts to promote breastfeeding