Determinants of breastfeeding in four Canadian Ojibwa communities: A decision-making model.

A prospective cohort study was conducted to determine the patterns of breastfeeding and factors associated with breastfeeding choice and duration among Canadian Aboriginal (Ojibwa) women from third trimester to 12 weeks postpartum. The survey included demographic, obstetric and infant feeding information, measures of "breastfeeding beliefs," "breastfeeding confidence," and "referent support." Thirty-six Treaty-status women, living in or near four Manitoba First Nations communities, were interviewed prenatally and subsequently gave birth to a live infant between December 1993 and June 1994. Demographic, obstetric and infant feeding information from 20 women who missed the prenatal interview were obtained retrospectively. The overall response rate was 98% of eligible women. Outcome measures included initiation and duration of breastfeeding. Explanatory variables included factors associated with breastfeeding initiation/duration, based on a revision of the Ajzen and Fishbein (1980) decision-making model. Breastfeeding rates were 57% (initiated), 44% (week 1), 32% (week 4), and 18% (week 12). The decision-making model demonstrated construct validity for breastfeeding choice. Multivariate modelling indicated "prenatal intent" and "breastfeeding confidence" as best predictors of breastfeeding choice. Best predictors of duration were "satisfaction with breastfeeding at 2 weeks" and "postpartum referent scores." "Satisfaction" was negatively correlated with the number of verbalized problems. Reasons for weaning included "insufficient milk" and "soreness." Community intervention programs could focus on breastfeeding beliefs, confidence and referent support, and decrease early weaning by screening for preventable problems. Am. J. Hum. Biol. 9:579-593, 1997. © 1997 Wiley-Liss, Inc.