890: Exclusive formula feeding among socioeconomically disadvantaged (SED) women: a necessity rather than a choice?

Abstract

SED women are comparatively less likely to breastfeed. Many breastfeeding (BF) educational interventions assume SED women choose formula feeding because of limited knowledge of BF benefits or poor social support. We compared patient-reported reasons for BF cessation between SED women who chose exclusive formula feeding and SED women who chose to supplement BF with formula. This cross-sectional study occurred in 2016 at a single, university-based tertiary care center, which is designated a Baby Friendly Hospital. SED women without a BF contraindication who delivered non-anomalous singletons were recruited at scheduled appointments within 6 months of delivery. Consenting women completed a validated BF survey. Study outcomes included reasons for formula initiation and BF cessation. We compared outcomes in women who exclusively formula fed to those who supplemented BF with formula. 149 women completed the survey; of these, 47 (31.5%) chose to supplement BF with formula, and 51 (34.3%) chose exclusive formula feeding. Compared to those who chose BF with formula supplementation, women who chose exclusive formula feeding were more likely to have an annual family income of <$25,000 but were otherwise similar in age, ethnicity, and level of education. On a 1-4 scale, with 4 denoting more importance, women who chose exclusive formula feeding were more likely to rate their desire or need to return to work or school (4 (3,4) versus 3 (1,4), p<0.001) or to leave the baby for a few hours at a time (4 (1,4) versus 1 (1,3); p<0.001) as very important reasons for not BF on PPD2. Conversely, women who chose exclusive formula feeding reported being less likely to start formula due to their concern the baby was still hungry after BF (13.7% versus 36.2%, p=0.01). There was no difference between groups in BF problems such as pain or difficulty latching. The majority of SED women feed their infants formula by PPD2. This decision appears driven more by logistical necessity than by a lack of BF knowledge or personal problems with BF. These data suggest BF educational interventions should target strategies to continue BF when returning to work or school.