Stress, social support, and racial differences: Dominant drivers of exclusive breastfeeding.

Abstract

Exclusive breastfeeding is recommended for 6months; however, many childbearing people wean their infants before 6months. Psychosocial factors such as stress, social supportand race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stressand social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, raceand social support on exclusive breastfeeding over 6months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared withWhite, participantswere less likely to breastfeed exclusively for 6months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio:0.01,95%confidence interval: 0.001-0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress.