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Abstract
Background: Breastfeeding promotes lifelong wellness for mother-infant dyads. Whileany breast feeding is beneficial, there are vast benefits for sustained breastfeeding. In the
United States (US), majority of infants are breastfed; however, there are significant
racial/ethnic differences in breastfeeding initiation. Furthermore, most women stop
breastfeeding before they desire resulting in only one in four infants exclusively breastfed
at six months. Improving the rate of exclusively breastfed infants at six months is a
national priority. Diverse factors influence a mother’s desire and ability to breastfeed.
Among these, family economic instability (FEI), a complex determinant of health, shapes
health behaviors and overall wellbeing. The purpose of this dissertation is to (1) examine
the distribution and prevalence of FEI among US mothers (2) Examine the association
between cumulative FEI and breastfeeding initiation (3) Examine the association between
cumulative FEI and exclusively breastfeeding at six months. Methods: Data from this
dissertation came from the National Survey of Family Growth (NSFG) 2017-2019. Six
FEI components were examined: underemployment, living below the federal poverty
level, medical insecurity, food instability, housing instability, and receipt of government
assistance. Using survey weights, descriptive statistics and bivariate analyses were used
to examine associations between demographic characteristics and FEI. Logistic
regression was used to examine associations between (1) components and (2) cumulative
FEI and breastfeeding initiation and exclusively breastfeeding at six months. Results:
Approximately 74% of mothers breastfed their last infant. FEI experienced ranged from
5.6% (housing instability) to 36.7% (receipt of government assistance). As cumulative
FEI increased, the odds of breastfeeding initiation decreased; however, this decrease in
odds was not statistically significant. The same effect was observed between cumulative
FEI and exclusively breastfeeding at six months. However, medical insecurity had a
statistically significant effect of decreasing the odds of exclusively breastfeeding at six
months. Conclusions: We provided a baseline of FEI experience among mothers.
Findings from our study highlight the complex relationship between FEI and
breastfeeding. In the NSFG, an increase in cumulative FEI was not associated with a
decrease in breastfeeding initiation or a decrease in exclusively breastfeeding at six
months.