Why breastfeed?, applying the reasons model to infant feeding decisions

Abstract

Breastfeeding an infant for a minimum of six months is an important health promotion activity, yet many women do not breastfeed for the recommended length of time. This study used the reasons model to understand how women make their decisions about breastfeeding initiation and duration. The reasons model, developed by Meichenbaum and Fong (1993), suggests that there are three levels of reasons for and against adherence to health-related advice evidence-based (Level I) reasons; self-consequential (Level II) reasons; and affective, schema-related (Level III) reasons. The model suggests that reasons at all three levels will be predictive of health behavioral decisions, but that Level III reasons may be particularly important.

This study tested the ability of the reasons model to predict the breastfeeding decisions of 317 pregnant women. The reasons that women gave for and against breastfeeding and numerous other factors were assessed before they gave birth to their babies. All women who breastfed were followed after the birth of their babies to assess their breastfeeding experiences and their ongoing pro and con breastfeeding reasons. The study also assessed the breastfeeding beliefs of 213 male partners of study participants before the birth of their babies. Women who breastfed their babies were followed in the first and second month postpartum, and at 4 months, 6 months, 9 months, and 12 months after birth, as long as they continued to breastfeed.

The reasons model was predictive of prenatal intentions to breastfeed, and postpartum intentions to continue breastfeeding. Level III reasons were predictors of Level I and II reasons, which predicted breastfeeding intentions. Level III reasons were also independent predictors of prenatal breastfeeding intentions and intentions to continue breastfeeding over the first few months postpartum. Level I and II reasons, particularly Level II con breastfeeding reasons, were the strongest independent predictors of postpartum intentions to breastfeed for more than 4 months. Intentions to breastfeed were consistently significant predictors of actual breastfeeding behaviour.

The reasons model was also predictive of male partners' prescriptive beliefs about breastfeeding duration from 4 months on. The prescriptive beliefs of male partners were significantly related to participants' breastfeeding reasons but predicted participants' breastfeeding intentions over and above participants' breastfeeding reasons. The relationship of additional variables such as happiness, stress, and education to prenatal breastfeeding intentions was partially mediated by the reasons model. In addition to the relationships that education had to pregnant women's breastfeeding reasons, education was an independent predictor of breastfeeding intention s and behavior.

The reasons model was also tested against the theory of reasoned action (TRA) *Fishbein & Ajzen, 1975) and the theory of planned behavior (TPB) (Ajzen, 1991). Although both TRA and TPB predicted prenatal breastfeeding intentions, the reasons model added to the prediction of intentions, over and above TRA and TPB.

This study underscores the importance of individuals' own value-relevant, affective, schema-related reasons as well as evidence-based and self-consequential reasons as predictors of their intentions and subsequent behaviour. It suggests that the reasons model may a useful and powerful model for predicting and understanding behavior across a variety of health domains.