P2B146: Perception and Practices of Breastfeeding in Dominican Mothers in the Dominican Republic

Background: Breastfeeding provides optimal nutrition, offering many benefits for infants and mothers. As a result, exclusive breastfeeding for the first 6 months is the recommendation of the American Academy of Pediatrics and the World Health Organization. In the 2013 report from Encuesta Demográfica y de Salud, the six-month exclusive breastfeeding rate in the Dominican Republic (DR) was only 7% despite report that 82% of babies less than two months had received breast milk. Studies suggest early initiation of complementary foods in the DR could contribute to low exclusivity rates. Our goal was to understand mothers’ feeding practices and perceptions in the DR to inform appropriate local interventions to promote exclusive breastfeeding.

Methods: We performed a cross-sectional survey of mothers in the NICU and post-partum units in a public women’s hospital in Santo Domingo, DR. Eligible participants were mothers who spoke Spanish or English.

Results: We approached 105 mothers to participate. Twenty-three mothers did not speak Spanish or English, one declined, and two surveys were incomplete for a total N=79. Eighty-seven percent were Dominican-born mothers, with 11% of Haitian origin. First time mothers accounted for 32% of the study population with median gravidity and parity of 2; and 90% had history of cesarean section. Approximately 28% had at least one premature infant. Financial insecurity was endorsed by 79% of participants.

We found 86% endorsed having breastfed and 32.6% of mothers had exclusively breastfed at least one infant. Mothers of premature infants were 5.4 times more likely to have expressed breastmilk compared to term counterparts (p=0.002); and Dominican-born bothers were 7 times more likely to have expressed breast milk compared to those from Haiti (p=0.045). Despite high breastfeeding rates, 46% of breastfeeding mothers used formula with 45% introducing formula soon after birth. The most common reason for supplementation was perceived low milk supply (55%). Introduction of complementary intake before 6 months was 54.5%, with 44% of infants receiving water and 15% receiving baby foods between 0-3 months. Seventy percent of all participants received breastfeeding education during prenatal visits, 87% felt it influenced feeding decisions.

Almost all mothers understood that breastfeeding is the ideal nutrition (99%), healthier than formula (93%) and easier to digest (95%). However, 81% of mothers believe they have full supply the day of delivery, and 69% believed the nutritional benefits only last until the infant is weaned.

Conclusion: This population had similar breastfeeding initiation rates as prior studies, but a higher exclusive breastfeeding rate than expected. Most participants view breastfeeding in a positive light, though have high rates of formula use despite high levels of financial insecurity. Opportunities for improving breastfeeding exclusivity include prenatal education with emphasis on breastmilk expression, complementary food and water introduction, and expectations for milk supply.