Maternal Religious Involvement and Breastfeeding Initiation and Duration

Abstract

Although religious involvement is associated with a number of beneficial health outcomes, few studies have investigated whether religious involvement is associated with breastfeeding behaviors. Our analyses of 2 waves of data from the Fragile Families and Child Wellbeing Study (n = 4 166) indicate that mothers who frequently attend religious services are more likely to initiate breastfeeding than are mothers who never attend services. Understanding religious variations in breastfeeding may allow public health officials to more effectively target vulnerable populations.

Researchers note important demographic and socioeconomic disparities in breastfeeding behaviors.^1–4 Understanding variations in breastfeeding is critical given the numerous benefits that breast milk is shown to confer.^5–8 Our study builds on recent interest in religion and health. Scholarship on maternal health suggests that church attendance is inversely associated with risky health behaviors among pregnant and postpartum women.⁹ Religious attendance, as well as specific religious subcultures, may influence breastfeeding behaviors.^10,11 Investigating the link between religion and breastfeeding could bring to light potential public health interventions.

We used data from 2 waves of the Fragile Families and Child Wellbeing Study (FFCWS) to analyze the association between religious involvement and breastfeeding initiation and duration. Ours is the first study to our knowledge to examine the association between religion and breastfeeding in a large, religiously and racially diverse sample of predominately unmarried mothers. Exploring religious variations in breastfeeding among this economically disadvantaged population is vital because breastfeeding rates remain low. Because religious institutions are well represented in the poorest neighborhoods, where there are few protective social institutions,^12,13 understanding religious differences in breastfeeding may provide practitioners with opportunities to target programs in poorer communities.

METHODS

We used data from the FFCWS, a longitudinal birth cohort study of 4898 children. Between 1998 and 2000, children were sampled at birth from 75 randomly selected hospitals in 20 US cities with populations greater than 200 000.¹⁴ Roughly three quarters of the FFCWS includes births (both first and higher order) to unmarried parents, and thus includes a relatively disadvantaged sample in terms of education and income. Mothers were interviewed shortly after the birth, and follow-up interviews were conducted 1 year after the child’s birth with a response rate of 90%. Mothers were excluded from the analyses if they did not participate in the 1-year follow-up (n = 534), were not going to live with their child (n = 28), had twins (n = 98), or had incomplete measures for breastfeeding or religion (n = 72).We used multiple imputation to account for missing data on covariates.^15,16

We utilized logistic regression to predict (1) the odds of ever having breastfed and, among those who breastfed, and (2) the odds of having breastfed for 6 months or more. Religious affiliation was coded as a series of dummy variables, including no affiliation (omitted category), Mainline Protestant, Catholic, Muslim, Baptist, other Conservative Protestant, other Christian, and “other” religion. This coding scheme reflects the major religious groups within the United States and is similar to that of other research using FFCWS data.¹⁷ Religious attendance consisted of 5 dummy variables: never attend (omitted category), less than a few times a year, a few times a year, a few times a month, and once a week or more. Each model included an extensive set of control variables, including mother’s age, race/ethnicity, education, immigrant status, relationship status, and first birth. We also included the child’s age at the year 1 interview, household income-to-needs ratio, maternal health, low birth weight, working or in school between the birth and the year 1 interview, and dummy variables for city of residence (not shown). Descriptive statistics are presented in Table 1.

TABLE 1—

Demographic and Descriptive Statistics: The Fragile Families and Child Wellbeing Study, United States, 1998–2001

	% or Mean ±SD
Ever breastfed	56.94
Breastfed ≥ 6 moa	36.41
Religious affiliation
No religion	11.05
Mainline Protestant	5.36
Catholic	29.03
Muslim	1.35
Baptist	26.46
Other Conservative Protestant	4.61
Other Christian	15.76
Other non-Christian religion	6.38
Attendance
Never	14.54
< a few times/y	25.77
A few times/y	21.2
A few times/mo	16.43
≥ once/wk	22.07
Mother’s age, y	25.14 ±6.04
Race/ethnicity
White non-Hispanic	21.8
Black non-Hispanic	47.38
Hispanic	27.1
Other non-Hispanic	3.72
Education
< high school	33.63
High school degree	30.41
Some college	24.99
≥ bachelor’s degree	10.97
Immigrant	16.02
Relationship status
Married	24.78
Cohabiting	36.2
Single	39.02
First birth	38.55
Child’s age, mo	15.01 ±3.48
Income-to-needs ratio	2.25 ±2.43
Fair or poor health	7.33
Baby had low birth weight	9.58
Enrolled in school or working at year 1	74.39

Note. All characteristics refer to the mother unless stated otherwise. The sample size was n = 4,166.

^aAmong mothers who ever breastfed (n = 2,374).

RESULTS

Multivariate results are displayed in Table 2. Conservative Protestants, Muslims, other Christians, and members of other religious faiths all displayed higher odds of breastfeeding compared with their unaffiliated counterparts. Model 2 suggested that attending church once a week or more was associated with a 55% increase in the odds of initiating breastfeeding in contrast to never attending services. The inclusion of church attendance with religious affiliation in model 3 diminished the effect of affiliation for all religious groups except Muslims, Conservative Protestants, and members of other religious faiths. Members of each of these religious groups continued to display higher odds of breastfeeding than did mothers with no affiliation. Frequent church attendance continued to be associated with higher odds of breastfeeding in model 3 (49% increase). Unlike the results for breastfeeding initiation, there were few religious variations in breastfeeding 6 months or longer, with only marginally significant associations for Muslim affiliation (model 4) and church attendance (models 5 and 6).

TABLE 2—

Logistic Regression of Breast Feeding Behaviors on Religious Involvement and Background Factors: The Fragile Families and Child Wellbeing Study, United States, 1998–2001

	Ever Breastfed (n = 4,166)			Breastfed ≥ 6 Mo (n = 2,374)
Variables	Model 1, OR	Model 2, OR	Model 3, OR	Model 4, OR	Model 5, OR	Model 6, OR
Religious affiliation
Mainline Protestant	1.178		1.056	0.869		0.832
Catholic	0.911		0.803	1.111		1.028
Muslim	2.677**		2.382*	1.925		1.791
Baptist	1.135		1.013	0.921		0.861
Other Conservative Protestant	1.846**		1.600*	0.965		0.856
Other Christian	1.348*		1.164	0.975		0.895
Other non-Christian religion	1.693**		1.431	0.926		0.854
Church Attendance
< a few times/y		0.985	0.985		0.995	1.029
A few times/y		1.247	1.218		0.968	1.003
A few times/mo		1.347*	1.346*		1.025	1.063
≥ once/wk		1.554***	1.485**		1.314	1.362
Sociodemographic/control
Age	0.992	0.988	0.990	1.016	1.014	1.015
Black	0.551***	0.550***	0.519***	1.061	0.987	1.031
Hispanic	0.916	0.800	0.882	0.956		0.942
Other	0.698	0.695	0.687	0.638	0.640	0.641
< high school	0.774**	0.788**	0.790**	0.948	0.951	0.957
Some college	1.863***	1.855***	1.833***	1.279	1.268	1.260
≥ college	3.326***	3.153***	3.196***	2.380***	2.329***	2.306***
Immigrant	4.572***	4.166***	4.348***	2.030***	2.051***	1.990***
Cohabiting	0.652***	0.666***	0.694**	0.672**	0.703**	0.702**
Single	0.549***	0.547***	0.570***	0.663**	0.674**	0.681**
First birth	1.297**	1.292**	1.293**	0.729**	0.741**	0.733**
Child’s age, mo	0.971	0.973	0.972	1.010	1.012	1.012
Income to needs ratio	1.003	1.000	1.004	0.984	0.987	0.988
Fair or poor health	0.796	0.811	0.802	1.001	0.993	1.003
Baby had low birth weight	0.764*	0.780*	0.774*	0.571**	0.574**	0.571**
In school/working at year 1	1.235*	1.235*	1.234*	0.672***	0.665***	0.671***
Constant	5.372	6.035	5.262	0.463	0.443	0.446

Note. OR = odds ratio. Omitted categories: No religion, never attend, White, high school, married. Models included 19 dummy variables for city of residence at baseline interview (coefficients not shown).

* P < .05; ** P < .01; *** P < .001.

DISCUSSION

Consistent with studies noting the positive association between church attendance and health,^9,18,19 our results suggest that frequent service attendance is associated with increased odds of breastfeeding initiation. Our analyses revealed a weaker association between attendance and breastfeeding duration. These patterns may suggest an opportunity for practitioners to reach a population that may initiate, but not sustain, breastfeeding. Scholars have noted the importance of church-based health programs in reaching underserved populations.^20,21 Further investigation into the mechanisms linking religious involvement and breastfeeding behaviors would be valuable to public health researchers and practitioners. Mechanisms may include church-based social networks, attitudes toward childrearing, and health behaviors.

The FFCWS is only representative of births in large urban areas, which limits our ability to generalize our findings to the broader US population. Despite this limitation, our study makes an original contribution to our understanding of the social distribution of breastfeeding by highlighting the significant role of religious involvement.