Employing an extended Theory of Planned Behaviour to predict breastfeeding intention, initiation, and maintenance in White British and South-Asian mothers living in Bradford

Background. Despite reported differences in breastfeeding rates amongst women of different ethnic groups, little research has investigated whether the thoughts and feelings (social cognitions) of women from these different groups during pregnancy influence their later breastfeeding behaviour. Objective. This study investigates the extent to which social cognitions (based on the Theory of Planned Behaviour; TPB) predict differences in breastfeeding intentions, initiation, and maintenance between White British (WB) and South Asian (SA) women. Design and methods. Two hundred and fifty women (predominantly WB or SA) in the last trimester of pregnancy completed a questionnaire based on the TPB. The women were followed up 6 months later and their breastfeeding during the previous 6 months was recorded. Results. The TPB predicted significant variance in breastfeeding across the sample and was able to account for differences between SA and WB women. Affective attitudes (emotional reactions to breastfeeding) and moral norms (reactions about whether breastfeeding is right or wrong) were the strongest predictors of intentions. Intentions and affective attitudes were predictive of breastfeeding initiation, whilst only affective attitudes were predictive of breastfeeding maintenance. Conclusion. Stronger intentions to breastfeed led to higher rates of breastfeeding amongst SA women. In turn, intentions were predicted by emotional and moral beliefs about breastfeeding, beliefs that were less positive amongst a WB sample. This suggests that those tasked with encouraging breastfeeding may need to have a different conversation with women about breastfeeding that goes beyond a focus on costs and benefits. Statement of contribution What is already known on this subject South Asian women living in Britain are more likely to breastfeed their infants than White British women. The constructs of the Theory of Planned Behaviour have been shown to predict breastfeeding initiation and maintenance. However, few studies measure longer term breastfeeding or test whether TPB constructs from the extended TPB measured before the delivery of the baby predict breastfeeding initiation or maintenance. No studies have explored this amongst a British South Asian population. What this study adds This study demonstrates that intentions and affective attitudes are strong predictors of initiation of breastfeeding, but that only affective attitude predicted maintenance of breastfeeding for 6 months. Moreover, we demonstrated that stronger intentions were able to explain the higher breastfeeding initiation rates and affective attitudes were able to explain the greater likelihood of maintenance of breastfeeding amongst South Asian women.