Cultural Analysis of Infant Feeding Decision in the US - Literature review Example

Cultural Analysis of Infant Feeding Decision in US I. History of Infant Feeding in U.S The last century is a significant time period to define the dramatic changing pattern affecting the prevalence in breastfeeding decision in U.S. Starting from the onset of twentieth century it decreased to a significant level almost two thirds of the century and then again it rose to a certain level. Prior to twentieth century, more than 66% of mothers were engaged in breastfeeding practices with their babies, whereas the rate fell down to its lowest point during 1972 when only 22 women among 100 were actually engaged into breastfeeding. But the scenario got changed radically from 1975 when the breastfeeding rate began to increase once again and the trend continues throughout following decades with a considerable statistical changing ratio such as 60 among 100 mothers took interest and actually engaged in breastfeeding practices (Wright. 2001). A national survey on breastfeeding practices had been conducted during 1971 – 1995. It illustrated and identified factors related to the breastfeeding practices among the mothers that primarily depend on education, ethnicity and level of income (Wright. 2001). For example, women with less education and lower income group are less likely to engage in breastfeeding practices and white women are more likely to breastfeed their babies compared to black or Hispanic women (Hirschman & Butler, 1981). Studies also suggest that the finale of the survey indicated that the breastfeeding practices had been increased among participants who were previously less likely to participate in the breastfeeding practices such as increased rate in breastfeeding practices for black (33.3% - 37.0%) and Hispanic (53.8% - 61.0%) compared to the white (65.0% - 64.3%), (Wright, 2001) the group who were more likely in the practice during the onset of the survey. Research on breastfeeding suggests that there is a correlation among the breastfeeding rate and maternal employment and the rate had been significantly influenced prior to seventies leading to a great decrease in the rate of breastfeeding decision among employed women. However, the pattern shifted to the other extent during nineties when studies have found that the employed mother did not show any difference in the initiation of their breastfeeding decision, whereas, they were more likely to disengage faster in breastfeeding process than that of unemployed women (Martinez & Nalezienski, 1979). The changes in birthing practices from anaesthesia or analgesic induced centralized birthing process to natural child-birth, since the midst of twentieth century brought a dramatic changes in the decision making process regarding breastfeeding. In fact, the revolution in the management of childbirth occurred in the midst of 20th century has drawn a significant influence in breastfeeding practices. The non-medicated delivery system influenced the mother-child bond to quite a length and also the immediate breastfeeding, even before the detachment of umbilical chord in some cases, was promoted. The history of breastfeeding practices in U.S also witnessed the importance of increased knowledge associated with the benefits of breastfeeding and its influence on infant feeding practices. Throughout the last few decades the various successful interventions have been taken into considerations regarding infant feeding practices including hospital management, improved social support, educational guidance to both health care providers as well as mothers, which eventually affecting the attitudes and practices among particular culture, but non-affecting the national point of view as such. II. Sociological arguments and/or theories regarding infant feeding decisions. a. Cultural Arguments: Likewise England, breast milk was considered as a valuable medicine in United States. Women, in general, used to provide milk for medicinal use. On the other hand, there are ample evidences like the case of Ebenezer Parkman's where breast milk had been used for the nourishment purpose for the adults along with infants. (Salmon, 1994). This quite evidently leads to the query whether these practices reveal the cultural significance attached to breastfeeding and the role of women as breast-feeder considering the culture implying the shared system determined by attitudes and beliefs. The modern belief that woman’s efforts in breastfeeding practices and the physical needs of their young children were predominantly important for realizing the cultural significance of motherhood. The role of women as a mother in a wider cultural context is the first thing needs to be addressed, leading to the understanding of the significance of breastfeeding in relation to the motherhood in general. During the early modern era, the high cultural value attached to the physical side of motherhood is established by adulation of women as breast-feeders, the nurturers of a new life. The concept of motherhood in the context of breastfeeding is itself a complex issue which sometimes has been undervalued by different historians at different times ignoring the cultural values, time-variation and original meaning of motherhood and breastfeeding practices (Salmon, 1994). In early modern belief, the breast milk was considered as food for infants whereas a medicinal supplement for the adults leading a reflection of not only considering the power of breast milk for life prolonging liquid, but it reflects a respect for women’s physical nature in general. This is illustrated in Thomas Laqueur's recent discussions of "one sex body”, where he described the cultural significance attached to this bodily fluid in women. He transcribed by comparing to the role of semen in a male body by mentioning the necessity of semen for the creation of life; however, the essential sustainability for life goes with the breast milk. Women's roles as the breast-feeders of infants define the ministerial representations of women's lives being useful for setting down cultural rules and potentiality. In cultural setting, the belief in the eternal joy associated with infant satisfaction at the breast reveal the deep admiration for the supremacy of breastfeeding mothers to pacify and soothe as well as nurture. In the spiritual context, David Leverenz commented that the breast itself stands to represent God’s loving nurturance putting the reference from Bible affirming that the breastfeeding baby received the nurture and comfort in a far superior fashion than that of hand-feeding baby. There is a crucial role of medical science in advocating the role of breastfeeding which inevitably influenced the cultural significance of breast feeding and infant care at a wider context. Likewise, religious writers, the medical writers always encourage the positive attitudes towards breastfeeding by praising their efforts and involvement in breastfeeding practices. On the other hand, the medical writers strongly criticized those women who did not participate in this practice with their infant by emphasizing the scope of maternal duties involved in not only giving birth, but with breastfeeding as well and also medical science took a major role in describing the scientific importance of breastfeeding practices for both the mother as well as the infants. On the other dimension, this is also true that the contemporaries understand the excessive strain associated with the case of weak, unhealthy or malnourished women. However, diaries, treatise, medical journals and other historical documents coincided with the fact of praising breast feeding practices during 17th and 18th centuries implying the respect for breast milk and breastfeeding mother with a cultural framework. b. Economic and Educational Arguments Ongoing research the primary influential factors on breast feeding practices in the United States analyzes the role of economic and educational variables on the decision affecting the infant feeding practices. There are primarily three interrelated and interdependent variables in the course of designing interventions on infant feeding decision, including (a) target of health education, (2) educational diagnosis and (3) cultural appropriateness of the health behaviour (Brown et al, 1997). Studies suggest that the value and beliefs influence the feeding type, its schedule, feeding amount and the introduction of cereal, other supplements and water in an infant’s diet which is greatly influenced by community sharing practices and interaction with other family members. The economic factor influences greatly in the decision making style regarding infant feeding in a controlled study implicating to the exposure of various substitutes of the nutritional supplements for the infants including bread sprinkled with warm water, pet milk, baked mashed potatoes as a substitute for cereal or other baby milk. Research studies with low-income African American women suggest that the culture and economy play a crucial role in the determination of infant feeding decisions among women which, by context, affect the role of health care professionals by encouraging their knowledge in cultural and economical influences in different community setup. The belief and values regarding infant feeding and the preparation for infant formula influence to a great extent in the decision-making policies. Most of the beliefs and values are said to derive from cultural traditions, responsible authorities and previous experience either in direct or indirect fashion. It is apparent from various studies conducted on the acknowledgement of various factors influencing the decision-making style regarding infant feeding reveal that the lack of appropriate knowledge regarding breastfeeding practices lead to over-concentration on infant formula, dilution of infant formula, early introduction to solid food, over-hydration, bottle-feeding of cereal. Pragmatic research has been established to ensure the beneficial factors related to breast feeding which include nutritional composition (Lawrence et al, 1989), protective properties (Goldman, Garza, Nichols, & Goldblum, 1982; Victoria et al., 1989) and emotional values for both infant and mother (Libbus, 1994). Research conducted on how education influences the breastfeeding practices in specific groups results mixed outcome. For example, a Midwest Women, Infant and Children (WIC) demonstration project intervened by group class, one-to-one peer counselling and lactation consultation did not evaluate any significant difference in either phase of initiation or post intervention (Sanders, Romashko, Fleischman, Hopstock & Willette, 1990). However, research has found that many low-income group women are interested to get information regarding their breastfeeding practices from health care providers. But these public clients receive less attention than that of private clinic patients from middle and higher socio-economic group (Grossman, Fitzisimmons, Larsen-Alexander, Sachs & Harter, 1990; Shapiro et al, 1983). Moreover, providing education related to breastfeeding practices is greatly affected by the extensive variation in health care providers (Andersen & Geden, 1991) and also ambivalence and lack of support from health workers affects the maternal choice and success in breastfeeding practices (Kearney, 1988). Also studies have found that health workers can involuntarily destabilize women’s interest in their own breastfeeding decision by employing an induced condition with inadequate information regarding the practice (Bryant et al, 1989). Therefore, the objective of educating women must focus on providing information regarding lactation benefits within a positive environmental framework as well as to convey the importance of this rewarding experience for both mother and child, but the focus must not coincide with lack of information or a mere ordeal (Bryant et al, 1989). In the course of spreading awareness and developing an educational framework among women in general as well as from lower socioeconomic group, researchers show a great interest in not only physiological and immunological aspects of breast milk but social and psychological nourishment for both mother and infant. Klaus et al (1972) argued that the physical contact between mother and child must occur early in postpartum period in order to develop an optimum bond between them. Several studies have been conducted on breastfeeding to provide the mothers suggestive results including the association of breastfeeding to positive maternal bonding process (Nicole M. Else-Quest et al., 2003). Klaus et al (1972) argued that lack of early postpartum contact may lead to adverse maternal performance in some women as well as early contact might avert maternal rejection. Various studies support that breastfeeding has a directly proportionate to less parental negative affect; parental intrusiveness and infant deregulation at 12 months of age (Nicole M. Else-Quest et al, 2003). There are studies which put emphasis on the ego-maturity of women and have related it to their breastfeeding practices by mentioning that more ego-mature women tends to get involved more into breastfeeding practices with more empathy, nurturance, responsibility and enjoyment accompanying children (Jacobson et al, 1991). Studies also suggested that more a woman is ego-mature, less authoritarian she would be and the authoritarian characteristic is negatively related to the breastfeeding practices. However, several demographic variables and behavioural parameters such as maternal age, education, role of family member are associated to the choice of feeding in some of the cases. c. Feminist Arguments Breastfeeding, an embodied experience, is likely to provide important insights and apparent contradictions concerning women’s body-image (Stearns, 1999). There is a psychological conflict between maternal image and sexual image, though there is no difference in physiological term such as reproductive process (Daivs-Floyd, 1992; Newton, 1977). According to feminist perspective, breastfeeding raises the questions regarding the appropriate uses of women bodies – as sexual purpose or nurturing purpose (Stearns, 1999). Young (1998) argued that about breast being a scandal shattering border between motherhood and sexuality. The behaviour related to the exposure of breasts in public during breastfeeding has drawn attention to many researchers. In performing breastfeeding activity in a public place, a woman generally acts depending on the environment, situation and the culture or norm she belongs including barriers and expectations related to that culture. In some cases breastfeeding in public place becomes uncomfortable due to perceived verbal or body languages of others (Stearns, 1999) which leads women in concern to feel in a negative fashion. To choose the appropriate place for breastfeeding a woman’s concept of ideal place has been frequently influenced by other’s preference. In general, the most advices and come from the family members regarding the decision related to breastfeeding location. The idea of location seems to be varied according to the child’s birth order. It has been observed that the women tend to breastfeed longer for the second child compared to the first one and most of the women reported that they feel more comfortable about their body-image as well as breastfeeding practice in general, in front of public, friends, family members (Stearns, 1991). It is quite prevalent that women reported that they enjoy breastfeeding more in front of family members or friends rather than doing it in a public place. In some cultures, as well women commented that their breastfeeding practices are considered as very normal activities and a part of everyday lives without experiencing any kind of problems. In a true sense, theoretical debates among femininity and women’s body defines a complex relationship between powerful hegemonic ideologies and women’s agency as a reflection of their own lived experience (Dellinger & Williams, 1997). d. Psychological Arguments Few recent studies on breastfeeding show a great interest in the psychological aspect of breastfeeding and maternal psychology as well as predictors of mother-child relation and future outcome. Field et al (1999) suggested that skin-to-skin contact between mother and child can reduce anxiety and improve the affect. These studies concluded with the breastfeeding as one of the essential factors of parenting style and parenting influence on the child in concern. In postpartum period, maternal oxytocin circulation (as a component of labor) becomes the highest. Few studies have shown that at times when central oxytocin levels are high in women, they are predisposed to form bonds and display affinitive behaviour (Carter, 1998; Klaus, 1998; Kennell & Klaus, 1998).However, several other studies argued that as because parenting functioning is not dependent on a single factor, rather multiply determined by factors stemming from parental involvement, child’s own functioning, and the family bond as well as social framework, thus breastfeeding as a single factor does not exert a uniform effect on parenting alone (Belsky, Rosenberg, 1995). III. Studies regarding infant feeding predictors and demographics Breastfeeding can be influenced by various factors including sociological, cultural, biological as well as educational. Sociological and behavioural factors can influence a women’s decision to initiate or terminate the breastfeeding practice. The other influential factors are urbanization, maternal education, and different intervening variables of socio-economical and socio-cultural factors, health services, employment status and availability of breastfeeding substitutes. The biological or physiological factors influencing breast milk production and output is dependent on suckling process, including three factors namely frequency, intensity and duration (Huffman, 1984). The factors decreasing the frequency of breastfeeding involve scheduled feeds, no night feeds, and usage of pacifiers, bottled supplements as well as hand-fed supplements. The decrease in frequency eventually affects the milk output resulting the increased maternal anxiety and termination of the process. General Findings Suckling patterns can influence the initiation and duration of breastfeeding process by virtue of physiologic mechanisms. It may also be affected by sociological and behavioural factors. Demographically the factors associated with the prevalence of breastfeeding influencing the initiation and duration of the process are the effects of urbanization, education and income through the intervening variables such as socio-cultural environment, health care services, and mother’s working pattern as well as knowledge and availability of breast milk substitutes (Winikoff & Solimano, 1982). However, severe illness can also influence the lactation but this does not have any significant demographical influence in general (Gray, 1982). Socio-cultural environment The breastfeeding behaviour pattern are affected by modernization stemming from changing pattern of social, cultural and economical influences on parental attitudes and behaviour in relation to self-images (Jelliffe & Jelliffe, 1978). Rapheal (1979) argued that life styles in modern corporate cities are not suitable to breastfeeding practices. To find out the reason behind the decline in breastfeeding practices some of the researchers stressed on the subconscious attempts to move from traditionalist outlook to modernized outlook (Jelliffe & Jelliffe, 1978). Health Care Services Prevalent to some health care settings women have to contend to the hospital schedule and are exposed to the beliefs and practices of health care practitioners often detrimental to the initiation of breastfeeding practices (Baer, 1981). Changes in hospital routines are likely to positively affect the initiation and duration of breastfeeding promoting the immediate breastfeeding following delivery, rooming-in system throughout day and night and not separated from mother so that mother may feed their infant according to the infant’s desire (demand feeding) instead of an hospital schedule (schedule feeding). Women’s Working Pattern There are opposing views regarding breastfeeding decision influenced by women’s working pattern. Some studies suggested that the relationship between the demands of employment and breastfeeding is less significant (Van Esterik & Greiner, 1981), whereas the authors like Butz (1981) and Popkin (1980) argued women’s work pattern conflicts with the breastfeeding practices. In research, the primary concern analyzing the effect of female employment on their breastfeeding practices both initiation and duration is focused on city areas and a decline in decision of breastfeeding is noticed. The associated parameters of breastfeeding and women’s employment involve availability of time, access to infant, location of work setting, type of work, income, transportation, alternative child care, maternity leave, crèches and legislation (Huffman, 1984). Implication of the Study for Future Research Studies have found that there is a strong correlation between enhanced duration of breastfeeding and fertility regulation (Huffman, 1984). Based on studies several policies attempting to improve the initiation and duration of breastfeeding can function at different levels. The most difficult situation promoting this practice varies depending on socio-cultural background. In developed countries like U.S the trend is in its higher limit seems to be as a result of an increased understanding of the benefits of breast milk along with more trained health professionals’ support and intervention in this area (Baer, 1981). The primary implication of these studies include the enforcement of the International Code of Marketing of Breast Milk Substitute approved by World Health Assembly promoting the activities related to provision of information and education on breastfeeding involving restricting the promotion of the use of breast milk substitutes, encouraging the health workers to promote breastfeeding, setting limit on the manufacture and distribution of infant formula, instructing for proper labelling on substitute products defining the superiority of breast milk. Limitations of the Study The studies did not include the crucial role of family planning service into account (Huffman, 1984), whereas family planning services may have a direct and crucial role affecting breastfeeding practices through the careful prescriptions of contraceptives during the early postpartum phase while breastfeeding is being initiated. IV. Studies regarding race and infant feeding decisions. a. Whites General Findings Study conducted on breast-feeding incidence and duration involving population samples with 43% white and 57% black with a significant socio-demographic difference including significant difference in age, education, marital status, child-birth class attendance suggest that there is a strong correlation between demographic variables and ethnicity (Natalie Kurinij et al). Studies found that a higher educational level has increased the likelihood of breastfeeding practices. Among white, one of the most important parameters affecting the prevalence of infant-feeding choice is associated with the delivery location which is significantly related to the university teaching hospital rather than a public county hospital. In establishing a relationship among the duration and socio-demographic factors a regression analysis has been estimated denoting a significant interaction between ethnic group and marital status. In another study conducted on defining disparities about infant-feeding decision across ethnic group suggested that 72% white, 73% Hispanic and 52.9% African American mothers actually breastfed their children in early postpartum phase during 2001 and 34% white, 33% Hispanic and 22% African American mothers continue to nurse their babies after 6months of birth (Ryan AS, Wenjun Z, Acosta A, 2002). Implications of Future Research All studies suggest there is a significant difference among the infant-feeding decisions among African American with that of Whites and Hispanics. The black show a consistent lower breastfeeding rates compared to whites or Hispanic independent of their socio-demographic status. The difference is prevalent in high and low socioeconomic classes suggesting the great influence of socioeconomic status influencing the decision regarding infant feeding. Thus future scope of these studies implicates a better understanding of ethnic differences established in the decision-making policies among women belonging to different ethnic groups. Moreover, these studies can help in planning programs related to future breastfeeding goals and ensuring public health strategies to get optimal uses of resources of US (Ruowei Li, Laurence Grummer-Strawn, 2002). Limitations The primary limitation of these studies include that these studies provide evidences on racial and ethnic disparities in practicing breastfeeding but are unable to provide underlying principles governing these differences (Ruowei Li, Laurence Grummer-Strawn, 2002). b. African American General Findings There are various studies conducted to identify the predictors of breast feeding practices, attitudes governing the breast feeding decision and practices among African Americans. Findings from the study conducted in Mississippi Delta area by Kum-nji, et al suggested breastfeeding friend or relative as the most significant predictor. The study also argued that there is no racial difference found as a result of their study after controlling the other socio-demographic cofounders implicating the probable reason may be involved with lack of strong views against breastfeeding. Another study conducted on African American women by brown, et al (1997) in a central city community of Wisconsin suggests that the culture affects greatly the decision regarding infant feeding or breastfeeding practices. Studies affirm that the economical status influences on the breast feeding decision among the women participated in the focus group as well – as for example when the cost becomes a challenging issue while feeding issue, women in general, relied on their experience and wisdom to make the choice for infant feeding. Implication to Future Research Research suggests that the factors governing socio-demographic differentials need to be identified as well as poor and less educated African American need to be targeted for promotion, protection and support for breastfeeding practices (Ruowei, Laurence Grummer-Strawn, 2002). Various studies conducted on finding out the cross-cultural differences suggesting that the incidence of breastfeeding is lower in African American women than White women in general (Jacobson, 1991). Studies also suggested that economically disadvantaged African American women are more reluctant for absorbing current norms and health advisories regarding the advantage of breastfeeding than a comparatively poor White American women (Jacobson, 1991). Limitations The studies were unable to focus on cognitive competence and ego-maturity factors influencing the breast feeding decision in a cross-cultural setting. An understanding of these factors across different cultures may well be helpful in designing the proper intervention program and to promote breastfeeding within disadvantaged African American communities (Jacobson, 1991). The studies primarily focused on the maternal behaviour and attitude relating to breastfeeding decision, and influence of father has not received much importance. In some cases, the stress on incidence of breastfeeding is much more considered than its duration (Kum-Nji). Other limitations observed during these cross-cultural studies sometimes not to involve the strict definition of exclusive breastfeeding without including any other liquids or solids (Labbok, Krasovec, 1990) rather than introducing water feeding for exclusive breastfeeding. Informational studies need to be employed in order to understand the basis of low breastfeeding practice rates in large differentials among African American women. The factors behind the substantial differences in breastfeeding practices between high and low socioeconomic groups among African American women need to be identified. c. Hispanic General Findings Several studies argued that marital status, head of household, maternal and paternal ethnicity, maternal education, income and birth order are the most significant parameters associated with breastfeeding practices (Rassin et al, 1982). Different studies have stressed on the fact that breastfeeding is a health-promoting behaviour for Hispanic women (Schlickau & Wilson, 2004) and hence has a direct influence of several determinants including prior related behaviour, personal factors, perceived benefits, perceived barriers, perceived self-efficacy, activity related affect, interpersonal influences, situational influences, immediate competent demands and commitment to plan for an action (Schlickau & Wilson, 2004). According to Pachon and Oslon (1999) Hispanic women not belonging to US by birth were 5.8 times more likely to get involved into breastfeeding practices than that of Hispanic women born and brought up in US. Studies argued that the likelihood of intention regarding breastfeeding practices was higher for mothers born in Mexico and migrated to U.S later in life (Romareo-Gwynn & Carris, 1989). Humphrey et al suggested that Hispanic women in US are more likely to participate in breastfeeding practices than that of other ethnic group in US. Scrimshaw et al (1987) & Cohen et al (1999) argued that Hispanic women are more like to report about pleasure and satisfaction involved with breastfeeding than other ethnic groups as well as they report their perception about the breastfeeded child as more healthier affirming that the breastfeeding practice is the superior method of infant feeding (Wood et al, 1998). Differential factors are quite prevalent in duration and exclusivity of breastfeeding decision among Whites and Mexican Americans (Ruwoei, 2002). Several studies have found that there is a significant role of advisory figures in influencing the decision regarding breast feeding among Hispanic women. Langer at al (1998) suggested that the presence and involvement of doula (a woman who provides support to the mother during and post labour phase) may increasingly affect the initiation and duration of breastfeeding among Hispanic women 1 month after birth. Implications for Future Research Most of the studies are limited in their efforts in making policies to promote breastfeeding decisions in working mothers which may influence further in designing the awareness program regarding the infant feeding decision (Scrimshaw et al, 1987). Few researchers also argued the virtual impossibility of breastfeeding during working days, so programs can be designed to facilitate behaviour encouraging breastfeeding during night (Scrimshaw et al, 1987). Encouraging commitment to breastfeeding and facilitating the plans and behaviours related to the breastfeeding decisions need future attention. Also researches need to be conducted to find out the relation between competing demands and breastfeeding outcomes (Schlickau & Wilson, 2004). Limitation Several studies conducted on finding out the ethnic differentials covering Hispanic women decision regarding infant feeding practices show a great level of limitations in some areas like they accounted the influencing factors regarding breastfeeding intention and initiation, but effect of prior behaviour on the duration of breastfeeding is largely ignored (Schlickau & Wilson, 2004). In health promoting researches few influential factors such as smoking, stress, nutritional aspects and exercise need to be precisely addressed (Schlickau & Wilson, 2004). d. Puerto Rico General Findings The Puerto Rican society has passed with reflective changes throughout the past 50 years. The gradual industrialization as well as the shifting role of women’s image to the labour force have been escorted by improved medicinal influence on of the reproductive process and an accelerated reduction in the occurrence of breastfeeding considering as the cultural norm for nourishment of infants (Parrilla Rodriguez & Gorrin Peralta, 1999). The multivariate analysis regarding breast feeding decision suggests that the parameters such as breastfeeding the previous child, duration of maternal residence in U.S, not susceptible to receiving pre-natal bottle-feeding advice, recent birth and higher birth weight are significantly and positively correlated to the association with breast feeding decision among Puerto Rico women (Perez-Escamilla). Studies strongly argued that prenatal exposure to various efforts promoting or discouraging in nature have a high probability of influencing the behaviour and attitude related to breastfeeding decision (Balcazar, 1995; Romero-Gwynn, 1989; Pugin, 1996). Balcazar et al (1995) suggested that the prenatal advice to breastfeeding decision was the strongest predictor influencing breastfeeding decision. Evidences are there to show that Puerto Rico (40%) women are less likely to get involved into breastfeeding practices compared to U.S (54%) and Latin America (74%-97%) [Smith & Becerra, 1990]. Studies argued that the majority of participants reported about the embarrassments relating to the public breastfeeding practices, painful as well as baby’s being uncomfortable on latch are the primary parameters for not breastfeeding (Anderson et al). Different cross-cultural studies suggest that one of the most important predictors of breastfeeding practices among Puerto Rican women is social capital. The feeling of support related to cognitive perception is an important factor associated with a women’s intention to breastfeed (Damio & David). Balcazar et al reported that the more a woman receives support from her partner or husband, the more likely she shows her intention towards breastfeeding decision. Implications for Future Research The designing for promoting the breastfeeding programmes among Puerto Rico women has a great scope to involve and research the parameters such as breastfeeding intentions and the level of maternal acculturation (Perez-Escamilla, 1998). Programmes may be developed by strengthening the scope of societal and cultural intervention along with much active paternal involvement. Moreover, further studies need to be encouraged in order to understand the effect of acculturation and infant feeding preferences among different Latino American communities (Anderson et al). Limitations There are limitations related to the retrospective infant feeding decision studies as the women are being asked to recollect the prenatal and perinatal events which they have already implemented in their breastfeeding decision (Perez-Escamilla, 1998). The involvement of parental role influencing breastfeeding decision is not taken into account. Works Cited 1. Martinez GA, Nalezienski JP. The recent trend in breast-feeding. Pediatrics 64:686-692, 1979 2. Hirschman C, Butler M: Trends and differentials in breast feeding: An update. Demography 18:39-54, 1981 3. 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