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Breast-Feeding

Intentions

and Practice

Among

Hispanic

Mothers

in Southern

California

Eunice Romero-Gwynn,

PhD, and Lucia Carias, BS

From the Department of Nutrition, University of California, Davis

ABSTRACT. Breast-feeding intentions, breast-feeding in the hospital, and breast-feeding at home were studied among 132 Hispanic mothers participating in the Ex-panded Food and Nutrition Education Program in south-em California. There was not a large difference between total breast-feeding intention (77.7%) and total breast-feeding practice (63.8%). However, the 67.7% intention of exclusive breast-feeding drastically decreased to 19.7% and 17.2% in the hospital and at home, respectively. Formula supplementation increased by 4.5 times from intention to practice. Exclusive formula feeding increased from 10.0% to approximately 37.0% in the hospital and at home. Stepwise logistic regression identified that the likelihood of intending breast-feeding was greater for

mothers who migrated from Mexico than for mothers

born in the United States (odds ratio 4.75). The likelihood of breast-feeding practice was greater for mothers who initiated breast-feeding within the first 10 hours after birth as opposed to 11 or more hours (odds ratio 1.27),

for mothers who had a vaginal rather than cesarean

delivery (odds ratio 12.76), for mothers who did not return to work postpartum as opposed to working mothers (odds ratio 28.26), and for mothers who migrated from Mexico compared with mothers born in the United States (odds ratio 8.54). The importance of assessing and supporting mothers’ breast-feeding intentions in the pre- and post-partum period is documented. Training in the clinical aspects of breast-feeding and improvement of hospital protocols is recommended. Mothers intending to breast-feed should be identified and supported. Pediatrics

1989;84:626-632; breast-feeding, Hispanic women,

mi-grant, breast-feeding.

In the United States, a resurgence of

breast-feeding has occurred in the last 15 years,’ reversing

a downward trend initiated after World War II

which reached a low breast-feeding incidence of

approximately 25.0% in the early 19705.2 National

data from Martinez and Krieger1 for 1984 (collected

through mailed questionnaires) show an incidence

Received for publication Aug 15, 1988; accepted Oct 28, 1988. Reprint requests to (E.R.-G.) Dept of Nutrition, University of California, Davis, CA 95616.

PEDIATRICS (ISSN 0031 4005). Copyright © 1989 by the

American Academy of Pediatrics.

of in-hospital breast-feeding of 65.0% and 33.3%

among white and black mothers, respectively.

How-ever, no figures for Hispanics are provided in this

study.

Data from small studies of Hispanics show a large

variation in breast-feeding practice between

differ-ent Hispanic subgroups studied (ie, Mexicans,

Cu-bans, Puerto Ricans). Breast-feeding incidence for

women of Mexican descent living in the United

States has been reported by several authors.3

Fig-ures for breast-feeding intention vary from 22.6%

found by Rassin et a!4 in Texas to 82.0% reported

by Scrimshaw et al7 in Los Angeles. Data

concern-ing breast-feeding practice show variation from

31.1% to 60.0%. Smith et al3 found that 31.1% of

the Hispanic women studied between 1976 and 1979 along the United States/Mexican border breast-fed their infants. Samuels et al6 in Oakland, California,

and Young and Kaufman8 in North Carolina both

found a breast-feeding incidence of 60.0%.

Data concerning breast-feeding for Puerto

Ri-cans and Cubans is more limited. Figures reported

for Puerto Ricans by Mohrer9 in Connecticut and

by Bryant’#{176} in Florida are 11.0% and 10.0%,

re-spectively. The incidence for Cubans reported by

Bryant’#{176}in Florida is 12.0%. The extent to which variations in breast-feeding intention and practice

of Hispanics reported in the literature are

influ-enced by differences in definitions of terms and

research methodology is not clear.

Factors associated with breast-feeding have been

studied extensively. For black and white mothers,

the highest incidence of breast-feeding has been

found among college-educated women older than

20 years of age, with incomes of more than $15 000

per year. The most common factors associated with

breast-feeding among Hispanics are education,3’4”

mothers employment,7 infant birth order,4

grand-mother and members of network system,’#{176}

experi-ence with breast-feeding,3 and attitude of fathers’#{176}

and mothers toward breast-feeding.’2

The study reported in this paper provides

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practices and variables related to these among a

group of Hispanic mothers (Mexican and Mexican

descent) living in three counties in southern

Cali-fornia. The purposes of the study were (1) to assess

the mothers’ breast-feeding intentions regarding

their last born infant and to identify variables

associated with their intentions, (2) to assess the

incidence ofbreast-feeding initiation in the hospital

and its associated factors, and (3) to assess the

incidence of breast-feeding practice at home

follow-ing hospital discharge and factors associated with

this practice.

SUBJECTS AND METHODS

The sample consisted of 132 low-income

His-panic mothers participating in the Expanded Food

and Nutrition Education Program in three counties in southern California. From a total of 450 Hispanic mothers enrolled in this program (winter of 1986

and spring of 1987), all mothers of infants 24

months of age or younger were listed as eligible for

the study. Of the 175 mothers eligible, 30 were

excluded because of lack of a home telephone, 10

were not reached by four phone calls, and 3 declined

to participate. The remaining 132 agreed to respond

to the interview and made up the sample of this

study.

The focus of the study was the milk-feeding

intentions before partum and milk-feeding

prac-tices of the mothers regarding their youngest child.

Mothers were asked before their infants were born

whether they had a clear idea as to how they would

feed their infants and what their milk choice was

at that time (breast only, formula only, breast and

formula).

The dependent variables ofthe study were

breast-feeding intentions prepartum, breast-feeding in the

hospital, and breast-feeding at home after hospital

discharge. Feeding modes were defined as follows:

an exclusively breast-fed infant was fed (or

in-tended to be fed) only breast milk with no

supple-mentation of formula. An exclusively formula-fed

infant was fed only formula with no

supplementa-tion of breast milk. A partially breast-fed infant

was fed one or more bottles of formula in addition

to breast milk. In some parts of this article, the

term “total breast-feeding” is used and refers to the

total number of mothers who ever breast-fed,

in-cluding exclusive and partial breast-feeding.

The following sociodemographic information re-lated to the mother and health care provider and the infant was collected. Mother and health care

provider-related data were mother’s age, country of

origin, education, infant’s birth order (first vs

sec-ond or higher), employment during and after

preg-nancy, breast-feeding advise given by health

profes-sionals, type of delivery (cesarean vs vaginal), time

of breast-feeding initiation (hours after birth), type

of milk fed to infant in the hospital, and milk

samples given at the time of hospital discharge.

Infant-related data were birth order, birth weight,

and sex.

Data concerning demographic characteristics

were collected through personal interviews at the

time of enrollment in the Expanded Food and

Nu-trition Education Program. Information regarding

infant feeding was obtained through telephone

in-terviews using Dillman’s techniques’3 and a

stand-ardized survey instrument. Two bilingual Hispanic

students from the University of California at Davis

were trained in telephone interviewing. To increase

reliability, standardization of questioning

tech-nique and recording procedure was performed by

telephone interviewing 20 Hispanic women

partic-ipating in the Expanded Food and Nutrition

Edu-cation Program in a county not included in the

study. Data collection began when recording

van-ation between interviewers decreased to two

incon-sistencies out of 54 recordable items in the

ques-tionnaire.

Data analysis consisted of descriptive, bivaniate,

and multivaniate statistics. Association and

coline-arity among variables were tested using

x2

statistics

and Pearson correlations.’4 Explanation of the

de-pendent variables (breast-feeding intention prepar-tum, breast-feeding in the hospital, and

breast-feeding at home) was assessed using stepwise

logis-tic regression.’5 The role of independent variables

was screened using the forward inclusion method.

Odds ratios for variables entered in the final model

were calculated following Freeman’s method’6 and

using coefficients obtained in the logistic regres-sion.

RESULTS

Sociodemographic

Characteristics

The mean age ofthe mothers was 28.7 ± 5.3 years

and the level of education was 7.8 ± 3.6 years.

Eighty-eight percent of the mothers were from

Mexico and 12.0% were born in the United States. All infants studied were born in US hospitals.

Twenty-eight percent of the mothers worked during

pregnancy and 26.0% returned to work after the

infant was born. Seventy-two percent of the

moth-ens were advised by their doctor or nurse to breast-feed. The average number of children born to these mothers was 3.1 ± 1.5, and the average age of their

youngest child (child studied) was 14.3 ± 3.7

months. Thirty-five of these were firstborn infants and the rest were of higher birth order. Fifty-six

percent were boys. The infants’ mean birth weight

(3)

were born at term and 8.0% were born within the

7th and 8th month of pregnancy. Seventy-six

per-cent were born vaginally and 24.0% by cesarean.

The average time of breast-feeding initiation was

13.7 ± 8.0 hours after birth.

Milk-Feeding Intention

As shown in Table 1, choice of feeding mode was

exclusive breast-feeding (67.7%), partial

breast-feeding (10.0%), and exclusive formula (22.3%).

The total number of mothers intending to

breast-feed (exclusive and partial breast-feeding) was 101

(77.7%). The first five sources of influence of their

milk choice reported by mothers were their own

decision independent of others (47.0%), their

mother (10.5%), infant’s father (10.5%), doctor/ nurse (9.0%), and friends/relatives (8.7%).

Cross-tabulations of selected sample

character-istics and milk choice are shown in Table 2.

Inten-tion to breast-feed was significantly associated (P

= .01) with mother’s country of origin. Mothers

TABLE 1. Breast-Feeding Intention Prepartum and

Breast-Feeding Practice in the Hospital and at Home (N = 132)0 ______________________

Prepartum Breast-Feeding Intention

Hospital Home

Breast-feeding mode

Exclusive 67.7 19.7 17.2

Partial 10.0 44.7 46.9

Exclusive formula feeding 22.3 36.2 35.9

0 Results are percentages of women.

from Mexico were more likely to choose

breast-feeding than Hispanic mothers born in the United

States (P = .05). Mothers with 9 or less years of

education were more likely to choose breast-feeding

than mothers who attended school for 10 to 14

years. Logistic regression was used to assess the

independent effect of sociodemographic variables

on the mothers’ intentions to breast-feed. When

the independent variables (mother’s country of

or-igin, age, education, employment, breast-feeding

advice given by health professionals, and infant’s

birth order) were adjusted in the regression model,

the only variable with a significant (P = .05)

influ-ence on milk choice was the mother’s country of

origin (Table 3). The odds of mothers choosing

breast-feeding rather than formula feeding were

4.75 times higher (95% confidence limit 1.80 to

12.50) for women from Mexico than for Hispanic

mothers born in the United States. Mother’s

edu-cation was not significant in the regression analysis.

Milk Fed in the Hospital

As shown in Table 1, the total incidence of

breast-feeding (exclusive and partial

breast-feed-ing) was 63.8%. However, there was a marked

dif-ference between exclusive breast-feeding intention

and practice (Figure ). Although 67.7% of the

mothers intended exclusive breast-feeding

prepar-tum, only about one third (19.7%) exclusively

breast-fed their infants in the hospital. Hospital supplementation of breast milk with formula (par-tial breast-feeding) increased from 10.0% intention

TABLE 2. Sample Characteristics by Mother’s Milk-Feeding Intentions0

Characteristics Milk-Feeding Intention

Breast Formula (n = 101) (n = 29)

Age (y)

18-29 55 (54.5) 18 (62.1)

30-34 46 (45.5) 11 (37.9)

Education ()t

9 70 (69.3) 15 (51.7)

10-14 31 (30.7) 14 (48.3)

Country of origins

Mexico 89 (88.1) 18 (62.1)

United States 12 (11.9) 11 (37.9)

Child’s birth order

First 17 (16.8) 6 (20.7)

Second or higher 84 (83.2) 23 (73.3)

Breast-feeding advise by health professionals

Yes 73 (72.3) 20 (68.9)

No 28 (27.7) 9 (31.1)

Employment during pregnancy

Yes 28 (27.7) 7 (24.0)

No 73 (72.3) 22 (76.0)

0 Results are numbers (%) of women. Breast-feeding includes exclusive and partial

breast-feeding.

tx2 3.07;P .05.

(4)

Intention Hospital Home Figure. Exclusive breast-feeding intentions and prac-tice in hospital and at home (N = 132).

TABLE 3. Adjusted Odds Ratio for Breast-Feeding Rather Intention and Practice in the Hospital and at Home0

Than Formula Feeding

Dependent and Independent Variables

Odds Ratio

95% Confidence Limits

Breast-feeding intention (n = 132) Mother’s country of origin

Breast-feeding in the hospital (n = 84)t Time of breast-feeding initiation Milk fed at home (n = 80)t

Time of breast-feeding initiation Infant delivery method

Employment postpartum Country of origin

4.75#{176}

0.96”

1.27” 12.76a 28.26c

854b

1.80-12.50

0.94-0.99

1.04-1.56 1.06-154.08 2.67-229.30 1.17-62.05

0 Adjusted odds ratios were derived from the logistic regression coefficients. Significance:

ap 05;bp .ol;cP= .001.

t

Only the mothers who intended breast-feeding were included to assess factors influencing departure from breast-feeding intention.

C U

0.

to 44.7% practice in the hospital. The actual

num-ber of women who exclusively formula fed their

infants in the hospital was almost twice the number

of those who intended this feeding method

prepar-tum. The x2 analysis showed a significant

associa-tion (P = .05) between milk fed in the hospital,

infant delivery method, and time of breast-feeding initiation. Results of the logistic regression analysis showed a variation in the variables impacting breast-feeding initiation. When independent van-ables were adjusted in the regression, the only

van-able having a significant impact on breast-feeding in the hospital was time of breast-feeding initiation

(Table 3). The odds of breast-feeding during the

hospital stay, rather than exclusive formula feeding, were higher for women who initiated breast-feeding

within 10 hours after birth than for those who

initiated breast-feeding 11 or more hours after birth (odds ratio 0.96, 95.0% confidence limits 0.94 to 0.99). Child’s sex, birth order, and birth weight had no impact on type of milk fed in the hospital.

Milk Fed at Home

There was a large difference between

milk-feed-ing intentions prepartum and milk fed at home

after hospital discharge. Although 67.7% of mothers

intended exclusive breast-feeding, only one fourth

of them exclusively breast-fed their infants at

home. Correspondingly, the number of mothers who

supplemented breast-feeding with formula-feeding

increased by 4.5 times. The number of mothers who

exclusively formula fed increased by 1.5 times.

Re-sults of

x2

analysis showed a significant association

(P = .05) between milk fed at home and delivery

method, formula samples given at the time of

hos-pital discharge, mother’s country of origin, and

mother’s employment postpartum. When logistic

regression was used to assess the impact of the

independent variables on milk fed at home, the

following variables demonstrated a significant

in-fluence on this practice: time of breast-feeding

mi-tiation, delivery method, mother’s employment

postpartum, and mother’s country of origin (Table

3). Consequently, the odds for breast-feeding at

home were 1.27 greater for mothers who initiated

breast-feeding in the hospital within the first 10

hours rather than 11 hours or later, 12.76 times

greater for mothers who had a vaginal delivery as opposed to cesanean section, 28.26 times greater for mothers not returning to work after pregnancy, and 8.54 times greater for mothers from Mexico than for mothers born and raised in the United States. Although there was an association in the

x2

analysis between formula samples given at the time of

hos-pital discharge and formula feeding at home, it did

not reach statistical significance in the regression

analysis. Mother’s education and other

demo-graphic variables related to the infant and mother did not have a significant role in breast-feeding practice at home.

(5)

DISCUSSION

Our results for total breast-feeding intentions,

77.7% (exclusive and partial breast-feeding), are

much higher than the 22.6% reported by Rassin et

a14 from Texas and are similar to those reported by Scrimshaw et al7 for a similar group of Hispanic

mothers in Los Angeles. These authors found that

82.0% of mothers in one of the two hospitals they

studied wanted to breast-feed. However, a

break-down of figures for exclusive and partial

breast-feeding are not provided. Because of the negative

impact of formula supplementation on breast-feed-ing initiation and dunation,5’6”72#{176} the distinction

between these two breast-feeding modes is

impor-tant. Our figures for exclusive breast-feeding

inten-tion prepartum and for partial breast-feeding were

67.7% and 10.0%, respectively. Breast-feeding

in-tentions were significantly associated with mother’s

country of origin. Mothers from Mexico were

sig-nificantly (P = .01) more likely to intend

breast-feeding than mothers born in the United States,

suggesting a tendency toward the preservation of

traditional infant-feeding practices prevailing in

many areas of Mexico.21’22

In our study, there was a large discrepancy

be-tween exclusive breast-feeding intentions and

prac-tice. Although 67.7% of the mothers intended to

exclusively breast-feed, only about one fourth of

them (19.7%) did so in the hospital and 17.2% at

their home. Our figure for total breast-feeding

prac-tice (exclusive and partial breast-feeding) is 64.1% which is similar to the 75.0% breast-feeding goal

stated in the Surgeon General’s report23 for the

United States in 1990. Our data are also similar to

the 60.0% reported by Samuel et a!6 among

His-panic mothers in Oakland and by Young et al8 for

mothers of Mexican descent in North Carolina.

However, our breast-feeding rate is much higher than that reported by Smith et al3 for the subsample

of mothers studied between 1976 and 1979 in 51

counties along the United States/Mexican border.

This inconsistency may be due to differences in the

samples studied. The mothers in our sample were all below the poverty level (requirement for

enroll-ment in the Expanded Food and Nutrition

Educa-tion Program program) and levels of education were

low. The mothers in the Smith et a!3 sample had

higher levels of education (33.4% had 13 or more

years of schooling as opposed to 10.0% in our

sam-ple). Smith et a13 did not provide data regarding

income and did not distinguish between migrants

and mothers born in the United States.

It is not clear whether the extensive

formula-feeding practice in the hospital (80.9% total: 36.2%

exclusive formula feeding and 44.7% formula

sup-plementing breast) was the primary cause for the

sharp decline from exclusive breast-feeding

inten-tion to practice. Our data document type of milk

fed in the hospital, but it is not known whether the

formula was provided at the mother’s

request/con-sent or whether mothers misinterpreted formula

bottles in their infant’s bassinet as a prescription from their health care providers. Including formula

bottles in the bassinets of infants is a common

practice in many hospitals in California. Infants

whose mothers intend to exclusively breast-feed are

not always identified, and their bassinets are not

always labeled to prevent inclusion of formula bot-tles.

The time of breast-feeding initiation had a

sig-nificant impact on the rate of breast-feeding.

Moth-ers who attempted breast-feeding within the first

10 hours after birth were more likely to continue

breast-feeding during the hospital stay than

moth-ers who attempted breast-feeding 11 hours or more

after birth. Our results are consistent with those of

Feinstein et al’7 among low income mothers in

Chicago, who found that the incidence of

breast-feeding was reduced when the onset of breast-feed-ing was 16 or more hours postpartum. Scrimshaw

et al,7 Salaniya et al,24 and Taylor et al25 also

re-ported early breast-feeding onset as a significant

factor in breast-feeding success. Well-known pedia-tnicians specializing in breast-feeding6’27

recom-mend initiating breast-feeding as soon as possible

after delivery. Clinicians indicate that the period following birth when infants are most alert is the

optimum time to initiate proper “latch on” and

suckling behavior.25’26 Early and frequent suckling

contributes to the prevention of milk stasis in the

duct system and sinuses, consequently contributing

to the prevention of engorgement. Unrelieved

en-gorgement can inhibit milk production by causing

pressure and atrophy of milk secretory cells.28’

The feeding mode practiced in the hospital was

almost replicated at home (Table 1). It appears that

the hospital experience determined the feeding

mode for the infant afterward. Mothers who

for-mula fed in the hospital continued formula feeding

at home. Only two of the mothers who did not

initiate breast-feeding in the hospital attempted

breast-feeding at home.

The type of delivery method influenced the rate

of breast-feeding. Mothers whose infants were

de-livened by cesanean section were 12.76 times less

likely to breast-feed than mothers whose babies were delivered vaginally. These results are consist-ent with other studies.6’7’3#{176}Samuels et a!6 reported a breast-feeding incidence of 52.0% and 69.0% for cesarean section and vaginal births, respectively.

The rate of cesanean births, however, in their

mul-tiethnic sample was 18.0% compared to the 24.1%

(6)

higher than the 18.8% average rate for births in

California.3’ Although the discomfort caused by

cesarean section deliveries can be a deterrent to

breast-feeding, techniques developed by Frantz and

Kalmen32 have been effective in making

breast-feeding possible. In our study, only 2 of the 32

mothers attempted to breast-feed after cesarean

section.

The negative impact of mother’s employment

postpartum on breast-feeding in our study is

con-sistent with data obtained by Martinez and Stahle33

among mothers participating in the Supplemental

Food Program for Women, Infants, and Children.

In our sample, 28.0% of the mothers were employed

4 to 10 h/d during pregnancy and 26.0% worked

this much postpartum. The odds of breast-feeding

for women in our sample who did not return to

work after delivery were 28.6 times higher than for

women who returned to work. The study by

Mar-tinez and Stahle33 is one of the few in which the

effect of maternal employment on breast-feeding

among low income minorities was reported. Their

data indicated that mothers who were employed

full-time had lower rates of breast-feeding

com-pared with mothers who were employed part-time

postpartum. The duration of breast-feeding among

women who did not have plans to work was twice

as high as for employed women. The limited

avail-able studies suggest that, whereas mother’s

employ-ment can be significantly detrimental to

breast-feeding among the poor, it does not appear to have

the same impact on women of higher education and

income levels.33’34

Contrary to many reports in the literature,

moth-er’s education did not have a positive impact on

breast-feeding. Its influence tended to be in the

opposite direction. The least educated women were

most likely to breast-feed. These findings are, in

part, consistent with the findings of Rassin et al4

among Hispanic women in Texas. Their results

imply a U-shaped distribution in that the highest

breast-feeding rate was among the least and the

most educated mothers. Women with education

in-between the two extremes were the least likely to breast-feed.

To summarize, Hispanic mothers in our study

had breast-feeding intentions slightly greater than

the 75.0% goal established by the Surgeon General’s

Workshop on Lactation and Breast-Feeding for

American women for the year 1990. Although the

total number of mothers in our sample who even

breast-fed their infants did not decrease drastically,

the incidence of exclusive breast-feeding practice

was about 4 times less than intended. Both

exclu-sive formula feeding and partial breast-feeding

in-creased significantly from prepartum intention to

practice. Factors associated with breast-feeding

de-dine were specific hospital protocols and practices, as well as mother’s employment.

Intervention and policy implications of this study

include the development/improvement of hospital

practices supportive of breast-feeding, such as (1) early initiation of breast-feeding after delivery; (2)

special assistance and encouragement to mothers

whose babies are delivered by cesarean section and

wish to breast-feed; (3) instruction to employed

mothers regarding extraction, storage, and use of

stoned breast-milk; (4) training in the clinical as-pects of breast-feeding for hospital staff in obstet-nics services; and (5) avoidance of in-hospital for-mula supplementation to breast-fed infants (unless medically justified) and avoidance of formula dis-tnibution at the time of hospital discharge. The negative health and economic implications of for-mula use can be significant, particularly among

families with limited income and/on inadequate

home sanitation. The Surgeon General’s Workshop on Breast-Feeding and Human Lactation23 and the WHO International Code of Marketing of Breast-milk Substitutes35 articles 6.1 to 6.8 cleanly outline recommendations for health services to adopt.

Finally, the retrospective nature of this study

should be noted when interpreting our results.

Per-spective follow-up studies are needed to control for possible recall bias. More research concerning spe-cific ethnic minorities is needed to guide policy

making and programs that target populations at

risk. To prevent undennepresentation of minority

groups with limited education, written

question-names (the data collection method used in most

breast-feeding studies) should be avoided.

ACKNOWLEDGMENTS

We thank Mary Marshall, MA, Sandra Spencer, MA, and Eunice Williamson, MS, Expanded Food and Nutni-tion Education Program (EFNEP) coordinators in San Bernardino, Los Angeles, and Riverside counties for their cooperation in this study. We also thank Edward Dolber-Smith, BS, for his assistance in data analysis, Denise DiPietro, BA, for her assistance in editing the manu-script, and Dr Amy Block Joy, Director of the California EFNEP for the support provided for data collection and analysis.

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22. Romero-Gwynn E. Family Well-being, Fertility and Child Nutrition: A Comparative Study Between Migrant and Na-tive Families in Guadalajara, Mexico. Ithaca, NY: Cornell University; 1977. PhD dissertation23 Report of the Surgeon General’s Workshop on Breast-Feeding and Human

Lacta-tion. Washington, DC: Government Printing Office; 1984. US Dept of Health and Human Services publication HRS-D-MC 84-2

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MedicalProfes-sian. St Louis, MO: CV Mosby Co; 1985:186

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among WIC infants. Am J Public Health. 1982;72:68-71 34. Auerbach K, Guss E. Maternal employment and

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35. International Code of Marketing of Breastmilk Substitutes.

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1989;84;626

Pediatrics

Eunice Romero-Gwynn and Lucia Carias

California

Breast-Feeding Intentions and Practice Among Hispanic Mothers in Southern

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1989;84;626

Pediatrics

Eunice Romero-Gwynn and Lucia Carias

California

Breast-Feeding Intentions and Practice Among Hispanic Mothers in Southern

http://pediatrics.aappublications.org/content/84/4/626

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