Effect of Literacy on Breast-feeding Outcomes
Background. We studied the effect of functional health literacy on the initiation and continuance of breast-feeding in women at a public health clinic.
Methods. Subjects were 61 first-time mothers aged 18 years or older who spoke English as their first language. They were divided into two groups, one who exclusively breast-fed for at least the first 2 months and one who never initiated breast-feeding or did not exclusively breast-feed for at least 2 months. The Rapid Estimate of Adult Literacy in Medicine (REALM) was administered, providing reading grade-level estimates for each subject.
Results. An association between functional health literacy and breast-feeding was seen, with only 23% of the women in the lower literacy group exclusively breast-feeding during the first 2 months compared with 54% of women in the higher literacy group.
Conclusion. Many patients need simpler health education materials encouraging breast-feeding. These materials are needed both before and during pregnancy.
The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Public Health Association, and the American Dietetic Association all recognize breast milk as the preferred source of nutrition for at least the first 4 to 6 months of an infant's life. The Healthy People 2010 report, issued by the US Secretary of Health and Human Services in 1998, proposes that the United States aim to "increase to at least 75% the proportion of mothers who breast-feed their babies in the early post-partum period" as a public health measure. Breast-feeding provides health, nutritional, and psychologic benefits, and the latest research continues to uncover additional mechanisms by which breast milk's unique qualities provide for the newborn. However, despite the proven benefits of breast milk over formulas, breast-feeding rates are declining in the United States, due in part to educational, social, and economic factors.
Women are often left to educate themselves about breast-feeding. This learning often comes from breast-feeding books or pamphlets provided in the clinic. Women who choose and are most likely to succeed at breast-feeding share the following characteristics: they are white, in the middle to upper economic class, well-educated, married, and in their early twenties or thirties; they also are nonsmokers, were breast-fed themselves as infants, are healthy with healthy infants, and were successful with previous breast-feeding attempts.
Data from the English Language Proficiency Study indicate that many of the patients cared for in public clinics have low literacy skills, and those most likely to have low literacy skills are the poor, minorities, immigrants, the unemployed, those who failed to finish high school, and those who live in inner-city areas. Many patients with inadequate literacy skills also have difficulty with verbal explanations and communication with their physicians in general, which suggests that effective health education is even more of a challenge for this population.
New Mexico has a high proportion of individuals with several of the characteristic risk factors for decreased literacy. The state's
ethnic mix as reported in the 1990 census was 51% white, 38% Hispanic, 9% Native American, and 2% African American. In 1995, New Mexico ranked 47th among the states in per capita income, with 21% of the population living at or below the poverty level. One of six families and one of five people in New Mexico live below the poverty level, and one half of the Native Americans, as well as one fourth of the Hispanic population, live at or below the poverty level. New Mexico is thus an ideal setting in which to study the effect of literacy level on a population's health behaviors.
The fact that poorer women with less formal education tend to breast-feed less may be linked to their literacy skills, which prevent them from accessing breast-feeding literature as a source of education and support. However, literature review fails to uncover any studies examining the effect of literacy, not education, on breast-feeding. Education signifies grade of schooling completed, whereas literacy represents functional reading and comprehension skills. Therefore, our study examines the relationship between new mothers' literacy skills and their decision to breast-feed or bottle-feed their infants.
Background. We studied the effect of functional health literacy on the initiation and continuance of breast-feeding in women at a public health clinic.
Methods. Subjects were 61 first-time mothers aged 18 years or older who spoke English as their first language. They were divided into two groups, one who exclusively breast-fed for at least the first 2 months and one who never initiated breast-feeding or did not exclusively breast-feed for at least 2 months. The Rapid Estimate of Adult Literacy in Medicine (REALM) was administered, providing reading grade-level estimates for each subject.
Results. An association between functional health literacy and breast-feeding was seen, with only 23% of the women in the lower literacy group exclusively breast-feeding during the first 2 months compared with 54% of women in the higher literacy group.
Conclusion. Many patients need simpler health education materials encouraging breast-feeding. These materials are needed both before and during pregnancy.
The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Public Health Association, and the American Dietetic Association all recognize breast milk as the preferred source of nutrition for at least the first 4 to 6 months of an infant's life. The Healthy People 2010 report, issued by the US Secretary of Health and Human Services in 1998, proposes that the United States aim to "increase to at least 75% the proportion of mothers who breast-feed their babies in the early post-partum period" as a public health measure. Breast-feeding provides health, nutritional, and psychologic benefits, and the latest research continues to uncover additional mechanisms by which breast milk's unique qualities provide for the newborn. However, despite the proven benefits of breast milk over formulas, breast-feeding rates are declining in the United States, due in part to educational, social, and economic factors.
Women are often left to educate themselves about breast-feeding. This learning often comes from breast-feeding books or pamphlets provided in the clinic. Women who choose and are most likely to succeed at breast-feeding share the following characteristics: they are white, in the middle to upper economic class, well-educated, married, and in their early twenties or thirties; they also are nonsmokers, were breast-fed themselves as infants, are healthy with healthy infants, and were successful with previous breast-feeding attempts.
Data from the English Language Proficiency Study indicate that many of the patients cared for in public clinics have low literacy skills, and those most likely to have low literacy skills are the poor, minorities, immigrants, the unemployed, those who failed to finish high school, and those who live in inner-city areas. Many patients with inadequate literacy skills also have difficulty with verbal explanations and communication with their physicians in general, which suggests that effective health education is even more of a challenge for this population.
New Mexico has a high proportion of individuals with several of the characteristic risk factors for decreased literacy. The state's
ethnic mix as reported in the 1990 census was 51% white, 38% Hispanic, 9% Native American, and 2% African American. In 1995, New Mexico ranked 47th among the states in per capita income, with 21% of the population living at or below the poverty level. One of six families and one of five people in New Mexico live below the poverty level, and one half of the Native Americans, as well as one fourth of the Hispanic population, live at or below the poverty level. New Mexico is thus an ideal setting in which to study the effect of literacy level on a population's health behaviors.
The fact that poorer women with less formal education tend to breast-feed less may be linked to their literacy skills, which prevent them from accessing breast-feeding literature as a source of education and support. However, literature review fails to uncover any studies examining the effect of literacy, not education, on breast-feeding. Education signifies grade of schooling completed, whereas literacy represents functional reading and comprehension skills. Therefore, our study examines the relationship between new mothers' literacy skills and their decision to breast-feed or bottle-feed their infants.
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