Confident Commitment Is a Key Factor for Sustained Breastfeeding


  • Alexis Avery MPH, PhD,

    Corresponding author
    1. Alexis Avery is an Epidemiologist for the New Mexico Department of Health, Santa Fe, New Mexico;
      Alexis Avery, MPH, PhD, P.O. Box 23480, Santa Fe, NM 87502-3480, USA.
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  • Kristine Zimmermann MPH,

    1. Kristine Zimmermann is a Project Coordinator for the Center for Research on Women and Gender at the University of Illinois at Chicago, Chicago, Illinois;
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  • Patricia W. Underwood PhD, RN, FAAN,

    1. Patricia Underwood is the Executive Associate Dean for Academic Programs for the School of Nursing, Case Western Reserve University, Cleveland, Ohio; and
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  • Jeanette H. Magnus MD, PhD

    1. Jeanette Magnus is Acting Chair of the Community Health Sciences Department at Tulane University School of Public Health, New Orleans, Louisiana, United States.
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Alexis Avery, MPH, PhD, P.O. Box 23480, Santa Fe, NM 87502-3480, USA.


Background:The characteristics that distinguish women who breastfeed successfully from those who do not are just beginning to be identified in breastfeeding literature. The objective of this study was to identify the processes contributing to breastfeeding decisions among Caucasian and African American women.Methods: Data were initially collected through 24 focus groups consisting of separate groups of African American and Caucasian pregnant women, and breastfeeding and formula-feeding mothers from three major United States cities. The focus group study was initiated by the U.S. Department of Health and Human Services to obtain data on salient messages that would inform a national campaign to promote breastfeeding. This study was a secondary analysis of those data using a modified grounded theory approach.Results:The process that emerged associated with successful breastfeeding was labeled “confident commitment.” This process included several components: a) confidence in the process of breastfeeding, b) confidence in their ability to breastfeed, and c) commitment to making breastfeeding work despite obstacles.Conclusions: Contrary to popular conceptions, breastfeeding appears to be a learned skill. If mothers achieved a level of “confident commitment” before the birth, they were able to withstand lack of support by significant others and common challenges that occurred as they initiated breastfeeding. Without the element of “confident commitment,” a decision to breastfeed appeared to fall apart once challenged.