Hospital practices and concerns about infant satiety are barriers to exclusive breastfeeding in American Samoa

Introduction: Initiation of breastfeeding is almost universal in American Samoa, but duration of exclusive breastfeeding is short. Increasing the duration of exclusive breastfeeding may be an efficacious strategy for childhood obesity prevention in American Samoa.Aim: To understand influences on infant feeding in American Samoa and to identify potential barriers to exclusive breastfeedingMethods: A mixed-methods, prospective study following Samoan women (n=44), their partners, and their infants from late pregnancy (average 37 weeks gestation) until eight weeks post-partum was completed in 2013. Participants reported intentions for infant feeding before birth, and practices were self-reported in questionnaires completed at 3- and 8-weeks postpartum.Results: While 79.5% of women intended to exclusively breastfeed for the first few weeks postpartum, less than 40% were exclusively breastfeeding at 3-weeks postpartum. Many women of the women who introduced formula before 3-weeks did so before hospital discharge. Barriers to exclusive breastfeeding included lack of skin-to-skin contact after delivery, delays in the initiation of breastfeeding, pain during breastfeeding, and a lack of education about infant satiety cues.Discussion: Structural rather than individual level barriers to breastfeeding were identified by American Samoan women. Existing evidence-based interventions to promote exclusive breastfeeding could be adapted for use in this setting and should begin before hospital discharge.