A new UConn study is helping provide a better understanding of the association between breast-feeding and infant health in the first year of life.

The study, published in the journal Social Science & Medicine: Population Health, found that pregnant women who said they intended to exclusively breast-feed, but then used formula once the baby was born, had children with health outcomes similar to exclusively breast-fed infants. Only about half of mothers who intend to breastfeed are able to do so, and often their ability to breast-feed is beyond their control and not known until their baby is actually born.

Kerri Raissian, an assistant professor in the Department of Public Policy, and co-author Jessica Su, an assistant professor of sociology at the University of Buffalo, say the findings suggest that the benefits of breast-feeding reported in the vast majority of prior research could be influenced by the mother’s characteristics, such as socioeconomic advantages as well as what they know about health and nutrition.

The results from the study—“The best of intentions: Prenatal breastfeeding intentions and infant health”—could help guide policymakers and health-care professionals when it comes to providing critical information to expectant mothers about feeding their newborns. The findings are based on data from more than 1,000 participants in the Infant Feeding Practices Study II, designed by the Centers for Disease Control and Prevention and the US Food and Drug Administration.

“Our findings help to contextualize the finding that ‘breast is best,’ and add nuance to a body of literature on the benefits of breast-feeding for infant health,” say the authors in the study.

“Our main goal is to figure out what actually promotes—in a causal way—infant health,” says Raissian. “We think access to health care is an important policy focus. By sinking so much energy into getting moms to breast-feed, we miss something very important: that access to health care and the ability to take medical advice is critically important to a mother and her infant.”

She says that by exploring a range of factors influencing better infant health outcomes, information from the study helps contextualize the tradeoffs that a lot of mothers have to make when deciding how to feed their children.

The World Health Organization and the American Academy of Pediatrics both recommend exclusively breast-feeding a child for 6 months. That message used to be presented as a healthy lifestyle choice, but today these agencies communicate the benefits of breast-feeding as a matter of public health.

Raissian says public policy health intervention initiatives most often are influenced by research based on randomized control trials, such as drug research in which participants are randomly assigned the new drug or a placebo.

“But we do not randomly assign babies to breast-feeding,” she says. “For many women, breast-feeding isn’t easy, and it requires a lot of support, which might come from their doctor, partner, overall home environment, or employer—just to name a few. Moms who are unable to breast-feed may not have these kinds of resources, which could be linked to breast-feeding and improved infant health.”

Adds Su, “It’s important to understand that we are not trying to imply that just intending to breast-feed is what’s leading to these health outcomes. What we found is that intending mothers had more information about nutrition and diet; they more frequently consulted their physicians; and had better access to information related to infant health than those moms who did not intend to breast-feed.”

Raissian says many government health information websites are underutilized, and that using social media to provide public service announcements—such as pop-ups on Facebook—is an example of how to guide expectant mothers to where they can access the needed information.

The study also indicates that the federal Women, Infants, and Children (WIC) food and nutrition program is a frequent source of information for expectant mothers, providing nutritious food, such as iron-fortified adult cereal, fruits and vegetables, and milk. For mothers who do not breast-feed, WIC provides iron-fortified infant formula. WIC also provides health screenings, counseling, and immunizations.

Su notes that the US is the only developed country with no federal paid maternity leave, and only about 12% of mothers in the private sector have access to paid leave.

“Paid maternity leave likely increases breast-feeding success, and also seems to have additional health benefits for mothers and infants,” Su says. “If we have concerns about disparities in infant health, we need social policies that support these recommendations and also go beyond simply encouraging breast-feeding over formula.”