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J Community Health (2009) 34:1–5 DOI 10.1007/s10900-008-9122-8

ORIGINAL PAPER

Knowledge About Breastfeeding Among a Group of Primary Care Physicians and Residents in Puerto Rico ´ Gloria Leavitt Æ Silma Martınez Æ Nerian Ortiz Æ ´ Lourdes Garcıa

Published online: 27 September 2008 Ó Springer Science+Business Media, LLC 2008

Abstract Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support. Keywords Breastfeeding knowledge Á Breastfeeding barriers Á Medical education ´ G. Leavitt Á L. Garcıa (&) Neonatology Section, Department of Pediatrics, UPR School of Medicine, P.O. Box 365067, San Juan 00936-5067, PR, USA e-mail: lougarcia@rcm.upr.edu ´ S. Martınez Department of Pediatrics, San Juan City Hospital, PMB # 79, P.O. Box 70344, San Juan 00936-8344, PR, USA N. Ortiz Department of Pediatrics, UPR School of Medicine, P.O. Box 365067, San Juan 00936-5067, PR, USA

Introduction The American Academy of Pediatrics (AAP) emphasizes the essential role of the pediatrician in promoting, protecting, and supporting breastfeeding [1]. Breastfeeding is identified as the ideal method of feeding for infants and is primary in achieving optimal infant and child health, growth, and development. A breastfeeding policy was published by the AAP with recommended breastfeeding practices and recommendations to be followed by pediatricians. The American College of Obstetricians and Gynecologists (ACOG) has also issued guidelines strongly supporting breastfeeding and calling on its Fellows and health professionals caring for women and their infants, to support women in choosing to breastfeed their infants. The statement recommends to these professionals to regularly impart accurate information about breastfeeding to expectant mothers and be prepared to support them should any problems arise while breastfeeding [2]. The American Academy of Family Physicians (AAFP) recommends that all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for about the first 6 months of life. The Academy states that family physicians can make a difference in increasing breastfeeding initiation rates, and especially breastfeeding continuation rates, by advocating breastfeeding, supporting breastfeeding patients and providing appropriate, evidence-based care for breastfeeding couplets [3]. Before 1960, 59% of infants in Puerto Rico were breastfed for a mean duration of 7.8 months [4]. That number dropped to 25% during the 1970s. Duration also dropped to 4.9 months. The active industrialization of the island since 1950 has been associated to this drop. Data published in 1990 revealed that only 38% of the mothers ever breastfed in hospitals and the rate of exclusive

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J Community Health (2009) 34:1–5

breastfeeding at 2 months was less than 4% [4]. Infants who were breastfed in Puerto Rico were below the 74–97% of reported breastfeeding in...
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