


































GSJP Volume 16 final


Graduate Student Journal of  Psychology
2015 Vol. 16

Copyright 2015 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University

47

Pregnancy Intentions and Happiness: 
Psychological Predictors of  Breastfeeding 

in a National Sample

Lindsey Wallace, Rebecca Chad, and Melissa Rodriguez
Teachers College, Columbia University

Unintended pregnancies (mistimed or unwanted) are linked to lower rates of  breastfeeding, yet little research to 
date has investigated the role of  feelings of  happiness about the pregnancy on maternal health behaviors. Using 
data from the 2002 National Survey of  Family Growth, we examined whether breastfeeding initiation/duration was 
explained by (1) socio-demographic characteristics of  mothers and (2) pregnancy intentions/feelings of  happiness 
RI �PRWKHUV��3UHJQDQF\�LQWHQWLRQV�KDSSLQHVV�IDFWRUV�VLJQLÀFDQWO\�H[SODLQHG�DQ�LQFUHDVH�LQ�WKH�PXOWLSOLFDWLYH�RGGV�RI �
initiating breastfeeding better than a model with socio-demographic variables alone, G2 (5, 798) = 3622.5. Partici-
pants who indicated their pregnancies were unwanted or too soon breastfed for a shorter duration in comparison to 
those who said it was the right time; these effects remained after controlling for socio-demographic characteristics. 
Feelings of  happiness about the pregnancy did not alter the odds of  initiation or affect the duration of  breastfeeding. 
Keywords: breastfeeding initiation, breastfeeding duration, pregnancy intentions, happiness about the pregnancy

 While much research has investigated unintended 
pregnancies and their implications for maternal and 
infant health, less attention has been placed on the 
relationship between health behaviors and women’s 
thoughts and feelings about being pregnant (Blake et 
al., 2007). One particularly important health behavior 
that is worthy of  further investigation due to its prov-
HQ�SK\VLRORJLFDO�DQG�SV\FKRORJLFDO�KHDOWK�EHQHÀWV�WR�
both mothers and infants is initiation and duration 
of  breastfeeding (Davis, Savitz, & Graubard, 1988; 
Lawrence, 2000; Mortensen, Michaelsen, Sanders, 
& Reinsich, 2002; Newcomb et al., 1994; Visness, 
Kennedy, & Ramos, 1997). The physiological bene-
ÀWV�RI �KXPDQ�EUHDVW�PLON�DUH�QXPHURXV��DQG�LQFOXGH�
anti-infective, immunologic, and allergy protective 
properties; infants who are breastfed demonstrate a 
reduction in infections and lower rates of  child on-
set malignancies, such as acute leukemia (Davis et al., 
1988; Lawrence, 2000). Research has also demonstrat-
HG�WKH�KHDOWK�EHQHÀWV�RI �EUHDVWIHHGLQJ�IRU�PRWKHUV��
including an association between breast stimulation 
and the control of  excessive postpartum hemorrhag-
ing, as well as a decreased risk of  premenopausal 
breast cancer (Newcomb et al., 1994; Visness et al., 
1997). Breastfeeding has also been shown to have 
advantageous psychological associations, includ-
ing long range developmental and intellectual out-
comes for the breastfed infant, and a unique moth-
er-infant attachment bond (Mortensen et al., 2002). 
 Despite these optimal health outcomes for both 
infants and mothers, fewer than one third of  US in-
fants are breastfed exclusively for the recommended 

duration of  more than 6 months, followed by contin-
ued partial breastfeeding for at least a year (“Amer-
ican Academy,” 2013; Chen, Johnson, & Rosenthal, 
2012). Successful breastfeeding depends on multiple 
factors related to the mother, infant, and the envi-
ronment, and there are a variety of  barriers which 
inhibit initiation and continuation of  breastfeeding, 
such as the mother returning to work, lack of  access 
to breast pumps, sore nipples and pain, and access to 
free formula (Haughton, Gregorio, & Pérez-Escamil-
la, 2010). We recognize that not all women are phys-
ically able to breastfeed and some may experience 
GLIÀFXOW\� LQ� ERWK� LQLWLDWLQJ� EUHDVWIHHGLQJ� DQG� FRQ-
tinuing when it proves challenging (Kelleher, 2012).

Socio-Demographic Factors and Breastfeeding
� 'HVSLWH� WKH� ZHOO�NQRZQ� EHQHÀWV� RI � EUHDVW-
feeding in the existing literature, disparities exist in 
breastfeeding behavior among various population 
groups (Centers for Disease Control and Preven-
tion [CDC], 2011). A variety of  factors are associ-
ated with a mother’s decision or ability to initiate 
and continue breastfeeding, including personal char-
acteristics such as age, race/ethnicity, education, 
socioeconomic status, intrapersonal characteris-
tics, sources of  support, childcare status of  the in-
fant, and available breastfeeding interventions (Celi, 
Rich-Edwards, Richardson, Kleinman, & Gillman, 
2005; Dennis, 2002; Li, Darling, Maurice, Barker, 
& Grummer-Strawn, 2005). Research shows that 
across race, white non-Hispanic mothers breastfeed 
at a higher rate than black mothers (Smith-Gagen, 



48

Hollen, Walker, Cook, & Yang, 2014). Additionally, 
studies have shown that black women have a short-
er duration of  breastfeeding after 6 months (27.9%) 
compared with white (45.1%) and Hispanic (46%) 
mothers. By 12 months, only 12.9 % of  black moth-
ers still breastfeed in comparison with white (23.6%) 
and Hispanic (12%) mothers (CDC, 2011). Further-
more, breastfeeding mothers tend to be older with 
higher levels of  education (Jones, Kogan, Singh, Dee, 
& Grummer-Strawn, 2011; Taylor & Cabral, 2002). 
 Socio-economic status tends to be higher for 
those who initiate breastfeeding (Piper & Parks, 1996; 
Taylor & Cabral, 2002). Among low-income pregnant 
and postpartum women who receive nutrition and 
health services through the Women, Infant, and Chil-
dren (WIC) program, the largest supplemental food 
program in the United States, only half  of  participants 
report breastfeeding their youngest child (Haughton 
et al., 2010). Research demonstrates that participation 
in WIC may actually inhibit women from breastfeed-
ing. According to Ryan and Zhou (2006), for mothers 
with infants at least 6 months of  age, WIC status was 
actually the strongest negative determinant of  breast-
feeding; mothers who did not participate in WIC (but 
were eligible) were twice as likely to breastfeed for 
at least 6 months compared to those who were en-
rolled in the program (Ryan & Zhou, 2006). Thuli-
er and Mercer (2009) suggest that free samples and 
distribution of  infant formula through WIC inhibits 
women from initiating and continuing breastfeeding. 
The role of  WIC on low-income women’s breast-
feeding behavior cannot be ignored when consider-
ing the reasons why women of  lower socio-econom-
ic status tend to initiate breastfeeding less often and 
have trouble maintaining it for 6 months or more.

Pregnancy Intention and Breastfeeding
 Since about half  of  the pregnancies in the United 
States are unintended, pregnancy intentions, includ-
ing mistimed or unwanted pregnancies, have been 
studied in relation to health behaviors, including 
breastfeeding (Finer & Zolna, 2014). Several studies 
have linked unintended pregnancies to lower rates of  
breastfeeding (Cheng, Schwartz, Douglas, & Horon, 
2009; Taylor et al., 2008). Unwanted pregnancy, in 
particular, is associated with less initiation of  breast-

feeding (Joyce, Kaestner, & Korenman, 2000a). Fur-
thermore, research has demonstrated that when both 
parents intend to conceive, children are the most 
likely to be breastfed, while discrepancies between 
the parents regarding pregnancy intentions result in 
ORZHU�UDWHV�RI �EUHDVWIHHGLQJ��6SHFLÀFDOO\��FKLOGUHQ�DUH�
breastfed at lower rates when the mother does not in-
tend to conceive but the father does, as compared to 
when the mother does intend to conceive but the fa-
ther does not (Korenman, Kaestner, & Joyce, 2002). 
Inconsistent with previous research, Cheng and col-
leagues (2009) found that mothers with mistimed and 
unwanted births were as likely as mothers with intend-
ed births to initiate breastfeeding; however, mothers 
with mistimed and unwanted pregnancies were less 
likely to continue breastfeeding for 8 weeks or more. 
Cheng et al. (2009) hypothesized that continuing to 
breastfeed when it becomes challenging may be more 
GLIÀFXOW�IRU�PRWKHUV�ZKR�EHFRPH�SUHJQDQW�XQLQWHQ-
tionally compared to those with intended pregnancies. 

Psychological Factors and Breastfeeding Inten-
tion vs Outcome 
 Furthermore, researchers have investigated the 
effects of  other psychological factors on breast-
feeding intentions and outcomes. Noel-Weiss, Rupp, 
Cragg, Bassett, and Woodend (2006) found that the 
PRWKHU·V�FRQÀGHQFH�LQ�KHU�DELOLW\�WR�EUHDVWIHHG�ZDV�
positively correlated with breastfeeding duration. Re-
search by Fairlie, Gillman, and Rich-Edwards (2009) 
demonstrated that women with high pregnancy-re-
lated anxiety and prenatal depressive symptoms 
are less likely to plan to breastfeed; however, these 
symptoms were not associated with failure to initiate 
breastfeeding in this study. Most research, though, 
indicates that prenatal breastfeeding intentions pre-
dict postnatal breastfeeding behaviors (Forster, Mc-
Lachlan, & Lumley, 2006; Lawson & Tulloch, 1995). 
Previous research has also demonstrated that women 
intending to breastfeed have higher scores on ma-
ternal-fetal attachment than those not intending to 
breastfeed (Foster, Slade, & Wilson, 1996). Other 
research has found a modest relationship between 
prenatal attachment and exclusive breastfeeding in-
tentions, in that high maternal-fetal attachment is 
correlated with the intention to breastfeed exclu-

WALLACE, CHAD, RODRIGUEZ



49

sively; however, this relationship did not hold after 
controlling for other relevant covariates such as per-
ceived support and employment status (Lear, 2013). 

Pregnancy-Related Happiness and Health Out-
comes
 While previous research has investigated feel-
ings of  pregnancy-related anxiety, pregnancy inten-
tion, and maternal-fetal attachment, some research 
has investigated mothers’ perceived well-being and 
happiness during pregnancy. Su (2012) demonstrated 
that mothers with unintended births experienced de-
clines in overall happiness and well-being postpartum 
(rather than just pregnancy-related happiness) relative 
to childless women. Sable, Washington, Schwartz, & 
-RUJHQVRQ��������VSHFLÀFDOO\�H[SORUHG�ZRPHQ·V�IHHO-
ings of  happiness about having a baby. Pregnancy-re-
lated happiness was positively correlated with social 
support and negatively correlated with loneliness 
and family relationship problems (Sable et al., 2007). 
 Further research has investigated the link be-
tween pregnancy intentions and happiness about 
being pregnant, and the associated risk for adverse 
effects for the mother and the infant (Blake et al., 
������� $� VLJQLÀFDQWO\� KLJKHU� SURSRUWLRQ� RI � ZRP-
en who were unhappy about being pregnant (in 
comparison to those who were moderately hap-
py or happy) reported having smoked cigarettes in 
the past week, having been depressed in the past 
month, having experienced intimate partner vio-
lence in the past year, and having drunk alcohol 
or used drugs during the pregnancy (Blake et al., 
2007). Additionally, a woman’s happiness about be-
ing pregnant was more strongly associated with the 
above-mentioned behavioral and psychosocial risk 
factors than pregnancy intention, indicating that 
pregnancy-related happiness may be more related to 
prenatal care initiation/utilization and pregnancy out-
comes than pregnancy intentions (Blake et al., 2007). 

Investigation of  Pregnancy-Related Happiness 
and Breastfeeding
� %DVHG�RQ�WKH�ÀQGLQJV�GHPRQVWUDWLQJ�WKH�UHODWLRQ-
ship between pregnancy-related happiness and pre-
natal risk factors, further research into breastfeeding, 
which is one major component of  maternal health 

behavior, may also reveal an association with pregnan-
cy-related happiness. Even though Blake et al. (2007) 
found that pregnancy intentions and pregnancy-re-
lated happiness are strongly correlated, Sable (1999) 
states that measuring pregnancy intentions may not 
EH�D�VXIÀFLHQW�SUR[\�IRU�SUHJQDQF\�DWWLWXGHV��&RQVLG-
ering that pregnancy intentions and pregnancy-related 
happiness may differentially impact maternal health 
behaviors, research needs to expand on the role of  
maternal psychological factors. Although various so-
FLR�GHPRJUDSKLF�IDFWRUV�KDYH�EHHQ�LGHQWLÀHG�DV�SUH-
dictors of  breastfeeding practices, the added impact 
of  psychological factors (feelings of  happiness and 
wantedness) remains limited. Given the public health 
costs of  prenatal and postnatal programs which pro-
YLGH� HGXFDWLRQ� DERXW� WKH� EHQHÀWV� RI � EUHDVWIHHGLQJ�
behavior, it would be advantageous to better under-
stand such psychological factors, rather than simply 
socio-demographic factors alone. In addition, a bet-
ter understanding of  these psychological factors may 
help explain low rates of  breastfeeding by elucidating 
WKH�UHDVRQV�VRPH�ZRPHQ�KDYH�GLIÀFXOW\�ZLWK�LQLWLD-
tion and prolonged duration, including experiences 
of  physical discomfort and pain (Kelleher, 2012). 

Present Research 
� :H� VHHN� WR�ÀOO� WKLV� OLWHUDWXUH� JDS� E\� LQYHVWLJDW-
ing the relationship between wantedness and feel-
ings of  happiness about the pregnancy in relation 
to breastfeeding initiation and duration. Our re-
search question is: do wantedness and feelings of  
happiness about the pregnancy explain initiation 
and duration of  breastfeeding when controlling for 
VRFLR�GHPRJUDSKLF� IDFWRUV"� &RQVLVWHQW� ZLWK� SUHYL-
ous research, we hypothesize that mothers with un-
intended pregnancies and feelings of  unhappiness 
about the pregnancy are less likely to initiate breast-
feeding and more likely to breastfeed for a shorter 
duration, compared with mothers whose pregnancy 
was intended and who are happy about their preg-
nancy. In addition, we hypothesize that demograph-
ic characteristics, such as education, race, age, and 
SRYHUW\� OHYHO�ZLOO� VLJQLÀFDQWO\� SUHGLFW� LQLWLDWLRQ� DQG�
duration of  breastfeeding, as is consistent with pre-
vious research. Overall, however, we hypothesize 
that feelings of  happiness and wantedness of  preg-

PREGNANCY INTENTIONS AND HAPPINESS



50

nancy will better explain variation in breastfeeding 
outcomes than socio-demographic factors alone.

Method
Data
 In order to investigate these questions, we used 
data from the National Survey of  Family Growth 
(NSFG), which is a large periodic and popula-
tion-based survey (NSFG, 2002). The NSFG has 
been conducted by the National Center for Health 
6WDWLVWLFV� VLQFH� ������ ,W� ZDV� FRQGXFWHG� ÀYH� WLPHV�
with a national sample of  women periodically be-
tween 1973 and 1995. A sixth periodic survey was 
conducted in 2002, which included both men and 
women. We used data from the 2002 wave that in-
terviewed 12,571 men and women on factors affect-
ing birth rates, pregnancy rates and women’s repro-
ductive health. It contains information on 13,593 
pregnancies and 9,148 births from 5,033 women.
 From the sample of  5,033 women, we created a 
sub-sample of  women whose pregnancy resulted in a 
live birth, and who answered the questions based on 
WKHLU�ÀUVW�FKLOG��ZKHWKHU�LW�ZDV�DQ�RQO\�FKLOG�RU�QRW��,Q�
order to create this sub-sample, we excluded individu-
als who had lost a pregnancy, aborted their pregnancy, 
or were currently pregnant. The sub-sample includes 
4,413 participants. It is worth noting then that the sam-
ple only includes responses of  those women referring 
WR�WKHLU�ÀUVW�FKLOG��:KLOH�WKLV�PD\�SRWHQWLDOO\�OLPLW�WKH�
generalizability of  the results, this exclusion criteri-
on is based on previous research which suggests that 
mothers are likely to choose the same feeding meth-
od for each of  their children based on how they fed 
WKHLU�ÀUVW�FKLOG��UHJDUGOHVV�RI �WKH�QXPEHU�RI �FKLOGUHQ�
they have (Taylor et al., 2008). Considerations of  this 
assumption will be made in the limitations section. 

Measures
 Breastfeeding initiation/duration��7KH�ÀUVW�GH-
pendent variable selected was initiation of  breastfeed-
ing. Participants were asked whether they breastfed 
their child at all, so this is a binary outcome measure 
for either yes or no. The second dependent variable 
selected was a continuous outcome measure for du-
ration of  breastfeeding measured in weeks. To check 
for non-normality we constructed a PP-plot and his-

togram, which compared the cumulative probabili-
ties of  the normal distribution with the distribution 
of  residuals. Our PP-plot showed that our data was 
VOLJKWO\�VNHZHG�WR�WKH�ULJKW��7R�À[�WKLV�QRQ�QRUPDO-
ity problem, we transformed our Y dependent vari-
able (duration of  breastfeeding weeks) by taking the 
natural log and running our regression model again. 
Non-normality was no longer a problem after trans-
forming the dependent variable. All further analy-
ses with this continuous dependent variable were 
conducted with logged duration of  breastfeeding in 
weeks. Those who breastfed their child for less than 
one week were coded as 0.5 to indicate an average 
between 0 weeks (no breastfeeding) and 1 week. 
Participants who reported that they were still breast-
feeding their child were excluded from analyses be-
cause duration of  time was impossible to ascertain.
 Socio-demographic characteristics. Demo-
graphic variables included age, poverty, education, 
and race. Both age and poverty level were mea-
sured as continuous variables. Poverty level was the 
percentage of  the poverty level for the year 2001; 
participants who exceed 500 percent of  the pov-
erty level were grouped together. Education was 
also a continuous variable, which measured years 
of  completed schooling. Race was a categorical 
variable and included Hispanic, non-Hispanic black, 
non-Hispanic white, and non-Hispanic other. Hispanic 
was used as the reference category in all analyses.
 Intentions and feelings about pregnancy. In-
tention variables included wantedness of  pregnancy 
and feelings of  happiness about the pregnancy. Want-
edness of  the pregnancy was scored as a categorical 
variable, and included the response options of  too 
soon, right time, unwanted, indifferent, and don’t 
know. Participants whose answer was don’t know 
were coded as missing. Right time was used as the 
reference category in all analyses. Feelings of  happi-
ness were measured on a continuous scale where 0 
PHDQV�WKH�SDUWLFLSDQW�ZDV�YHU\�XQKDSS\�WR�ÀQG�RXW�
that she was pregnant, and 10 means the participant 
ZDV� YHU\� KDSS\� WR� ÀQG� RXW� WKDW� VKH�ZDV� SUHJQDQW�

Statistical Analysis
 Initiation of  breastfeeding. Logistic regres-
sion was conducted to explore the relationship be-

WALLACE, CHAD, RODRIGUEZ



51

tween the dependent variable (initiation of  breast-
feeding) and the independent variables. Omnibus 
tests were used to determine whether socio-demo-
graphic factors (age, poverty, education, and race) 
predicted breastfeeding initiation, and whether so-
cio-demographic factors with intentions/happiness 
variables predicted breastfeeding initiation. A log 
likelihood ratio test was used to investigate wheth-
er a model with socio-demographic factors (age, 
poverty, education, and race) and wantedness/hap-
piness about the pregnancy explains an increase in 
the multiplicative odds of  breastfeeding better than 
a model with only socio-demographic factors. Indi-
YLGXDO� FRHIÀFLHQWV� UHVXOWLQJ� IURP� WKH� VHFRQG� FRP-
parison were examined to determine which factors 
DUH� VLJQLÀFDQW� LQ� SUHGLFWLQJ� EUHDVWIHHGLQJ� LQLWLDWLRQ�
 Duration of  breastfeeding. Ordinary least 
squares (OLS) regression was used to examine the 
relationship between the dependent variables and 
the independent variable (the logged duration of  
breastfeeding in weeks). Since little research exists 
establishing an association between breastfeeding 
behaviors and happiness about the pregnancy, we 
decided to conduct two incremental F-tests. The 
ÀUVW� LQFUHPHQWDO� )�WHVW� FRPSDUHG�ZKHWKHU� D�PRGHO�
with socio-demographic factors (age, poverty, edu-
cation, and race) and wantedness/happiness about 
WKH� SUHJQDQF\� H[SODLQHG� D� VLJQLÀFDQW� SURSRUWLRQ�
of  the variation in logged duration of  breastfeed-
ing better than a model with socio-demographic 
variables alone. The second incremental F-test was 
structured the same, except that the second model 
included socio-demographic factors and only want-
HGQHVV� YDULDEOHV�� ,Q� DGGLWLRQ�� LQGLYLGXDO� FRHIÀFLHQWV�
resulting from the second comparison were ex-
amined to determine which variables were signif-
icant in predicting logged breastfeeding duration.

Results

Sample Characteristics
 Table 1 describes the characteristics of  our sam-
ple. Women who initiated breastfeeding, regardless of  
the duration, comprised 60.6% of  the sample, while 
39.4% did not breastfeed at all. The average duration 
of  breastfeeding in our sample was 16.37 weeks (SD 

= 25.60) with a minimum duration of  0 and a maxi-
mum of  208. This indicates that the average length of  
breastfeeding was about 4 months. Participants were 
48.7% white, 22.5% black, 24.5% Hispanic, and 4.3% 
non-Hispanic other. The average percentage of  the 
poverty level was 228.58, which for a family of  4 was 
about $40,000 per year in 2001 (“Annual Update,” 
2001). Average number of  years of  schooling was 
12.78, and the mean age was about 23 years old with 
a standard deviation of  about 0.5 years. The average 
for feelings of  happiness about the pregnancy was 
7.97 out of  10. Almost half  of  the participants re-
ported that their pregnancy occurred at the right time 
(47.5%), 7.8% reported they wanted it later, 31.5% in-
dicated it was too soon or mistimed, 1.4% didn’t care, 
and 11.8% reported that the pregnancy was unwanted.

Predictors of  Breastfeeding Initiation
 Table 2 shows results of  the logistic regression 
analyses. Results revealed that the socio-demograph-
ic factors (age, race, education, and SES) explain an 
increase in the multiplicative odds of  breastfeeding 
initiation,�ƶ2 (5, 3643) = 442.75, p < .001. The model 
predicts 67.6% of  breastfeeding initiation correctly. 
Nagelkerke R2 = .151, meaning that 15.1% of  the 
variation in breastfeeding initiation is explained by 
socio-demographic variables. The full model with 
socio-demographic and intention/happiness factors 
DOVR�VLJQLÀFDQWO\�H[SODLQV�DQ�LQFUHDVH�LQ�WKH�PXOWLSOL-
cative odds of  breastfeeding initiation, ƶ2 (11, 798) = 
80.48, p < .001. The model predicts 72.5% of  breast-
feeding initiation correctly. Nagelkerke R2 = .127, 
indicating that 12.7% of  the variation in breastfeed-
ing initiation is explained by socio-demographic and 
intention/happiness factors. Results from the likeli-
hood ratio test indicate that the full model, including 
socio-demographic and intentions/happiness, ex-
plains an increase in the multiplicative odds of  initiat-
ing breastfeeding better than a model with socio-de-
mographic variables alone, G2 (5, 798) = 3622.5. 
� 8SRQ�DQDO\]LQJ�WKH�FRHIÀFLHQWV�LQ�WKH�IXOO�PRGHO��
the odds of  initiating breastfeeding decrease by .1% 
for an increase in one year of  age, holding constant 
all other factors, p = .024, (exp(b) = 0.999). The odds 
of  initiating breastfeeding decrease by 15% for one 
more year of  schooling, holding constant all other 

PREGNANCY INTENTIONS AND HAPPINESS



52

�

�

Table 1��Sample Characteristics of Women from their First, Live Birth �
____________________________________________________________________________�
Variable          Valid  Missing   Mean           Std. Dev  Percent�
�
Breastfeeding Initiation       3738       675     -                      -      60.6�
Breastfeeding Duration        3403    1,010  16.37  25.60�
Education           4413        0     12.78    2.55        -�
Poverty           4413        0            228.58           151.16        -�
Age at Pregnancy Outcome  4413              0            2308.4            529.14        -�
Hispanic           1080        -     -    -          24.5�
White            2150        -        -    -         48.7�
Black              995        -     -    -          22.5�
Other              188        -        -    -              4.3�
Happiness   827     3586    7.97   2.94         - �
Wantedness:  
    Right Time                 2094         -       -     -       47.5 
    Later   343         -       -     -         7.8�
    Too Soon, Mistimed         1390         -       -     -      31.50�
    Didn’t Care/Indifferent   61         -       -     -         1.4�
    Unwanted   519         -       -     -        11.8�
    Don’t Know      6         -       -     -            .1�
�

WALLACE, CHAD, RODRIGUEZ



53

�

�

Table 2��Logistic Regression Analyses Predicting Breastfeeding Initiation from Socio-
Demographic Characteristics and Wantedness of Pregnancy Variables�
�
Variable� � Model 1� � � � Model 2� �
� Coefficient� SE� Exp(b)�  Coefficient� SE� Exp(b)�
Constant � 2.34**� .22� 10.37�  1.297*� .65� 3.66�
Age at Pregnancy � -.001**� .0001� .99�  -.0005*� .0002� .99�
Poverty Level Income� -.001**� .0003� .99�  -.001� .0006� .99�
Education� -.15**� .02� .86�  -.15**� .04� .86�
White� .71**� .10� 2.03�  .67**� .22� 1.94�
Black� 1.32**� .11� 3.74�  .97**� .26� 2.63�
Other� .24� .20� 1.27�  .47� .43� 1.60�
Later� -� -� -�  .10� .34� 1.11�
Too Soon, Mistimed� -� -� -�  .15� .22� 1.17�
Indifferent� -� -� -�  .77� .84� 2.16�
Unwanted� -� -� -�  .53� .33� 1.70�
Happiness� -� -� -�  .06� .04� .99�
Model Chi-Square [df]� 442.751 [6]� -� -�  80.484 [11]� -� -�
Block Chi-Square [df]� -� -� -�  3622.5 [5]� -� -�
% Correct Predictions� 67.6� -� -�  72.5� -� -�
Nagelkerke R2� .151� -� -�  .134� -� -�
* p < .05  
** p <.01�

� � � � � � �

�

PREGNANCY INTENTIONS AND HAPPINESS



54

factors, p < .05, (exp(b) = .85). The odds of  initiating 
breastfeeding increase by 94.4% for white mothers 
compared to Hispanic mothers, holding constant all 
other variables, p = .003, (exp(b) = 1.94). The odds 
of  initiating breastfeeding increase by 163.4% for 
black mothers in comparison to Hispanic mothers, 
holding constant all other variables, p < .001, (exp(b) 
= 2.63). Socio-economic status, non-Hispanic other, 
feelings of  happiness, and all of  the intention vari-
ables (i.e. later, too soon, indifferent, unwanted) were not 
VLJQLÀFDQW� IDFWRUV� LQ� WKH� LQLWLDWLRQ�RI �EUHDVWIHHGLQJ�

Predictors of  Breastfeeding Duration
 Table 3 describes the results of  the OLS regres-
sion on breastfeeding duration. In order to determine 
WKH�LQÁXHQFH�RI �VRFLR�GHPRJUDSKLFV�DQG�SUHJQDQF\�
intentions/happiness about the pregnancy on breast-
feeding behavior, an omnibus analysis of  variance test 
was conducted. It showed that socio-demographics 
DQG�LQWHQWLRQV�KDSSLQHVV�ZHUH�VLJQLÀFDQW�LQ�H[SODLQ-
ing the logged duration of  breastfeeding, F(11, 650) 
= 3.53,  p < .001. An incremental F-test, however, did 
not demonstrate that a model with socio-demograph-
ic factors and wantedness/happiness variables better 
explains breastfeeding duration than a model with 
socio-demographics alone, )¨ (5, 435) = 1.54, p > 
.05. Therefore, we sought to evaluate a model that did 
not include happiness to be pregnant, only socio-de-
mographic and intention variables. This decision 
ZDV� ODUJHO\� LQÁXHQFHG� E\� SUHYLRXV� UHVHDUFK� ZKLFK�
has demonstrated that pregnancy intentions predict 
breastfeeding, and the lack of  research establishing a 
link between feelings of  happiness and breastfeeding 
outcomes (Dye, Wojtowycz, Aubry, Quade, & Kil-
burn, 1996; Li et al., 2007; Taylor & Cabral, 2002).
� ,Q� RUGHU� WR� GHWHUPLQH� WKH� LQÁXHQFH� RI � VR-
cio-demographic and pregnancy intention variables 
on duration of  breastfeeding, an omnibus analy-
sis of  variance test was conducted. It revealed that 
socio-demographics and wantedness of  pregnan-
F\� ZHUH� VLJQLÀFDQW� LQ� H[SODLQLQJ� WKH� ORJJHG� GX-
ration of  breastfeeding, F(10, 2163) = 4.70,  p < 
.001 (Table 3). An incremental F-test then demon-
strated that a model with socio-demographic and 
intention factors better explains breastfeeding du-
ration than socio-demographic factors alone, )¨ 

(4, 2163) = 4.44, p = .001. It is important to note 
that while a model including socio-demographic 
factors and wantedness of  pregnancy variables bet-
ter explains breastfeeding duration, socio-demo-
graphic factors only explain 1.1% of  the variation 
in breastfeeding, and wantedness explains .6% more 
variation in outcomes, adjusted R2 = .017, p = .001.
� $QDO\VLV� RI � WKH� FRHIÀFLHQWV� UHYHDOV� WKDW� DV� DJH�
increases by one year, duration of  breastfeeding in-
creases, holding constant education, poverty, race, 
and wantedness of  pregnancy; however this does 
QRW� UHDFK� VWDWLVWLFDO� VLJQLÀFDQFH�� ơ� = .00004, p > 
.05 (Table 3). As income level increases, duration of  
breastfeeding increases, holding constant all other 
variables; yet this increase is not statistically signif-
icant, ơ = .00003, p > .05. As years of  completed 
schooling increases by one year, duration of  breast-
feeding increases by .02 weeks, holding constant all 
other variables; however, this increase is not statis-
WLFDOO\� VLJQLÀFDQW�� p > .05. The average difference 
in breastfeeding between Hispanics and whites is .03, 
holding constant all other variables, p > .05. This 
means that white women breastfed a longer duration 
than Hispanic women controlling for other factors, 
EXW�WKLV�GLIIHUHQFH�LV�QRW�VWDWLVWLFDOO\�VLJQLÀFDQW��7KH�
average difference in breastfeeding between Hispan-
ics and blacks is -.08, holding constant all other vari-
ables, which means that blacks breastfed a shorter 
duration in comparison to Hispanics, holding constant 
all the other variables, but this difference is not sta-
WLVWLFDOO\�VLJQLÀFDQW��p > .05. The average difference 
between Hispanics and individuals from other ethnic 
backgrounds, holding constant all other variables, 
is .18, indicating that individuals from other ethnic 
backgrounds breastfed a longer duration than Hispan-
ics, controlling for all other variables, but this differ-
HQFH�GRHV�QRW� UHDFK�VWDWLVWLFDO� VLJQLÀFDQFH��p > .05.
 In terms of  wantedness of  pregnancy, the av-
erage difference between those whose pregnan-
cy came later than desired compared to those who 
said it was the right time is -.12, meaning that those 
whose pregnancy came later than desired breastfed a 
shorter duration than those who said it was the right 
time�� WKLV�GLIIHUHQFH�ZDV�QRW� VLJQLÀFDQW� WKRXJK��p > 
.05. The average difference between those who said 
their pregnancy was too soon compared to those who 

WALLACE, CHAD, RODRIGUEZ



55

�

�

�

�

�

�

�

�

�

�

�

Table 3��Multiple Regression Analyses Predicting Breastfeeding Duration from Socio-
Demographic Characteristics and Wantedness of Pregnancy Variables�
�
� Model 1�  Model 2�
Variable� Coefficient� SE�  Coefficient� SE� 95% CI�
� � � � � � Lower � Upper �
Constant � 2.16**� 1.49�  2.43**� .17� 2.101� 2.758�
Age at Pregnancy 
Outcome �

.000*� .00�  .000� .00� .000� .000�

Poverty Level Income� .000� .00�  .02� .00� .000� .000�
Education� .02� .01�  .03� .01� -.001� .05�
White� .03� .07�  -.08� .07� -.09� .16�
Black� -.12� .08�  -.08� .09� -.25� .08�
Other� .21� .13�  .18� .13� -.08� .44�
Later� -� -�  -1.2� .09� -.31� .06�
Too Soon, Mistimed� -� -�  -.18**� .07� -.31� -.05�
Indifferent� -� -�  -42� .24� -.89� .04�
Unwanted� -� -�  -.34**� .09� -.53� -.15�
Adjusted R2� .01� -�  0.17� -� -� -�
F� 4.85� -�  4.70� -� -� -�
� R2 - -  .01 - - - 
� F - -  4.44 - - - 
* p < .05  
** p <.01 

       

�

PREGNANCY INTENTIONS AND HAPPINESS



56

said it was the right time was -.18, holding constant 
all other variables; this indicates that those who felt 
their pregnancy was too soon breastfed a shorter du-
ration than those whose pregnancy was at the right 
time��WKLV�GLIIHUHQFH�LV�VWDWLVWLFDOO\�VLJQLÀFDQW��p = .006, 
95% CI [-.31, -.05]. The average difference between 
those who said they felt indifferent about their preg-
nancy timing was -.42, holding constant all other 
variables. This indicates that those who felt indifferent 
about whether they wanted their pregnancy breast-
fed a shorter time than those who felt it was the 
right time��EXW�WKLV�GLIIHUHQFH�ZDV�QRW�VLJQLÀFDQW��S�!�
.05. The average difference between those who said 
their pregnancy was unwanted and those whose was 
at the right time, holding constant all other variables, 
was -.34; therefore, women whose pregnancy was un-
wanted breastfed a shorter duration than those who 
indicated it was at the right time.� 7KLV� FRHIÀFLHQW� LV�
VWDWLVWLFDOO\�VLJQLÀFDQW��p < .001, 95% CI [-.53, -.15].
� ,Q� VXP�� WKH� RQO\� VWDWLVWLFDOO\� VLJQLÀFDQW� FRHI-
ÀFLHQWV� DUH� too soon and unwanted; women who en-
dorsed their pregnancies as either too soon or unwant-
ed breastfed for a shorter duration than those who 
said theirs was at the right time. As mentioned pre-
viously, preliminary analyses revealed that the data 
was non-normal, so we transformed our depen-
dent variable (duration of  breastfeeding in weeks) 
by taking the natural log. Other assumption checks 
were performed to identify any problems relating 
to homoskedasticity, linearity, outliers, leverage, or 
LQÁXHQFH�SRLQWV�� DQDO\VHV� UHYHDOHG� WKDW� UXQQLQJ� WKH�
incremental-F� WHVW� ZLWKRXW� LQÁXHQFH� SRLQWV� \LHOG-
ed a negligible change in outcome variation and 
]HUR� GLUHFWLRQDO� FKDQJH� LQ� WKH� YDULDEOH� FRHIÀFLHQWV�

Discussion
Overall, our results replicate previous research which 
indicates that breastfeeding initiation is explained by 
socio-demographic variables (age, education, SES, 
and race); however, socio-demographic and inten-
tion/happiness factors better explain the initiation of  
breastfeeding than socio-demographics alone. The 
full model is able to predict breastfeeding initiation 
with 72.5% accuracy and explains 12.7% of  the vari-
ation in initiation of  breastfeeding. Even though our 
VDPSOH�RQO\�LQFOXGHG�GDWD�IURP�PRWKHUV·�ÀUVW�ELUWKV��

these results might possibly generalize to breastfeed-
ing outcomes at any birth because previous research 
has demonstrated that mothers are likely to choose 
the same feeding method for each of  their children 
EDVHG�RQ�KRZ�WKH\�EUHDVWIHG�WKHLU�ÀUVW�FKLOG��7D\ORU�
et al., 2008). However, in consideration of  the fact 
that pregnancy intentions, pregnancy-related anxiety 
and happiness, social support, and a multitude of  
other factors can vary from birth to birth, it seems 
likely that mothers may have different initiation/du-
ration of  breastfeeding from birth to birth. There-
fore, these results should be interpreted with cau-
tion, and may be generalizable only to new mothers. 
 In line with previous research, we found that 
older mothers are more likely to initiate breastfeed-
ing than younger mothers. Inconsistent with pre-
vious research, in our sample, individuals with less 
education are more likely to initiate breastfeeding 
than those with more years of  schooling (Jones et 
al., 2011; Taylor & Cabral, 2002). Although most 
studies have demonstrated that more education is 
associated with an increased likelihood to initiate 
breastfeeding, the interaction between race/ethnici-
ty and education as it relates to initiation of  breast-
feeding remains to be determined (Chin, Meyers, 
& Magnus, 2008). It is possible that such an inter-
action went undetected in our sample, resulting 
LQ� ÀQGLQJV� WKDW� DUH� LQFRQVLVWHQW�ZLWK� WKH� OLWHUDWXUH��
 Consistent with recent studies, we found that 
white mothers are more likely to initiate breastfeed-
ing than Hispanic mothers (CDC, 2011). Our model 
suggests that black mothers are more likely to initiate 
breastfeeding in comparison to Hispanic mothers, 
though this is not the typical trend in the literature 
(CDC, 2011). There is literature to suggest that ac-
culturation status affects breastfeeding behaviors 
for Hispanic women, such that more acculturated 
women tend to have lower initiation/duration of  
breastfeeding. Therefore, varying degrees of  accul-
turation among the Hispanic women in our sample 
(perhaps more acculturated women) may contrib-
ute to why our results indicated that black women 
were more likely to initiate breastfeeding (Ahluwalia, 
D’Angelo, Morrow, & McDonald, 2012). Our hy-
pothesis that intentions/happiness factors help to 
predict initiation of  breastfeeding better than so-

WALLACE, CHAD, RODRIGUEZ



57

FLR�GHPRJUDSKLF�IDFWRUV�DORQH�ZDV�FRQÀUPHG��KRZ-
ever, these results should be viewed with caution 
because pregnancy intentions and happiness about 
WKH�SUHJQDQF\�GR�QRW�VLJQLÀFDQWO\�DOWHU�WKH�RGGV�RI �
initiation of  breastfeeding as individual covariates.
 Furthermore, our results show that breastfeed-
ing duration is explained by socio-demographic fac-
tors and wantedness of  the pregnancy. Our original 
hypothesis was not supported because feelings of  
KDSSLQHVV�GLG�QRW�KHOS� WR�H[SODLQ�D� VLJQLÀFDQW�SUR-
portion of  the variation in duration of  breastfeeding, 
but a model with just wantedness of  the pregnancy 
and socio-demographic factors does indeed explain 
a higher proportion of  the variance in breastfeeding 
duration than just socio-demographic factors alone. 
This result should be interpreted with caution, how-
ever, because wantedness of  the pregnancy only ex-
plains .6% more of  the variation in breastfeeding 
outcomes than socio-demographic factors alone.  
 Consistent with previous research, as age, educa-
tion, and income levels increase, duration of  breast-
feeding increases (Jones et al., 2011; Piper & Parks, 
1996; Taylor & Cabral, 2002); these results should be 
viewed with care because they do not reach statistical 
VLJQLÀFDQFH��5HVXOWV�LQGLFDWHG�WKDW�ERWK�ZKLWH�ZRPHQ�
and women from other racial/ethnic minorities (who 
are not white, black, or Hispanic) breastfed their 
child for a longer time than did Hispanic women, 
and black women breastfed a shorter duration than 
+LVSDQLF�ZRPHQ��$OWKRXJK�WKHVH�FRHIÀFLHQWV�DUH�QRW�
VWDWLVWLFDOO\� VLJQLÀFDQW�� SUHYLRXV� UHVHDUFK� VXJJHVWV�
that white women breastfeed for longer durations 
than minority women, though the results tend to be 
mixed (Chen et al., 2012; Jones et al., 2011; Thulier & 
Mercer, 2009). Other research suggests that there are 
no differences in breastfeeding duration between dif-
ferent racial/ethnic groups, except that black women 
tend to breastfeed less often than women of  other 
racial/ethnic categories (Thulier & Mercer, 2009).
 Women with unwanted pregnancies or pregnan-
cies that occurred too soon breastfed for shorter 
durations than those who indicated theirs was at the 
right time; those who felt their pregnancies came later 
than desired or were indifferent about it also breastfed 
IRU�D�VKRUWHU�WLPH��EXW�WKHVH�FRHIÀFLHQWV�GLG�QRW�UHDFK�
VWDWLVWLFDO� VLJQLÀFDQFH��2YHUDOO� WKRXJK�� WKHVH� UHVXOWV�

replicate previous research which supports that unin-
tended, unwanted, or mistimed pregnancies are asso-
ciated with a shorter duration of  breastfeeding (Cheng 
et al., 2009; Taylor et al., 2008). Results did not sup-
port the hypothesis that feelings of  happiness would 
explain breastfeeding outcomes, in that more positive 
feelings would yield a longer duration of  breastfeed-
ing, but a logistic regression revealed that feelings 
of  happiness taken together with intention variables 
and socio-demographics did predict higher rates of  
breastfeeding initiation above just socio-demograph-
ics. In sum, women’s intentions and desires about her 
pregnancy do help to explain breastfeeding initiation 
and duration better than socio-demographic factors 
DORQH�� EXW� WKHVH� UHVXOWV� QHHG� IXUWKHU� FODULÀFDWLRQ�
 Women with unintended pregnancies and nega-
tive pregnancy-related feelings may have a challenging 
time initiating and sustaining breastfeeding for the 
recommended length of  time. Unintended pregnan-
cies and negative feelings surrounding the pregnancy 
PD\�PDNH�LW�PRUH�GLIÀFXOW�IRU�WKH�PRWKHU�WR�IDQWD-
size about her infant and create a psychological bond 
with the infant that continues after birth. For these 
women, there may be a denial of  the reality of  the 
pregnancy and a lack of  recognition of  the infant, its 
needs, and the role of  motherhood, possibly translat-
ing to physiological and psychological disengagement 
in maternal health behaviors, including breastfeeding. 
Future research should explore these hypotheses.

Limitations
 One limitation is that our sample only included 
ZRPHQ�ZKR�ZHUH�DVNHG�DERXW�WKHLU�ÀUVW�ELUWK��:KLOH�
previous research suggests that a mother tends to 
replicate her breastfeeding behavior with each subse-
quent birth (Taylor et al., 2008), feelings of  happiness 
and wantedness of  the pregnancy may change from 
pregnancy to pregnancy based on a variety of  factors. 
Thus, it would be advantageous to examine a model 
that takes into account multiple births in order to bet-
ter elucidate the relationship between breastfeeding 
behavior and happiness/wantedness of  pregnancy. It 
ZRXOG�EH�EHQHÀFLDO�WR�FRPSDUH�D�ZRPDQ·V�SUHJQDQF\�
intentions/feelings of  pregnancy-related happiness 
and breastfeeding initiation/duration for each anal-
ogous birth to determine if  shifts in intentions/feel-

PREGNANCY INTENTIONS AND HAPPINESS



58

ings correspond to shifts in breastfeeding behavior. 
 Another potential confound in our sample is the 
LQÁXHQFH�RI �D�GLYHUVH�DUUD\�RI �VRFLHWDO�QRUPV�UHJDUG-
ing breastfeeding behavior. Many women experience 
a cultural expectation to breastfeed, which has been 
equated to being a “good enough mother” (Stea-
rns, 2009). Feminist scholars explain that the med-
ical and cultural mandate for women to breastfeed 
places an undue burden on women, especially those 
who choose not to breastfeed or who cannot breast-
feed (Stearns, 2009). Examining women’s internalized 
expectations of  “good mothering” behavior during 
pregnancy, along with pregnancy-related anxiety and 
happiness, may help to better explain their prena-
tal and postnatal maternal behaviors. Other groups 
may experience the opposite cultural standards re-
garding perinatal behaviors, and are ensconced in 
communities that embrace formula as the preferred 
method of  feeding (Chin, Meyers, & Magnus, 2008). 
These variations in societal expectations are critical 
to take into account when addressing breastfeeding 
behavior, yet were unaccounted for in our sample. 
 Another limitation is that we did not investi-
gate the father’s feelings of  happiness or wantedness 
about the pregnancy. The father’s sentiments about 
WKH� SUHJQDQF\� PD\� LQÁXHQFH� WKH� PRWKHU� GXULQJ�
gestation, as well as after birth (Vaaler et al., 2011). 
Previous research has demonstrated that disagree-
ment between the parents’ intentions predicts the 
mother’s instability in pregnancy intention, which 
PD\�LQ�WXUQ�LQÁXHQFH�EUHDVWIHHGLQJ�EHKDYLRU��-R\FH��
Kaestner, & Korenman, 2000b). Further research 
by Chang, Valliant, and Bomba (2012) supports the 
strong evidence for a gender gap in breastfeeding 
knowledge and attitude (men tend to view breast-
feeding as less favorable and formula feeding as 
more favorable in comparison to women). There-
fore, the relationship between the mother’s feelings 
about the birth and breastfeeding may be far more 
complex, and interact with her partner’s feelings to 
LQÁXHQFH�WKH�LQLWLDWLRQ�DQG�GXUDWLRQ�RI �EUHDVWIHHGLQJ�
 One potential confound is that all the data from 
the NSFG was collected retrospectively. Joyce et al. 
(2000b) found that in their sample, 30% of  the wom-
en who reported their pregnancy to be unintended 
during pregnancy reported that their pregnancy was 

intended after delivery. Although other research has 
suggested that prospective assessments are not nec-
essarily superior to retrospective reports of  unintend-
ed fertility (Joyce et al., 2000b), we cannot rule out 
the possibility that retrospective reporting may have 
confounded the results of  our analyses. In regards 
to the data, another limitation is that our sample is 
drawn from the 2002 wave of  the NSFG. Although 
this was the most recent wave of  the study available, 
it was twelve years ago. These results should be in-
terpreted with caution since the social climate sur-
rounding breastfeeding has inevitably changed since 
then, making the results of  this study slightly dated. 
 Another limitation is the way that pregnancy-re-
lated happiness was measured in the NSFG. The 
interview contained only one question about hap-
piness, which asked participants to rate on a scale 
of  one to ten how happy they felt when they found 
out that they were pregnant (one meaning that they 
were very unhappy to be pregnant and ten meaning 
they were very happy to be pregnant). The limited 
operationalization of  the construct of  pregnan-
cy-related happiness, combined with a possible so-
cial desirability bias, may have contributed to our 
LQVLJQLÀFDQW�ÀQGLQJV�ZKHQ�FRQGXFWLQJ�RXU�DQDO\VHV��

Directions for Future Research
 Future research should identify potential mod-
erators in order to examine why those who indicate 
their pregnancies are too soon or unwanted tend to 
breastfeed for shorter durations. We suggest that 
women with unwanted or mistimed pregnancies may 
KDYH� D� GLIÀFXOW� WLPH� DWWDFKLQJ� WR� WKHLU� LQIDQWV� ERWK�
before and after birth. Since research has demon-
strated that women with higher levels of  maternal 
fetal attachment have intentions to breastfeed (Fos-
ter et al., 1996), one way in which challenges form-
ing an attachment bond may manifest is through 
breastfeeding, because the mother may lack the mo-
WLYDWLRQ�WR�IHHG�QDWXUDOO\�ZKHQ� LW�SURYHV�GLIÀFXOW�RU�
when formula feeding is convenient. Another way 
that unwanted sentiments during pregnancy could 
manifest after birth is through a lack of  warmth 
and responsiveness to the infant’s needs, which can 
cause an insecure attachment bond between mother 
and child (Ainsworth, Blehar, Waters, & Wall, 1978). 

WALLACE, CHAD, RODRIGUEZ



59

Since higher sensitivity to an infant’s needs is associ-
ated with a longer duration of  breastfeeding, an ab-
sence of  breastfeeding may be a sign that the mother 
is struggling with developing an attachment to her 
child (Britton, Britton, & Gronwaldt, 2006). Research 
should investigate whether feelings of  unwantedness 
prenatally translate to a lack of  warmth and respon-
siveness after birth. Future studies should also explore 
different ways to measure feelings of  happiness, want-
edness, and satisfaction with the pregnancy through-
out gestation in order to better understand how 
SV\FKRORJLFDO� IDFWRUV� LQÁXHQFH� SRVWQDWDO� EHKDYLRUV��
 Similar to our research, other studies investigat-
ing feelings about the pregnancy also use a single item 
question, rather than a valid scale, to measure preg-
nancy-related happiness (Blake et al., 2007; Sable et 
al., 2007). It would be advantageous for researchers to 
develop and validate a scale measuring pregnancy-re-
lated happiness in order to capture the nuances of  the 
construct better than a simple one-item measure can 
provide. Another methodological consideration for 
future research is to use an acculturation scale in addi-
tion to the demographic variable of  “race”. Previous 
research indicates that among Hispanic women, those 
who are less acculturated initiate and continue breast-
feeding longer than those who are more acculturated 
(Ahluwalia, D’Angelo, Morrow, & McDonald, 2012). 
The addition of  acculturation as a socio-demograph-
LF� IDFWRU�PD\� LQÁXHQFH� WKH� LQLWLDWLRQ�GXUDWLRQ� UDWHV�
of  breastfeeding and more accurately capture the 
experience of  individuals who immigrate to another 
country. It would be interesting to learn how accul-
turation interacts with pregnancy intentions/feelings 
of  happiness about the pregnancy in regards to pre-
natal and postnatal behaviors for immigrant mothers. 
 Future studies should also make a distinction be-
tween wantedness of  the pregnancy and pregnancy 
intentions. In the present study and in current re-
search, these two constructs are used interchange-
ably; however, these are potentially two separate 
constructs. For example, a woman who may not have 
planned to get pregnant may still want the pregnan-
cy once she learns that she is pregnant. Conversely, 
a woman who intends to get pregnant may realize 
that she does not want to be pregnant once it occurs. 
7KH�ÀHOG�RI �UHVHDUFK�VXUURXQGLQJ�SUHQDWDO�DQG�SHUL-

natal behaviors may make further advances by clari-
fying the distinction between these two constructs.
 Furthermore, even though we suggest an associa-
tion between pregnancy intentions and breastfeeding 
outcomes, there are several societal, environmental, 
and health factors that may impact or be associated 
with breastfeeding. These factors include prenatal 
care, working before and after birth, the amount of  
maternity leave taken, acculturation, and smoking 
before and after birth. Work barriers may limit the 
amount of  time that the mother has with her infant 
DQG�PDNH� LW� GLIÀFXOW� IRU� KHU� WR� VXFFHVVIXOO\� EUHDVW-
feed. In addition, socio-economic status may serve 
as a moderator between postnatal employment and 
breastfeeding. We acknowledge these factors and lim-
itations, yet push researchers to ask what psychological 
IDFWRUV�PD\� LQÁXHQFH�RU� LQWHUDFW�ZLWK�EUHDVWIHHGLQJ�
behavior as well, since experiences of  happiness and 
prenatal attachment-seeking behaviors by the mother 
may predict the likelihood of  breastfeeding outcomes. 
Future research should explore whether psycholog-
ical factors may help to address why some women 
do not intend to breastfeed, do not initiate breast-
feeding, experience pain and discomfort with breast-
IHHGLQJ��DQG�ZK\�WKH\�VWRS�GHVSLWH�LWV�KHDOWK�EHQHÀWV�

Conclusion

 Overall, our results show that when controlling 
for socio-demographics, pregnancy intentions may 
LQÁXHQFH� WKH� GXUDWLRQ� DQG� LQLWLDWLRQ� RI � EUHDVWIHHG-
ing. Pregnancy intentions and happiness about the 
pregnancy did contribute to an increase in odds of  
breastfeeding initiation, but these variables were not 
VLJQLÀFDQW� SUHGLFWRUV� LQGHSHQGHQWO\�� %UHDVWIHHGLQJ�
GXUDWLRQ� ZDV� LQÁXHQFHG� E\� SUHJQDQF\� LQWHQWLRQV�
while controlling for socio-demographic factors. 
Breastfeeding behavior has been a topic of  interest in 
a variety of  sectors, from public health to psychology, 
GXH�WR�LWV�KHDOWK�EHQHÀWV�IRU�WKH�PRWKHU��VXFK�DV�SRVLWLYH�
postpartum health outcomes (Newcomb et al., 1994; 
Visness et al., 1997) and advantageous psychological 
associations (Mortensen et al., 2002).   
 Breastfeeding has also been associated with 
several physiological and psychological health bene-
ÀWV� IRU� WKH�FKLOG�� VXFK�DV� LQFUHDVHG� LPPXQH�V\VWHP�

PREGNANCY INTENTIONS AND HAPPINESS



60

functioning, long range developmental outcomes, 
and a secure mother-infant attachment bond (Davis 
et al., 1988; Lawrence, 2000; Mortensen et al., 2002). 
 Research into breastfeeding behavior has fo-
cused heavily on socio-demographic factors, partic-
ularly on socio-economic status and how breastfeed-
ing initiation and duration can be enhanced through 
health education for low-income parents. We argue 
that interventions designed to improve breastfeeding 
should include evaluation of  the mother’s feelings 
about her pregnancy, and ways to address feelings of  
unwantedness/unhappiness. Poleschuck and Woods 
(2014) recommend that health psychologists should 
assist women who express surprise, ambivalence, or 
frustration about the pregnancy with exploring their 
feelings, reframing their expectations, garnering so-
cial support and resources, and preparing for the im-
pending changes of  a newborn. The assistance from 
a psychotherapist may help to improve a variety of  
perinatal behaviors besides just breastfeeding, such as 
nutrition, smoking, and responsiveness to the infant’s 
needs. Research should explore how psychosocial 
ZHOO�EHLQJ�DQG�LQWHQWLRQV�DERXW�WKH�SUHJQDQF\�LQÁX-
ence perinatal health behaviors and the psychological 
attachment formed between mother and child. While 
incentives and health education can be used to im-
prove breastfeeding among women, attending to the 
SV\FKRORJLFDO� YDULDEOHV� ZKLFK� LQÁXHQFH� EUHDVWIHHG-
ing outcomes could have lasting implications for the 
physical and mental health of  both the mother and 
WKH�FKLOG�ZKLFK�WUDQVFHQG�IDU�SDVW�WKH�ÀUVW�\HDU�RI �OLIH�
 

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