The best of intentions: Prenatal breastfeeding intentions and infant health.

Health organizations recommend that mothers exclusively breastfeed infants for the first six months of life. The current study contributes to a growing body of research that examines whether the purported benefits of breastfeeding are causal. We systematically evaluated the role of an expectant mother's prenatal breastfeeding intentions, which reflect not only demographic characteristics, but also knowledge, attitudes, and social norms about infant feeding, and therefore serve as a proxy for positive maternal selection into breastfeeding. We used the Infant Feeding Practices Study (IFPS) II (n = 1008) to examine a heretofore overlooked group of mothers-those who intended to breastfeed but did not actually breastfeed. Results suggest that mothers who intended to breastfeed had infants with fewer ear infections and respiratory syncytial viruses, and used fewer antibiotics in the first year of life compared to infants whose mothers did not intend to breastfeed, irrespective of whether they actually breastfed. Because breastfeeding intention is a confounding characteristic that proxies for positive maternal selection and does not represent a causal mechanism for infant health, we further examined how mothers who intended to breastfeed differed from mothers who did not intend to breastfeed. Results suggest that mothers who intended to breastfeed had more knowledge about potential food contaminants and consulted more sources of information about nutrition and diet than mothers who did not intend to breastfeed. Taken together, our results underscore the need for new policy interventions aimed at improving infant health.