Publication Date

2025

Document Type

Dissertation/Thesis

First Advisor

Gordon, Rachel

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Health Studies

Abstract

Breastfeeding provides substantial health benefits to both infants and mothers, yet breastfeeding rates in the United States remain below medically recommended levels. Multiple barriers include lack of insurance coverage for breast pumps, insufficient support in pump use, and demographic disparities contribute to early cessation. This dissertation investigates the impact of insurance type, breast pump provision, and support with breast pump use on breastfeeding continuation beyond six months, using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2022. Support with breast pump use is defined as someone to answer questions, help knowing if the baby was getting enough milk, help with managing pain or bleeding nipples, information about where to get a pump, help using the pump, and breastfeeding support group. Guided by the Health Action Process Approach (HAPA), three studies were conducted to examine the impact of insurance type and pump provision on breastfeeding outcomes, the effect of receiving assistance or information on pump use, and demographic and geographic moderating factors affecting breastfeeding duration. Results indicate that while private insurance is associated with higher breastfeeding initiation rates, it does not predict extended breastfeeding beyond six months. Insurance-paid pump provision alone did not significantly influence breastfeeding duration, highlighting the importance of a broader support model. Sociodemographic factors, such as age, income, race, and language, emerged as significant moderators of breastfeeding continuation. These findings emphasize the complex role that structural, policy, and individual factors shape breastfeeding behavior. Comprehensive and tailored interventions beyond equipment provision are necessary to support sustained breastfeeding. Recommendations include enhancing insurance policies to integrate robust educational support, formalize coverage requirements, and include outreach to diverse maternal populations.

Extent

166 pages

Language

en

Publisher

Northern Illinois University

Rights Statement

In Copyright

Rights Statement 2

NIU theses are protected by copyright. They may be viewed from Huskie Commons for any purpose, but reproduction or distribution in any format is prohibited without the written permission of the authors.

Media Type

Text

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Available for download on Friday, January 22, 2027

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