Abstract 1641

Background: To meet healthy People 2000 objectives, breastfeeding must be sustained among immigrant populations. However, declining incidence and duration of breast feeding is well documented among groups who have emigrated from developing countries to the US. Little is known about feeding practices of Somali women, most of whom arrived in the US after 1991 and who now comprise a large immigrant group in San Diego. Purpose: To ascertain knowledge and cultural attitudes about breastfeeding and to compare infant feeding practices among experienced Somali mothers before and after immigration to the US. Method: Twenty Somali women who had at least one child born and raised to two years in both Somalia and the US were surveyed by questionnaire administered in two medical and two WIC clinics, in the Somali language, by Somali staff. Questions concerned demographic characteristics, feeding practices (incidence, initiation, duration, supplementation and weaning of breast feeding); cultural beliefs about feeding (reasons for breast or formula feeding); and persons giving advice regarding infant care and feeding. Results: Virtually all mothers breastfed before and after immigration (90 vs 95%) and cited strong cultural, societal and religious support for doing so. Since colostrum was thought to be "unready" to fed, the initial milk was often discarded and initiation of breastfeeding delayed. Postnatal age at first breastfeeding was similar before and after immigration (23 and 18 hrs of age). More mothers did initiate breastfeeding within 24 hrs in the US (65 vs 45%), although 25% still delayed until after 72 hrs. All breastfed infants, whether in Somalia or the US, received supplements before 6 months of age, most often because breast milk was perceived to be "insufficient", and/or the addition of formula was thought to result in a fatter, healthier baby. The use of supplemental formula increased after emigration to the US from 50 to 95%. After immigration, the mean duration of breast feeding decreased from 17.5 ± 6.8 to 10.2 ± 4.4 months; the most common reason given for weaning was reaching "weaning age" (55%) in Somalia and pregnancy (55%) in the US. Since immigration, the health care provider has replaced the extended family, especially the maternal grandmother, as the primary support for advice related to infant care and feeding practices. Conclusion: Educational efforts to sustain and promote breastfeeding in this immigrant Somali population should focus on specific cultural issues related to time of initiation, perceived benefit of supplementation and reasons for weaning.