Background: Both breastfeeding and child spacing benefit infant and maternal health, however there is overlap between risk factors for not exclusively breast feeding and for short interval pregnancy, including socioeconomic status, educational level, race and ethnicity, and younger age. Our aim was to determine if prenatal infant feeding and contraceptive intentions were predictive of postpartum choice, and to examine the relationship of breastfeeding to contraceptive choice. Methods: We previously surveyed expectant publicly-insured women about infant feeding and contraceptive intentions; this follow up study recorded their feeding and contraceptive choices postpartum in-hospital and at the postpartum visit. Hospital and ambulatory records were reviewed for infant feeding choice (exclusive breastfeeding vs. mixed feeding [breast milk and formula] vs. exclusive formula) and contraceptive choices. We conducted McNemar Paired Exact Tests to compare intention with choice for feeding and contraception. We examined whether the three categories of infant feeding were related to contraceptive choice at postpartum pre-discharge using Fisher’s Exact Test, and whether any breastfeeding (exclusive breastfeeding or mixed feeding) was related to contraceptive choice using chi-square (χ2) test of association. Results: Of 223 surveyed expectant women, 214 (96%) delivered at our hospital, and 156 (73.0%) attended a postpartum visit. Of these 214, mean age was 25 years, 185 (89.80%) were African-American, 139 (74.5%) were multiparous, 104 (48.80%) were partnered, and 173 (81.6%) had a >high school education. In-hospital postpartum 116 (54.5%) women exclusively breastfed, 38 (17.8%) did mixed feeding and 59 (27.7%) were exclusively formula feeding; at the postpartum visit, 36 women (27.1%) were exclusively breastfeeding, 31 (23.3%) gave mixed feeding and 66 (49.6%) were formula feeding exclusively. After delivery, 103 women (48. 1%) chose no contraception, 45 (21%) a post-placental hormonal intrauterine device (IUD), 41 (18.1%) medroxyprogesterone acetate injection (“Depo”), and 22 (10.3%) a tubal ligation. Both prenatal visit infant feeding intent and prenatal contraceptive intent were significantly associated with postpartum pre-discharge choice (both p < .0001) and postpartum follow-up visit choice (both p < .0001). We failed to find a statistically significant relationship at postpartum pre-discharge between the 3-way infant feeding categories and contraceptive choice (p = .08). However, there was a statistically significant relationship between any breastfeeding and contraceptive choice (χ2 = 9.28, p = .03). More women who chose any breastfeeding chose no birth control (54.5%) compared to all other birth control types. None used Lactational Amenorrhea Method. Conclusions: Among low-income women at risk for not breastfeeding and short interval pregnancy, infant feeding and contraceptive prenatal intent each were significantly associated with postnatal choice. Mothers breastfeeding at all, compared to those feeding formula exclusively, were significantly more likely to choose no birth control postpartum. This emphasizes the need for effective prenatal education about contraceptive choice while breastfeeding.

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* One record missing information

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*Fisher’s Exact Test p = .08, ** χ2 = 9.28, p = .03 1- LARC = long acting reversible contraception, includes Nexplanon™ and IUDs

*Fisher’s Exact Test p = .08, ** χ2 = 9.28, p = .03 1- LARC = long acting reversible contraception, includes Nexplanon™ and IUDs

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