Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy


Nutritional Sciences

Major Professor

Katherine F. Kavanagh

Committee Members

Marsha L. Spence, Melissa B. Hansen-Petrik, John G. Orme


The objectives were to explore breastfeeding knowledge, attitudes, and intention of future parents, and to investigate indicators and causes of perceived insufficient milk (PIM) supply among Chinese mothers. Objectives were accomplished using a cross-sectional study design. Two questionnaires were developed, one targeting Chinese and US undergraduates, and a second targeting Chinese mothers. In total, 597 undergraduates (395 Chinese; 202 US) and 392 Chinese mothers participated in the study. Data cleaning resulted in a final sample size of 572 for undergraduates (383 Chinese; 189 US) and 341 for Chinese mothers. Results showed that undergraduates in both countries possessed some breastfeeding knowledge and expressed similar concerns. These concerns included perceived inconvenience and embarrassment associated with breastfeeding. In general, US students demonstrated a greater knowledge level than their Chinese counterparts. However, Chinese students possessed better attitudes about breastfeeding. For both groups, greater breastfeeding knowledge and attitudes, and having been breastfed as an infant, were associated with a greater likelihood of breastfeeding, or supporting a partner to breastfeed, a future child. The results of the questionnaire administered among Chinese mothers showed that perceived insufficient milk (PIM) supply was a common occurrence, as it was reported by over half of these mothers. In addition, nearly half of those reporting PIM experienced it within 2 days postpartum. Subjective indicators were frequently used by mothers to assess milk quantity, examples of which included not feeling the presence of milk, receiving a hungry look from the infant after a breastfeed, and having an infant that cried after a breastfeed. Objective indicators, such as the number of wet/soiled diapers, were rarely used. Most mothers were unable to explain why they experienced PIM. However, among those who did report perceived reasons for PIM, these were often diet-related, including having a poor appetite or not being able to “eat enough soup”. Results from both samples indicate the need to develop culturally relevant interventions to address identified misperceptions of future parents and to assist new mothers in correctly identifying and addressing PIM.

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