Journal of Japan Academy of Midwifery
Online ISSN : 1882-4307
Print ISSN : 0917-6357
ISSN-L : 0917-6357
Relationship between factors affecting the willingness to breastfeed in late pregnancy and IIFAS-J (Japanese version Iowa Infant Feeding Attitude Scale)
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JOURNAL FREE ACCESS Advance online publication

Article ID: JJAM-2019-0037



We will clarify the factors that determine the intention of breastfeeding based on the theory of planned behavior including the Japanese version of IIFAS.

Subjects and Methods

The subjects were women in the third trimester of pregnancy who were visiting maternity hospitals or clinics in Akita Prefecture. A self-administered, anonymous survey conducted by mail included 16 IIFAS items, measuring the intention to breastfeed along with the knowledge and attitudes toward nursing and lactation: 3 items on subjective norms; 4 items on behavioral control; and 12 items on the subjects' attributes.


Effective responses were obtained from 285 women (52.9% response rate) whose mean age was 31.3 (±4.6) years. There were 157 primiparous women (55.1%) and 128 multiparous women (44.9%).

The mean IIFAS score was 58.4 (±5.9). Measuring the level of intention, the 15 women (5.3%) who said they “definitely want to breastfeed” scored 63.7. Furthermore, 181 women (63.7%) who said they “want to breastfeed if possible” scored 59.1, 15 women (5.3%) who said “either is acceptable” scored 54.7, 68 women (23.9%) who said they “want to use mixed feeding” scored 56.1, and 5 women (1.8%) who said “want to use milk substitutes” scored 57.2. In intergroup comparisons, the women who chose breastfeeding had significantly higher scores.

When the women were divided based on those who wanted to breastfeed and those who preferred other options, the former group scored higher on the IIFAS, subjective regulation, and behavioral control. Choosing to breastfeed also significantly correlated with higher education, being a health care professional, not being self-employed, having a family business, or working for wages, receiving maternal counseling, having breastfed in the past, and the satisfaction with past nursing methods. A logistic regression analysis proved that the IIFAS correlated with the intention to breastfeed (p<.001).


The intention to breastfeed could be explained by the theory of planned behavior. In order to support the willingness to breastfeed, midwives should not only use IIFAS to understand their own perceptions and values of breastfeeding, but also understand the employment situation and past breastfeeding experience for multiparous women. Needs individual support.

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