Breastfeeding Disparities Among Rural Breastfeeding Dyads in High-Income Countries: A Scoping Study

Low breastfeeding initiation and duration of exclusivity put rural mothers and infants at risk for morbidity and mortality and significant economic costs. This scoping study aimed to identify determinants of breastfeeding disparities among rural dyads in high-income countries and their modifiable factors. The Arksey and O'Malley methodological framework was used. A literature review was conducted using PubMed, CINAHL Complete, Embase, and APA PsycInfo databases to identify studies related to rural breastfeeding that met criteria published between 2012 and 2022. Twenty-five studies were included. Rural mothers from high-income countries are more likely to be younger, be unmarried, have lower educational attainment, have lower socioeconomic status, smoke, and have a higher prepregnancy body mass index than their urban counterparts. Rural mothers across White, Black, and Hispanic racial and ethnic groups have significantly lower breastfeeding rates compared to urban mothers. Maternal physiological preparedness, breastfeeding problems, lifestyle choices, support from family, evidence-based practice, workplace support, and policy development and implementation for breastfeeding promotion were identified as modifiable factors. Interventions using technology are an emerging field to overcome rurality. Although breastfeeding disparities are prevalent in rural dyads, the basic challenges mothers face when breastfeeding are universal, despite geographical locations in high-income countries. More specific support needs to be provided for breastfeeding dyads to continue breastfeeding. Resource allocation needs to be improved to increase access to care. Patient-centered technology interventions may decrease breastfeeding barriers in rural areas.