Educational and Racial Disparities in Breastfeeding: Associations with Work Status, Social Support, and Stress

Addressing the need to further characterize socioeconomic status (SES) to understand its influence on breastfeeding, we sought to identify patterns of breastfeeding at discharge by both race and educational attainment, as well as whether social support, stress, and employment status mediated these patterns.

This secondary analysis of the Measurement of Maternal Stress Study included 636 pregnant individuals who were surveyed on perceived stress, social support, and hours worked outside the home in their second and third trimesters. Race was categorized as white or People of Color (POC) (Black or Latine), and educational attainment was categorized as low-SES (less than high school), mod-SES (high school and some college), or high-SES (college degree or more). Infant feeding at discharge was abstracted from medical records. Logistic regressions tested associations between race, SES, and race/SES with any breastmilk feedings.

In adjusted models we observed that low-SES POC had the lowest odds (adjusted odds ratio (OR): 0.10, 95% Confidence Interval (CI): 0.04, 0.23) of breast milk feeding at discharge when compared with high-SES white participants, and higher SES was associated with greater odds of breast milk feeding in all racial/ethnic groups. In adjusted models, working more hours and increased social support were not associated with greater odds of breast milk feeding. Perceived stress was not associated with breast milk feeding in unadjusted or adjusted models.

Breastfeeding initiation rates were driven by both educational attainment and race/ethnicity. Social support, stress, and employment status did not explain differences in breastfeeding outcomes. Our results highlight the importance of considering the combined effect of race/ethnicity and SES in strategies to achieve breastfeeding equity.