Examining Racial and Ethnic Breastfeeding Disparities and Contributing Factors in a National Dataset

Like other positive health behaviors, researchers have documented large racial and ethnic disparities in breastfeeding initiation and continuation rates. Understanding contributing factors to these disparities is important for designing effective interventions.

To examine whether sociodemographic and pregnancy-related factors explain racial and ethnic disparities in breastfeeding outcomes.

We conducted a cross-sectional, secondary analyses of the Pregnancy Assessment Monitoring Survey Phase 8, 2016-2022. We first examined breastfeeding outcomes (breastfeeding initiation, breastfeeding continuation at 8 weeks, and breastfeeding continuation at 8 weeks among those who initiated) across racial and ethnic groups (N = 193,917). Multivariable logistic regressions were used to examine these associations, adjusting for sociodemographic (race, age, insurance, marital status, and income) and pregnancy-related factors (WIC participation, adequacy of prenatal care, delivery type, and number of resources from which participants received breastfeeding information).

A total of 87% of the sample initiated breastfeeding, with 68% still breastfeeding at 8 weeks. Non-Hispanic Black participants were less likely to initiate breastfeeding (aOR = .73; CI [.68, .78]) or be breastfeeding at 8 weeks (aOR = .90; CI [.86, .95]) compared to Non-Hispanic White participants, even after adjusting for sociodemographic and pregnancy-related factors. However, the association between Black race and continuation of breastfeeding to 8 weeks postpartum among those who initiated was completely attenuated after adjustment. Hispanic participants also had lower rates of continuation, but this was reversed when adjusting for sociodemographic and pregnancy-related factors.

Sociodemographic and pregnancy-related factors contribute to, but do not fully explain, breastfeeding disparities. Efforts are needed to further understand and address breastfeeding disparities, especially breastfeeding initiation among Black mothers.