Breastfeeding disparities across racial and ethnic groups in the United States

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A recent CDC study reveals varying breastfeeding initiation rates among different racial and ethnic groups, emphasizing the importance of detailed data disaggregation for accurate public health insights.

Breastfeeding disparities across racial and ethnic groups in the United States  | Image Credit: © bernardbodo - © bernardbodo - stock.adobe.com.

Breastfeeding disparities across racial and ethnic groups in the United States | Image Credit: © bernardbodo - © bernardbodo - stock.adobe.com.

There are significant differences in breastfeeding initiation rates across racial and ethnic groups, according to a recent study from the Centers for Disease Control and Prevention (CDC).

Takeaways

  1. A study by the CDC revealed significant disparities in breastfeeding initiation rates across racial and ethnic categories in the United States. While breastfeeding rates have generally increased over time, rates differed notably among groups.
  2. Disaggregating data by detailed racial and ethnic subgroups uncovered specific trends that were not evident when data was analyzed using broader categories. For instance, within the Asian racial group, different subgroups like Japanese, Korean, Asian Indian, and Filipino had notably high breastfeeding initiation rates.
  3. Among Hispanic mothers, there was variability in breastfeeding initiation rates. While overall 86.8% of Hispanic mothers initiated breastfeeding, rates differed among subgroups, with Cuban mothers having the highest rate and Puerto Rican mothers the lowest.
  4. Black mothers had the lowest reported breastfeeding initiation rate at 74.5%, and rates below 80% were also observed among American Indian and Other Pacific Islander subgroups.
  5. The study underscored the importance of disaggregating health data by specific racial and ethnic subgroups. Such detailed analysis can help identify and address disparities, ensuring that the needs of diverse populations are adequately met.

Breastfeeding can reduce the risks of several adverse outcomes in mothers and infants, making it the optimal source of nutrition for infants. A rise in breastfeeding rates has been observed over time in the United States, but there are disparities based on race and ethnicity, with rates of 80% or greater among infants of Asian, Hispanic, or White individuals.

Within-group differences are difficult to determine because of aggregation of heterogeneous data, leading to limited data on health disparities among diverse subpopulations. To determine how greatly broad race and ethnicity categories conceal variation, investigators conducted a study evaluating differences in breastfeeding initiation rates.

Data was obtained from the National Vital Statistics System, a census of all US live births. Participants included infants born in 48 of 50 states and the District of Columbia between January 1, 2020, and December 31, 2021. 

Exclusion criteria included transfer to another facility within 24 hours after birth, death before birth certificate completion, and missing breastfeeding initiation or covariate data. Birth certificate data was reported by mothers and included race and ethnicity.

The question, “Is the infant being breastfed at discharge?” was asked on the birth certificate as a yes or no response question. Those responding “yes” were categorized as having initiated breastfeeding.

There were 5,962,133 US infants included in the final analysis, of whom 73.7% had White mothers, 17.1% Black mothers, and 5.2% Asian mothers. More than one-third of Asian births were of Asian Indian mothers.

Of mothers, 21.8% were Hispanic, with 10.9% of all births being of Mexican mothers and 4.6% Central or South American mothers. Of Hispanic mothers, 88.7% were White and 7.3% Black.

Breastfeeding initiation was reported in 84% of participants, with the lowest rate of 74.5% reported in Black mothers. A prevalence of under 80% was reported in 2 other subgroups, American Indian at 77.7% and Other Pacific Islanders at 79.4%.

Japanese mothers had the highest breastfeeding initiation rate at 94%, followed by Korean at 93.7%, Asian Indian at 93.4%, and Filipino at 91.3%. These groups were all disaggregated from the Asian racial group.

Of Hispanic mothers, 86.8% initiated breastfeeding, with breastfeeding most common in the Cuban subgroup at 90.9% and least common in the Puerto Rican subgroup at 82.2%.

These results indicated the efficacy of disaggregation by detailed racial and ethnic subgroups to increase the accuracy of breastfeeding initiation statistics. Investigators concluded disaggregation can make populations historically masked in public health surveillance more visible and able to have specific needs met.

Reference

Marks KJ, Nakayama JY, Chiang KV, et al. Disaggregation of breastfeeding initiation rates by race and ethnicity — United States, 2020–2021. Prev Chronic Dis. 2023;20:230199. doi:10.5888/pcd20.230199

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