Racial Disparities Remain in Breastfeeding

March 28, 2010— -- Rates of breastfeeding have been rising since 1990 but still fall below federal targets, particularly for non-Hispanic blacks, researchers found.

Among children born from 2003 to 2006, 73.4 percent started breastfeeding, 41.7 percent were breastfed for at least six months, and 21 percent were breastfed for at least a year, according to Kelley Scanlon of the CDC's Division of Nutrition, Physical Activity, and Obesity in Atlanta, and colleagues.

The rates fell short of the Healthy People 2010 targets of 75 percent, 50 percent, and 25 percent, respectively, the researchers reported in the March 26 issue of Morbidity and Mortality Weekly Report.

In general, Hispanics had slightly higher rates than non-Hispanic whites, but non-Hispanic blacks had rates far below both other groups.

"A better understanding of the underlying factors contributing to the racial/ethnic differences in breastfeeding is needed to develop specific interventions for addressing the differences," the MMWR editors noted in an accompanying comment.

In the meantime, broad interventions should be aimed at non-Hispanic black mothers, they said.

"Breastfeeding should be promoted through comprehensive clinical and social supports starting in pregnancy, and including the birth, delivery, and postpartum periods," Scanlon and her colleagues wrote.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for at least the first year.

To assess progress toward the Healthy People 2010 goals, Scanlon and her colleagues looked at data from the National Immunization Survey for children born from 2003 to 2006. Only Hispanics and non-Hispanic blacks and whites were included because of a low number of responders in other groups.

Breastfeeding initiation and duration were self-reported. Mothers were asked whether their child was ever breastfed or fed breast milk.

Although the overall rate of breastfeeding initiation (73.4 percent) was close to the target, there were major differences by race/ethnicity. Hispanics had the highest rate at 80.4 percent, followed by non-Hispanic whites (73.4 percent) and non-Hispanic blacks (54.4 percent).

Similar trends were found for the number of women breastfeeding for at least six months (45.1 percent, 43.2 percent, and 26.6 percent, respectively) and one year (24 percent, 21.4 percent, and 11.7 percent, respectively).

Some of the other findings:

Initiation was lower for non-Hispanic blacks than for non-Hispanic whites in all but two states: Minnesota and Rhode Island.

Hispanics generally had lower rates of initiation than whites in western states and higher rates in eastern states.

The rate of initiation was at least 20 percentage points lower for non-Hispanic blacks than for non-Hispanic whites in 13 states, mostly in the southeast.

The rate of breastfeeding initiation among non-Hispanic blacks failed to reach 45 percent in six states. The target of 75 percent was reached in just one state: Minnesota (90.6 percent).

According to the MMWR editors, many factors are associated with not breastfeeding, including younger maternal age, lower income, lower maternal education, and having a child outside of marriage.

However, they noted, the disparities between non-Hispanic blacks and whites exist across subgroups.

"Contributors to the differences include lack of culturally relevant information and images of non-Hispanic black women breastfeeding, perceptions that breastfeeding is inferior to formula feeding, non-Hispanic black women returning to work sooner (where support for breastfeeding often is insufficient), lack of social or partner support, and lack of knowledge of the health benefits associated with breastfeeding."