Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity — United States, 2020–2021

• Authors: Kristin J. Marks, Centers for Disease Control and Prevention; Jasmine Y. Nakayama, Centers for Disease Control and Prevention; Katelyn Chiang, Emory University; mary Ellen Grap, Centers for Disease Control and Prevention; Erica H. Anstey, Centers for Disease Control and Prevention; Ellen O. Boundy, Centers for Disease Control and Prevention; Heather C. Hamner, Centers for Disease Control and Prevention; Ruowei Li, Centers for Disease Control and Prevention
• Journal Title: Preventing Chronic Disease
• Volume: Volume 20
• Publisher: Centers for Disease Control and Prevention | 2023-12-14, Pages E114-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5888/pcd20.230199
• Subjects: Health Sciences, Nutrition; Health Sciences, Public Health; Sociology, General
• Keywords: breastfeeding; race and ethnicity; National Vital Statistics System birth certificate data; breastfeeding initiation

Abstract

Introduction Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initiation rates by disaggregation of data to finer subgroups of race and ethnicity. Methods We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate whether an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross-tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated categories. Results The overall prevalence of breastfeeding initiation was 84.0%, ranging from 74.5% (mothers identifying as Black) to 94.0% (mothers identifying as Japanese). The aggregated prevalence of breastfeeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Conclusion Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggregation of racial and ethnic data unmasked differences that could reflect variations in cultural practices or systemic barriers to breastfeeding. Understanding why these differences exist could guide public health practitioners’ efforts to improve and tailor breastfeeding support.