Breastfeeding Disparities and Their Mediators in an Urban Birth Cohort of Black and White Mothers

Abstract

Background: Black mothers in the United States have shorter breastfeeding (BF) durations and less exclusive breastfeeding (EBF) than others. The factors underlying these disparities require investigation. Methods: Using longitudinal data from a CDC-sponsored birth cohort in Cincinnati, Ohio, we analyzed the factors mediating racial disparity in BF outcomes. Study mothers were enrolled in prenatal clinics associated with two large birth hospitals. Analysis was restricted to racial groups with sufficient numbers in the cohort, non-Hispanic Black (n = 92) and White (n = 113) mothers, followed to at least 6 months postpartum. Results: Black mothers were 25 times more likely to reside in socioeconomically deprived neighborhoods and 20 times more likely to have an annual household income <$50,000/year than White mothers (p < 0.001). The gap in EBF for 6 weeks was 45 percentage points by racial group (13%-Black mothers versus 58%-White mothers, p < 0.001); in any BF at 6 months was 37 percentage points (28%-Black mothers versus 65%-White mothers, p < 0.001); and in mothers meeting their own intention to BF at least 6 months was 51 percentage points (29%-Black mothers versus 80%-White mothers, p < 0.001). Racial disparity in EBF at 6 weeks was mediated in logistic regression models by inequities in socioeconomic position, maternal hypertension, and BF intention. Racial disparities in BF at 6 months or meeting 6-month BF intention were mediated by inequities in socioeconomic position, maternal obesity, and EBF at 6 weeks. Not all BF disparities could be explained by models used in these analyses. Conclusions: Efforts to lessen BF disparities should address the underlying structural inequities that disproportionately affect Black mothers and children, should incorporate maternal health, and focus on breastfeeding exclusivity and duration. Few Black mothers achieved EBF at 6 weeks, which contributed to disparity in BF duration. Greater attention to Black mother-infant pairs is a public health priority.

Keywords: breastfeeding; equity; health disparity; race; social determinants of health.

FIG. 1.

Conceptual model of the influence of structural racism on breastfeeding intention and outcomes. SEP, socioeconomic position.

FIG. 2.

Sankey diagram and table of breastfeeding mode frequencies comparing Black and White mothers over the first 6 months of life. In this Sankey diagram (18), bars represent the relative frequency of the infant feeding behaviors at four time points, left to right: Week 2, week 6, month 4, and month 6. EBF is represented in dark orange, PBF in dark yellow, and EFF in blue. The gray lines between bars indicate the proportion of individuals who transition from one infant feeding state to another across the time points measured. EBF, exclusive breastfeeding; EFF, exclusive formula feeding; PBF, partial breastfeeding.