Breastfeeding Trends by Race/Ethnicity Among US Children Born From 2009 to 2015
Authors: Ruowei Li, Cria G. Perrine, Erica H. Anstey, Jian Chen, Carol A. MacGowan, Laurie D. Elam-Evans
Journal: JAMA Pediatrics (2019)

<h3>Importance</h3> Large racial/ethnic disparities in breastfeeding are associated with adverse health outcomes. <h3>Objectives</h3> To examine breastfeeding trends by race/ethnicity from 2009 to 2015 and changes in breastfeeding gaps comparing racial/ethnic subgroups with white infants from 2009-2010 to 2014-2015. <h3>Design, Setting, and Participants</h3> This study used data from 167 842 infants from the National Immunization Survey–Child (NIS-Child), a random-digit–dialed telephone survey among a complex, stratified, multistage probability sample of US households with children aged 19 to 35 months at the time of the survey. This study analyzed data collected from January 1, 2011, through December 31, 2017, for children born between 2009 and 2015. <h3>Exposures</h3> Child's race/ethnicity categorized as Hispanic or non-Hispanic white, black, Asian, or American Indian or Alaskan Native. <h3>Main Outcomes and Measures</h3> Breastfeeding rates, including ever breastfeeding, exclusive breastfeeding through 6 months, and continuation of breastfeeding at 12 months. <h3>Results</h3> This study included 167 842 infants (mean [SD] age, 2.33 [0.45] years; 86 321 [51.4%] male and 81 521 [48.6%] female). Overall unadjusted breastfeeding rates increased from 2009 to 2015 by 7.1 percentage points for initiation, 9.2 percentage points for exclusivity, and 11.3 percentage points for duration, with considerable variation by race/ethnicity. Most racial/ethnic groups had significant increases in breastfeeding rates. From 2009-2010 to 2014-2015, disparities in adjusted breastfeeding rates became larger between black and white infants. For example, the difference for exclusive breastfeeding through 6 months between black and white infants widened from 0.5 to 4.5 percentage points with a 4.0% difference in difference (<i>P</i> &lt; .001) from 2009-2010 to 2014-2015. In contrast, the breastfeeding differences between Hispanic, Asian, and American Indian or Alaskan Native infants and white infants became smaller or stayed the same except for continued breastfeeding at 12 months among Asians. For example, the difference in continued breastfeeding at 12 months between Hispanic and white infants decreased from 7.8 to 3.8 percentage points between 2 periods, yielding a −4.0% difference in difference (<i>P</i> &lt; .001). Because of positive trends among all race/ethnicities, these reduced differences were likely associated with greater increases among white infants throughout the study years. <h3>Conclusions and Relevance</h3> Despite breastfeeding improvements among each race/ethnicity group, breastfeeding disparities between black and white infants became larger when breastfeeding improvements decreased even further among black infants in 2014-2015. The reduced breastfeeding gaps among all other nonwhite groups may be associated with greater increases among white infants. More efforts appear to be needed to improve breastfeeding rates among black infants.