Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation

Objective: To determine the impact of immigration status as well as race/ethnicity and social and economic factors on breastfeeding initiation. Design: Cohort, Setting: Multisite group practice in eastern Massachusetts. Participants: One thousand eight hundred twentynine pregnant women prospectively followed up in Project Viva. Main Outcome Measure: Whether the participant breastfed her infant. Results: The overall breastfeeding initiation rate was 83%. In multivariate models that included race/ethnicity and social, economic, and demographic factors, foreignborn women were more likely to initiate breastfeeding than US-born women (odds ratio [OR], 3.2 [95% confidence interval (CI), 2.0-5.21). In models stratified by both race/ethnicity and immigration status, and further adjusted for whether the mother herself was breastfed as an infant and the mother's parents' immigration status, US-born and foreign-born black and Hispanic women initiated breastfeeding at rates at least as high as US-born white women (US-born black vs US-born white women, OR, 1.2 [95% Cl, 0.8-1.91, US-born Hispanic vs USborn white women, OR, 1.1 [95% CI, 0.6-1.91, foreignborn black vs US-born white women, OR, 2.6 [95% Cl, 1.1-6.0], and foreign-born Hispanic vs US-born white women, OR, 1.8 [95% CI, 0.7-4.8]). Calculations of predicted prevalences showed that, for example, the 2.6fold increase in odds for the foreign-born black vs USborn white women translated to an increase in probability of approximately 1.4. Higher maternal education and household income also predicted higher initiation rates. Conclusions: Immigration status was strongly associated with increased breastfeeding initiation in this cohort, implying that cultural factors are important in the decision to breastfeed. Immigrants of all races/ethnicities initiated breastfeeding more often than their US-born counterparts. In addition, US-born minority groups initiated breastfeeding at rates at least as high as their white counterparts, likely due in part to high levels of education and income as well as to access to a medical care system that explicitly supports brcastfeeding.