The Shocking Reality of Breastfeeding Inequality

Forget the so-called breastfeeding mommy wars.

The big issue isn’t whether well-educated, middle-class moms choose to breastfeed their babies. The real problem—and one we should be talking fiercely about—is breastfeeding inequality.

Socioeconomic forces are drastically affecting breastfeeding rates in the U.S., and globally. The result: A huge number of mothers are not getting an equal opportunity to breastfeed their babies.

The stats may shock you.

Why It’s a Problem

• Socioeconomically disadvantaged moms are far less likely to breastfeed (or meet the American Academy of Pediatrics’ recommendations for optimal breastfeeding).
• Babies born into conditions of hardship tend to receive less adequate health care, parental involvement and nutritious supplementary solid food once weaning begins.
• Essentially, the health benefits of breastfeeding are even more important for less-well-off mothers and their babies, and yet far fewer are breastfeeding.
• This inequality is a shocking reality that must be tackled.

Let’s dig into the data to see the extent of the problem.

The Zip code lottery. State to state, breastfeeding rates vary enormously. Mothers living in richer states, like California, are far more likely to breastfeed than those in poorer states, such as Louisiana. Breastfeeding rates are correlated with family income and local hospital practices, among other factors.

With regards to hospitals, 24 percent of babies born in the U.S. are born in Baby-Friendly designated facilities. The Baby-Friendly designation is awarded to hospitals that meet the Ten Steps to Successful Breastfeeding guidelines. These are a set of practices and procedure such as educating families to make informed decisions about infant feeding and offering expert lactation support throughout and beyond the hospital stay.

Currently, 1 in 6 hospitals or birthing centers in the U.S. is Baby-Friendly designated. These are disproportionately represented in wealthier states where there is more money available to implement the initiative.

Education. The higher her level of education, the more likely a mother is to breastfeed her child. Only 36 percent of mothers whose education level is high school exclusively breastfeed their babies for the first three months. In contrast, 56 percent of mothers with an advanced degree do so.

Earnings. Just 38 percent of mothers living below the poverty threshold will breastfeed their baby until 6 months, whereas 68 percent of mothers from wealthy families (earning six times over the threshold) will do so.

That is a huge disparity, which is made all the more stark when you consider that in 2016 there were 40.6 million people in poverty in the U.S. That’s a lot of babies not breastfed, simply because of the socioeconomic conditions they were born into.

Some reasons that well-off mothers have improved breastfeeding rates are:

• Longer maternity leaves;
• Jobs that allow for pumping breaks;
• Better support networks;
• Better hospital practices;
• Ability to hire outside help;
• A culture that unconsciously views breastfeeding as a desirable status symbol.

Urban/rural divide. Mothers in rural communities are less likely to initiate breastfeeding (42 percent of rural mothers will breastfeed to 6 months as opposed to 55 percent of urban mothers).

Studies indicated that rather than being caused by some inherent urban or rural culture, it has far more to do with confounding factors, such as maternal ethnicity and poverty level. Mothers living in rural communities are more likely to have a lower income and work in a job that doesn’t allow as maternity leave and doesn’t provide a lactation programme. They are also less likely to receive social breastfeeding support.

Ethnicity. There are significant disparities in breastfeeding rates among Asian, Black, Hispanic and White mothers. A major part of this trend has to do with socioeconomic measures such as poverty, education and relationship status.

Reasons for the difference, however, run deeper than income. Other influencing factors include whether a mother receives supplementary breastmilk in hospital, whether she has experienced a close family member breastfeeding and whether she believes breast is best.

One startling statistic is that Black mothers are nine times more likely to be given formula in the hospital than White mothers.

Another interesting insight is that Hispanic mothers from low-income families are more likely to breastfeed than their Black or White counterparts. The reasons appear to be that Hispanic mothers tend to experience another family member breastfeeding. This intergenerational influence plays a huge role in whether a mother chooses and successfully breastfeeds.

Formula use in the hospital. Breastfeeding rates differ from hospital to hospital. It is in part a worrying reflection on the differing quality of maternity and lactation support. (The silver lining is that this area may be one of the easier wins in the fight to reduce inequality.)

Use of formula within hospitals is an issue. Firstly, 66 percent of hospitals reported giving breastfeeding mothers free infant formula in their hospital discharge packs. Hospitals generally do this as part of an agreement with commercial formula brands in return for free formula provision.

Perhaps even more worrying is that 24 percent of maternity services provide supplements of commercial infant formula as a general practice within the first 48 hours after birth.

Both practices have been shown to negatively affects whether a mother exclusivity breastfeeds and for how long she does so.

Lactation support in the workplace. In the U.S., only 28 percent of workplaces are lactation friendly (i.e., provide comfortable and private rooms where mothers can use breast pumps and store milk safely). These tend to be in middle to high-income jobs. This is bad news for the majority of working mothers and creates another dimension of inequality. Especially since 25 percent more women breastfeed to six months if their workplace provides decent lactation rooms and breaks to express.

Clearly, there is a long way to go before mothers are properly supported in their breastfeeding efforts within their workplace. This is having a significant impact on the number of babies getting breastfed across the U.S.

Marital status. Married women are more than twice as likely to breastfeed for  six months than mothers who have never married. Clearly, the support fathers can bring plays a significant role. New Zealand researchers found when dads cooked dinner (and washed up), it had a positive effect on the mother’s breastfeeding success. It allowed Mom time to focus on feeding the baby and provided her with rest that helped with maintaining her milk supply.

How to Reduce Breastfeeding Inequality