Disparities in breastfeeding duration

Breastfeeding duration among New York City Latinx mothers by their birth region significantly varies, according to a survival analysis in the journal Breastfeeding Medicine.¹

The study evaluated mothers from 4 regions: the United States, the Caribbean, Mexico/Central America, and South America.

A Caribbean birthplace significantly signaled early breastfeeding cessation.

Lauren Gerchow, MS, RN

“Both my personal and work histories came together as motivating factors for this project,” said lead author Lauren Gerchow, MS, RN, a Ph.D. student in nursing at the New York University (NYU) Rory Meyers College of Nursing in New York City. “As a nurse home visitor for the Nurse-Family Partnership program in both New York City and San Francisco, I have engaged with Latinx families from the 4 regions included in the study.”

In addition, Gerchow’s father's family is from Costa Rica. “Through my work as a home visitor, I learned of both shared and distinct aspects of my own family’s culture and the cultures of my Latinx clients,” she said. “Latin America encompasses an enormous geographic region, where a multitude of cultures comprise the Latinx identity, and this study shows how that can translate into health disparities.”

The investigators analyzed data from the 2016 New York City Work and Family Leave Survey (WAFLS), which queried residents who gave birth in 2014.

The sample consisted of 271 Latinx-identifying mothers, 34.0% of whom were born in the U.S., 26.8% born in the Caribbean, 23.6% born in Central America or Mexico and 6.6% born in South America.

“Mothers in the study from the Caribbean breastfed for a significantly shorter time than mothers born in the U.S., Mexico/Central America or South America,” Gerchow told Contemporary OB/GYN®. “Half of all Caribbean-speaking participants stopped breastfeeding by 3 months postpartum, compared to 5 months for U.S.-born mothers, 7 months for Mexico/Central American-born mothers and 8 months for South America-born mothers.”

The risk of mothers breastfeeding for a shorter time was 50% less for South America and Mexico/Central America-born mothers compared to Caribbean-born mothers, and 36% less for U.S.-born mothers compared to Caribbean-born mothers.

“I was surprised that the Caribbean-born outcomes were significantly poorer than the U.S.-born outcomes,” Gerchow said. “Acculturation is commonly associated with poor breastfeeding behaviors, yet U.S.-born mothers continued breastfeeding for longer than Caribbean-born mothers.”

Being partnered at the time of childbirth and neonate hospitalization of 6 days or longer also were significantly associated with a greater risk of earlier breastfeeding cessation. Longer neonate lengths of stay are often linked to prematurity, neonatal intensive care or birth complications, which impact breastfeeding both in the hospital and after discharge.

The treatment of Latinx individuals as a monolithic group for breastfeeding behaviors loses significant differences between groups, according to Gerchow. “Providers should not assume that Latinx ethnicity is a protective factor for breastfeeding duration,” she said.

Because breastfeeding is a complex health behavior with many factors driving continuation, Gerchow recommends that breastfeeding mothers “seek out peer, familial or provider support, as well as learn about their local legislation for breastfeeding rights in the workplace or breastfeeding in public to support continued breastfeeding.”

The findings of the study, coupled with Gerchow’s own clinical practice, has inspired her to continue to investigate within-group disparities in the Latinx maternal health population. “I suspect that health behaviors beyond breastfeeding show similar differences based on birthplace,” she said.

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Disclosure

Gerchow reports no relevant financial disclosures.

Reference

1. Gerchow L, Squires A, Jones S. Disparities in breastfeeding duration of New York City Latinx mothers by birth region. Breastfeed Med. Published online April 7, 2021. doi:org/10.1089/bfm.2021.0030