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Am Fam Physician. 2006;74(7):1230

CDC Reports on Racial and Socioeconomic Disparities in Breastfeeding

The Centers for Disease Control and Prevention (CDC) analyzed data from the 2004 National Immunization Survey to find current estimates of racial and economic disparities in breastfeeding in the United States. Its report was published in the March 31, 2006, issue of MMWR Weekly and is available at

Although breastfeeding initiation rates increased and breastfeeding disparities decreased in past decades, the 2004 data showed substantial racial and economic disparities in breastfeeding initiation and continuation rates to at least age six months. Race and demographic factors were associated with breastfeeding independently of each other. About 72 percent of white children and 50 percent of black children were ever breastfed. Rates of ever-breastfeeding were 10 to 17 percentage points lower among black children than white children in each income group. Within each race, the proportion of children ever breastfed was 23 to 26 percentage points higher in the highest income group than in the lowest. About 54 percent of white children who were ever breastfed were being breastfed at six months of age, compared with about 43 percent of black children.

The greatest differences between breastfeeding rates in each race occurred among children in rural areas. Children were more likely to have ever been breastfed if they were not eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); if their mothers were 20 years or older, married, or had some college education; if they lived in the West or in urban areas; or if their families were above the federal poverty threshold. Factors positively associated with breastfeeding at six months in both races were older maternal age, higher maternal education, mother being married, and living in the Northeast.

Increasing breastfeeding rates is crucial to improving children’s health, reducing childhood overweight, and reducing health care costs. Barriers to initiation and continuation of breastfeeding include lack of social support, lack of proper guidance from health care professionals, lack of adequate and timely postpartum follow-up care, and disruptive hospital maternity-care practices (e.g., delays in breastfeeding initiation, use of pacifiers for newborns, promotion of formula through discharge packs). Public health measures to promote breastfeeding should target those with low initiation rates, including black mothers living in rural areas or those who are younger than 20 years, mothers who have not completed high school, and participants in the WIC program. Breastfeeding interventions should take into account racial, ethnic, and socioeconomic variations in attitudes. The CDC’s Guide to Breastfeeding Interventions provides an introduction to interventions that promote and support breastfeeding.

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