Data show low exclusive breastfeeding rates | Image Credit: bernardbodo - stock.adobe.com

Only a slight increase in the prevalence of exclusive breastfeeding was observed among children in the United States aged under 4 months from 2016 to 2022, according to a recent study published in JAMA Network Open.¹

Exclusive breastfeeding in the first 6 months of life was recommended by the American Academy of Pediatrics (AAP) and World Health Organization (WHO) in 2022. According to the AAP and WHO, this exclusive breastfeeding period should be followed by stepwise introduction of complementary food up to 2 years of age and onward.

Studies have indicated safety from introducing solid foods in children aged as young as 4 months, but the prevalence of a 6-month breastfeeding rate was only 25.4% in 2020. This indicated the Healthy People 2030 goal for exclusive breastfeeding is not being met.

To evaluate how exclusive breastfeeding rates at 4 and 6 months have changed between 2016 and 2022 among children aged 4 and 6 months in the United States, investigators conducted a cross-sectional study. Publicly available data was obtained from the National Survey of Children’s Health (NSCH).

The NSCH is a survey conducted among US noninstitutionalized children aged 0 to 17 years to evaluate their health and well-being. Parents or other primary caregivers completed mail- or web-based questionnaires annually, and responses between 2016 and 2022 were included in the analysis. Self-reported race and ethnicity data was also obtained.

Participants were aged 4 to 6 months old, did not stop breastfeeding before 4 to 6 months of age, and did not begin taking formula before 4 to 6 months of age. Joinpoint, version 5.0.² (National Cancer Institute) was used to assess temporal changes in exclusive breastfeeding prevalence.

There were 18,261 infants included in the analysis at 4 months and 16,793 in the analysis at 6 months, 51.7% and 51.9%, respectively, of whom were boys. An overall prevalence of exclusive breastfeeding at 4 months of 33.5% was reported in 2016, vs 20.5% for breastfeeding at 6 months. These rates were 37.5% and 26.1%, respectively, in 2022.

Sociodemographic factors were not linked to rates of exclusive breastfeeding. However, nonsmoking households had higher rates of exclusive breastfeeding at 6 months of age than smoking households.

These increases in exclusive breastfeeding rates at 4 months were minor, leading to under half of US children meeting the APA and WHO breastfeeding recommendations. Additionally, while rates increased for breastfeeding at 6 months, they remained under the Healthy People 2030 goal of 42.4%.

This data indicates the maximum health benefits of exclusive breastfeeding have not reached 3 in 4 US children. As the study was limited by not allowing for casual inferences regarding factors that may impact exclusive breastfeeding practices, investigators recommended further research to identify causes of early breastfeeding abandonment.

Racial and ethnic disparities may be a potential source of lower breastfeeding rates among US individuals.² A study from the Centers for Disease Control and Prevention reported a breastfeeding rate of 84% among the overall population, but a reduced rate of 74.5% among Black mothers.

In a previous video interview (below) conducted by Contemporary Pediatrics, Tracie W. Kirkland, PhD, DNP, ANP-BC, PPCPNP, CPNP-BC, highlighted the importance of awareness to the benefits of breastfeeding, and ways to rethink equitable breastfeeding using patient-centered care.³

Assessing knowledge of breastfeeding benefits among ethnic minority groups³:

Kirkland is an associate professor at Suzanne Dworak-Peck School of Social Work, University of Southern California and spoke to Contemporary Pediatrics during the 2024 National Association of Pediatric Nurse Practitioners conference that took place in March.³

"Breastfeeding has so many benefits that are not just short term, but long term as well, in terms of prevention of certain chronic diseases like obesity, different cancers, and diabetes" said Kirkland. "My discussion and/or expertise is surrounding ethnic minorities and breastfeeding. Having that conversation early on, encouraging different members of different communities and background, to breastfeed, and to really ask to assess, 'what is your knowledge about breastfeeding?'"³

Based on these results, disaggregation based on racial and ethnic subgroups may improve the accuracy of breastfeeding statistics. Additionally, disaggregation may allow historically masked populations to have their breastfeeding needs met.

References:

1. Ding G, Wen C, Chen Y, Vinturache A, Zhang Y. Prevalence of exclusive breastfeeding among US children. JAMA Netw Open. 2024;7(9):e2436644. doi:10.1001/jamanetworkopen.2024.36644

2. Krewson C. Breastfeeding disparities across racial and ethnic groups in the United States. Contemporary OB/GYN. January 3, 2024. Accessed October 1, 2024. https://www.contemporaryobgyn.net/view/breastfeeding-disparities-across-racial-and-ethnic-groups-in-the-united-states

3. Fitch, J. Assessing knowledge of breastfeeding benefits among ethnic minority groups. Contemporary Pediatrics. March 14, 2024. Accessed October 8, 2024. https://www.contemporarypediatrics.com/view/assessing-knowledge-of-breastfeeding-benefits-ethnic-minority-groups