Economics Behind Racial Differences in Breast-feeding Rates

SAN FRANCISCO — Economic factors, not culture, might explain racial differences in breast-feeding rates, according to the results of a new study.

This highlights the importance of helping women overcome practical obstacles to breast-feeding, said Rachel Horowitz, BS, from the Sidney Kimmel Medical College in Philadelphia.

Often, the decision to breast-feed depends on the type of work women do, she told Medscape Medical News.

Horowitz presented the study findings here at the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting 2015.

In the United States, breast-feeding rates have long been lower in black women than in white women. A lack of role models and family support have been proposed as explanations for this disparity by some researchers.

To see what other factors might be contributing to the difference, Horowitz and her colleagues analyzed the medical records of 523 women (342 black, 181 white) who delivered singleton term infants from July to December 2013 in their institution.

Of these, they identified 337 women (white and black) for whom method of feeding was documented during a postpartum visit.

More white women than black women fed their babies at least partly with breast milk (64% vs 53%; P < .05). However, when the researchers adjusted for age, parity, and marital status, the difference between races was no longer significant (odds ratio [OR], 0.91, 95% confidence interval [CI], 0.52 - 1.56).

"The only factor that was significant was insurance status," Horowitz reported. More white women than black women had private insurance (60% vs 33%).

Insurance Status and Breast-feeding

In a separate analysis, the research team looked at the association between insurance status and breast-feeding in a mixed-race cohort (including Asian and Hispanic women) of 405 women who delivered singleton term infants from July to December 2013 in their institution.

The women all completed postpartum follow-up within 8 weeks and had feeding methods recorded.

Women were less likely to breast-feed at least part of the time if they were covered by Medicaid than by commercial insurance (48% vs 69%; OR, 0.53; 95% CI, 0.29 - 0.77), even after adjustment for age, race, parity, education, and marital status.

The effect of insurance status was much stronger on white women than on black, Hispanic, and Asian women. In fact, in women covered by Medicaid, the rate of breast-feeding was lowest in white women, followed by black women, then Hispanic women and Asian women.

The analysis did not pinpoint how insurance status affects breast-feeding, but Horowitz said she believes it is a proxy for other aspects of poverty.

Women in low-paying jobs might not get breaks from work to pump milk and might not have access to refrigerators to store breast milk, she explained.

Previous research has shown that intention is a more important factor in breast-feeding than demographic characteristics, which means clinicians could use prenatal discussions with mothers to encourage breast-feeding, she added.

"If you can plan in advance, hopefully that will increase breast-feeding rates," said Horowitz.

She said she and her colleagues are planning to conduct a clinical trial of this approach.

This study illustrates why it is important not to jump to conclusions about race, said Sharon Phelan, MD, from the University of New Mexico in Albuquerque.

"This was thinking outside of the box, and could serve as a challenge to some of the other things we say about ethnicity and race," she told Medscape Medical News.

Dr Phelan said she agrees that working conditions could be the driving factor behind the racial differences. In fact, many of her patients have told her, "I work in fast food; I can't take off time to breast-feed."

Ms Horowitz and Dr Phelan have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting 2015: Abstracts 73 and 78. Presented May 3, 2015.

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Cite this: Economics Behind Racial Differences in Breast-feeding Rates - Medscape - May 08, 2015.