Socioeconomic Determinants of Breastfeeding Initiation and Continuation for Families Living in Poverty

Background: Breastfeeding initiation and duration is associated with better immunologic status and neurodevelopment for the breastfed infant in both the short- and long-term. Literature consistently illustrates lower rates of breastfeeding in low-income populations, including those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Socioeconomic determinants of breastfeeding initiation and continuation within a cohort at-risk for low breastfeeding rates remain unknown. Objective: To characterize socioeconomic determinants of breastfeeding initiation and continuation to 3 months postpartum in a Midwestern cohort of families living in poverty. Method: The Kids in Columbus Study (KICS) measures access and use of community resources during the first five years of life. KICS participants (n=322) were recruited from WIC locations during pregnancy through 3 months postpartum. Data analyzed here were collected at enrollment and approximately 6 months later when the infant was between 4 and 7 months of age. Caregivers (98.6% mothers) reported infant feeding practices (i.e., breastfeeding, formula feeding, solid foods introduction) and completed a socioeconomic profile. Breastfeeding initiation and continuation to 3 months postpartum was examined in relation to sociodemographic variables, institutional resources (e.g., checking account, savings account), economic hardship (e.g., difficulty paying bills), and food insecurity using log-binomial regression to estimate relative risk (RR). Results: The average age of the 212 (56%) caregivers who participated in both data collection timepoints was 26.6 (SD=5.1) years, 49% reported a high school or lower level of education, 58% were unemployed, 59% were single, and 66% reported an annual household income below $20,000. Children were 57% female, 41% black, and 7% Hispanic. Approximately 75% of mothers initiated breastfeeding, 42% of the cohort breastfed (BF) and 12% exclusively breastfed (EBF) to 3 months postpartum. Lower likelihood of breastfeeding initiation and continuation was associated with lower educational attainment (RRInitiation=0.76, 95% CI: 0.64,0.89; RRBF=0.68, 95% CI: 0.48,0.96) and being single (RRBF=0.55, 95% CI: 0.40,0.77; RREBF=0.43, 95% CI: 0.21,0.90). Caregivers who reported losing utility service in the past year (RR=1.20, 95% CI: 1.03,1.34) and difficulty affording balanced meals (RR=1.17, 95% CI: 1.01,1.36) were more likely to initiate breastfeeding. C