Rural-Urban Differences in Breastfeeding Initiation in the United States

Sparks, P. Johnelle

doi:10.1177/0890334409352854

Cited by 39 publications

(50 citation statements)

References 41 publications

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“…The conclusions reached may not be applicable to the larger Lebanese population, especially given the likely differences in breastfeeding practices among urban and rural mothers [40]. Furthermore, different factors may come into play with ill mothers and children.…”

Section: Discussionmentioning

confidence: 99%

Determinants of exclusive breastfeeding in an urban population of primiparas in Lebanon: a cross-sectional study

et al. 2013

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BackgroundThe proportion of mothers who exclusively breastfeed their babies up to 6 months remains low. Determinants of breastfeeding practices have been largely documented in high-income countries. Little evidence exists on possible predictors of breastfeeding behaviors in the Middle East. Our aim was to assess the prevalence of breastfeeding in Beirut and determine the factors that impact breastfeeding behavior in this population.MethodsData for this longitudinal study is nested within a randomized controlled trial (RCT) assessing the impact of a 24-hour hotline and postpartum support film on postpartum stress. Healthy first-time mothers delivering in the capital Beirut between March and July 2009, were interviewed at 1–3 days and 8–12 weeks post delivery. A multiple logistic regression analysis was used to determine the factors associated with exclusive breastfeeding at 8–12 weeks postpartum.ResultsThe overall breastfeeding rate at 8–12 weeks postpartum was 67%. The exclusive breastfeeding rate was 27.4%. Factors associated with exclusive breastfeeding included maternal work (OR=3.92; p-value<0.001), planned pregnancy (OR=2.42, p-value=0.010), intention to breastfeed (OR=3.28; p-value=0.043), source of maternal emotional support (OR = 1.87, p-value=0.039) and the use the postpartum support video, the hotline service or both (OR=2.55, p-value=0.044; OR=3.87, p-value=0.004 and OR=4.13, p-value=0.003).ConclusionsThe proportion of healthy first-time mothers who exclusively breastfeed in Beirut is extremely low. Factors associated with breastfeeding behavior are diverse. Future research and interventions should target different levels of the maternal-child pair’s ecosystem.Trial registrationClinicalTrials.gov, NCT00857051

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Section: Discussionmentioning

confidence: 99%

Determinants of exclusive breastfeeding in an urban population of primiparas in Lebanon: a cross-sectional study

et al. 2013

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“…Rural–urban differences in breastfeeding initiation, exclusive breastfeeding, and duration of breastfeeding have been reported from some countries [2,14-17]. The prevalence of breastfeeding was higher in an urban setting as compared to a rural in USA and Tanzania [2,17].…”

Section: Introductionmentioning

confidence: 99%

Breastfeeding practices in urban and rural Vietnam

et al. 2012

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BackgroundThe aim of this study was to describe and compare breastfeeding practices in rural and urban areas of Vietnam and to study associations with possibly influencing person and household factors. This type of study has not been conducted in Vietnam before.MethodsTotally 2,690 children, born from 1st March 2008 to 30th June 2010 in one rural and one urban Health and Demographic Surveillance Site, were followed from birth to the age of 12 months. Information about demography, economy and education for persons and households was obtained from household surveys. Standard statistical methods including survival and regression analyses were used.ResultsInitiation of breastfeeding during the first hour of life was more frequent in the urban area compared to the rural (boys 40% vs. 35%, girls 49% vs. 40%). High birth weight and living in households with large number of assets significantly increased the probability for early initiation of breastfeeding. Exclusive breastfeeding at three months of age was more commonly reported in the rural than in the urban area (boys 58% vs. 46%, girls 65% vs. 53%). The duration of exclusive breastfeeding as well as of any breastfeeding was longer in the rural area than in the urban area (medians for boys 97 days vs. 81 days, for girls 102 days vs. 91 days). The percentages of children with exclusive breastfeeding lasting at least 6 months, as recommended by WHO, were low in both areas. The duration of exclusive breastfeeding was significantly shorter for mothers with three or more antenatal care visits or Caesarean section in both areas. High education level of mothers was associated with longer duration of exclusive breastfeeding in the rural area. No significant associations were found between duration of exclusive breastfeeding and mother’s age, household economy indicators or household size.ConclusionIntervention programs with the aim to promote breastfeeding are needed. Mothers should particularly be informed about the importance of starting breastfeeding early and to prolong exclusive breastfeeding. In order to reach the WHO recommendation of six months exclusive breastfeeding, we propose an extended maternity leave legislation to at least six months.

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“…While several studies have found breastfeeding rates to be higher in urban versus rural counties (Flower et al, 2008; Li & Grummer-Strawn, 2002; Lynch, Bethel, Chowdhury, & Moore, 2011), one previous study found that among low-income women, those living in urban areas had a lower odds of breastfeeding initiation than those living in rural areas (Sparks, 2010). While IBCLC availability does not guarantee utilization of services, our finding of higher six-week breastfeeding prevalence in urban counties with IBCLCs present suggests that IBCLC services in more urban settings may be easier for low-income families to access, potentially as a result of public transportation or cultural norms.…”

Section: Discussionmentioning

confidence: 96%

Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement

Wouk

Chetwynd

Vitaglione

et al. 2016

Matern Child Health J

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Objectives While the Affordable Care Act improves access to lactation services for many women across the US, low-income mothers in states without Medicaid expansion lack coverage for lactation support. As these states consider individual Medicaid reimbursement policies, the availability, effectiveness, and cost-benefit of lactation services must be evaluated. We conducted such an analysis for low-income mothers in North Carolina (NC), providing a model for other states. Methods First, we analyzed the distribution of NC International Board Certified Lactation Consultants (IBCLCs) and county-level breastfeeding rates among low-income infants. Logistic regression was used to examine the association between IBCLC density and six-week breastfeeding duration. Finally, state advocates collaborated on a cost-benefit analysis of Medicaid coverage of IBCLCs. Results Maps of the NC breastfeeding support landscape indicate that IBCLCs are available to provide services to low-income women across the state. Compared to counties with no IBCLCs, those with high IBCLC density were found to have a six-week breastfeeding prevalence ratio of 1.20 (95% CI: 1.12, 1.28). Medicaid reimbursement of IBCLCs showed an estimated annual cost savings of $2.33 million. Conclusions In one state without Medicaid expansion, we found that breastfeeding support resources are available across the state, high density IBCLC support is associated with increased breastfeeding by low-income mothers, and services are cost-effective. Our model for Medicaid reimbursement in NC provides a framework for states to improve equity in access to optimal lactation support.

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Rural-Urban Differences in Breastfeeding Initiation in the United States

Cited by 39 publications

References 41 publications

Determinants of exclusive breastfeeding in an urban population of primiparas in Lebanon: a cross-sectional study

Determinants of exclusive breastfeeding in an urban population of primiparas in Lebanon: a cross-sectional study

Breastfeeding practices in urban and rural Vietnam

Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement

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