Objective: Breast-feeding is associated with positive maternal and infant health and development outcomes. To assist identifying women less likely to meet infant nutritional guidelines, we investigated the role of socio-economic position and parity on initiation of and sustaining breast-feeding for at least 6 months. Design: Prospective cohort study. Setting: Australia. Subjects: Parous women from the Australian Longitudinal Study on Women's Health (born 1973-78), with self-reported reproductive and breast-feeding history (N 4777). Results: While 89 % of women (83 % of infants) had ever breast-fed, only 60 % of infants were breast-fed for at least 6 months. Multiparous women were more likely to breast-feed their first child (~90 % v.~71 % of primiparous women), and women who breast-fed their first child were more likely to breast-feed subsequent children. Women with a low education (adjusted OR (95 % CI): 2·09 (1·67, 2·62)) or a very low-educated parent (1·47 (1·16, 1·88)) had increased odds of not initiating breast-feeding with their first or subsequent children. While fewer women initiated breast-feeding with their youngest child, this was most pronounced among high-educated women. While~60 % of women breast-fed their first, second and third child for at least 6 months, low-educated women (first child, adjusted OR (95 % CI): 2·19 (1·79, 2·68)) and women with a very low (1·82 (1·49, 2·22)) or low-educated parent (1·69 (1·33, 2·14)) had increased odds of not breast-feeding for at least 6 months. Conclusions: A greater understanding of barriers to initiating and sustaining breastfeeding, some of which are socio-economic-specific, may assist in reducing inequalities in infant breast-feeding.
KeywordsBreast-feeding initiation Breast-feeding duration Social inequalities Socio-economic position Infant feeding guidelinesThe Australian Dietary Guidelines recommend exclusive breast-feeding of infants up to at least 6 months, with further continued breast-feeding up to 12 months and beyond (1) . These recommendations are based on the numerous positive and protective short-/long-term effects of breast-feeding for both the infant and mother (2)(3)(4)(5)(6)(7) and are in accordance with the WHO recommendation of exclusive breast-feeding up to 6 months, followed by an introduction of complementary foods and continued breast-feeding thereafter (2) .In 2010, it was estimated that breast-feeding was initiated with 96 % of Australian infants; however, only 15 % of infants were exclusively breast-fed up to the recommended 6 months (21 % predominantly breast-fed) (6) . With 60 % of infants breast-fed at all (be it exclusive, full/predominant or complementary) at 6 months, information about breast-feeding duration based on birth order is scarce.Maternal attributes positively associated with breastfeeding initiation and duration include: higher maternal age (6,(8)(9)(10)(11) ; higher maternal education (6,(8)(9)(10)(11)(12)(13) , although not in all studies (10) ; higher family income (8) ; being married (9,11) , although no...