Exclusive Breastfeeding Rates in Latin America

Dear Editor:

The article “Racial and Ethnic Disparities in Breastfeeding” by Jones et al. ¹ is a welcome analysis of the literature on this topic. Especially important to the advancement of improved breastfeeding support for Hispanics is their acknowledgment that U.S. national data do not break down breastfeeding rates by individual Hispanic subgroups. As the authors noted, Hispanic subgroups are heterogeneous, owing no doubt in part to the diversity of the 20 different countries from which they originate.

Jones et al. ¹ correctly point out that breastfeeding rates vary across Latin America. However, the rates of exclusive breastfeeding in various Latin American countries, reported by the authors in support of that conclusion, greatly exceed those reported recently by international sources such as the United Nations Children's Fund (UNICEF). Other national data, such as that reported by the U.S. Agency for International Development via the Demographic and Health Surveys Program and others, confirm this discrepancy (Table 1).

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Table 1.

Rates of Exclusive Breastfeeding in Various Latin American Countries

	Jones et al. 1	UNICEF 2	National data (5 months)
Chile	97%	NA	NA
Ecuador	96%	40%	35% 4
Colombia	95%	43%	24% 5
Bolivia	59%	60%	44% 6
Mexico	38%	14%	3% (6 months) 7
Dominican Republic	10%	7%	1% 8

NA, not available.

It is important to note that the UNICEF measurement defines exclusive breastfeeding as the “percentage of children aged 0–5 months who are fed exclusively with breast milk in the 24 hours prior to the survey.” ² So, based on UNICEF's work, the true rate of children 6 months of age who are exclusively breastfeeding is even lower because UNICEF's data include all children less than 6 months of age who were exclusively breastfeeding at the time of the survey. Therefore, even UNICEF's rate for Bolivia is not as close to the authors' reported rate as would appear.

The reference offered by Jones et al. ¹ as the source of the higher exclusive breastfeeding rates, Sussner et al., ³ is an article from 2008—several years older than UNICEF's data—on the impact of acculturation on breastfeeding. It is not itself source data about the breastfeeding rates in those countries. In fact, there are no breastfeeding rates for these countries anywhere in that reference. And so, the elevated exclusive breastfeeding rates reported by Jones et al. ¹ are without an accurate reference.

Misunderstanding about Hispanics is widespread in the United States, and that misunderstanding hampers efforts to improve the breastfeeding care that these families receive. One of the most harmful myths held about Hispanics is the assumption that they breastfeed, in their native countries, more exclusively than they actually do. I fear that the exclusive breastfeeding rates reported by Jones et al. ¹ in their otherwise helpful article will only further entrench that myth, in no doubt contrary to the authors' own intentions. I welcome a correction of the record.