A Spatial Analysis of Breastfeeding and Breastfeeding Support in the United States: The Leaders and Laggards Landscape

Abstract

Background:

To better track progress in achieving the Healthy People 2020 goals, the Centers for Disease Control and Prevention (CDC) publishes an annual Breastfeeding Report Card (BRC) that represents a compilation of data on breastfeeding practices in all states. With data drawn from the CDC National Immunization Survey, the BRC provides an especially valuable source of information about geographic trends in breastfeeding and related support activities.

Research aim:

This study aimed to identify important geographic trends in both breastfeeding practices and support structures in the United States, highlighting their spatial disparities.

Methods:

Exploratory spatial data analysis, including local indicators of spatial association, is combined with spatial regression models to highlight geographic variations in breastfeeding practices and support.

Results:

Geographic variation in both breastfeeding practices and allied support exists within the United States. Geographic hot spots of breastfeeding are found in the western and northeastern sections of the United States, and cool spots are located primarily in the Southeast. Regression results suggested that unemployment and demographic diversity are negatively associated with breastfeeding rates, whereas higher education and the presence of International Board Certified Lactation Consultants® (IBCLCs®) are positively connected to persistent breastfeeding practices. Further, although the availability of professional support (IBCLC) strengthened nationwide between 2011 and 2016, the availability of mother-to-mother support (La Leche League) softened.

Conclusion:

Although breastfeeding initiation rates continue to increase in the United States, rates of exclusive breastfeeding at 3 and 6 months remain low, displaying significant geographic variation. The ability to pinpoint lagging regions can help to efficiently allocate additional breastfeeding support resources and interventions.

Keywords

breastfeeding breastfeeding rates breastfeeding support La Leche League International lactation counseling

Get full access to this article

View all access options for this article.

References

American Academy of Pediatrics & Section on Breastfeeding. (2012). Breastfeeding and the use of human milk. Pediatrics, 129, e827–e841.

American College of Obstetricians and Gynecologists Committee on Obstetric Practice. (2016). Optimizing support for breastfeeding as part of obstetric practice. Washington, DC: American College of Obstetricians and Gynecologists.

Anselin

(1988). Spatial econometrics: Methods and models. London, England: Springer Science & Business Media.

Anselin

(1995). Local indicators of spatial association—LISA. Geographical Analysis, 27(2), 93–115.

Anstey

E. H.

Chen

Elam-Evans

L. D.

Perrine

C. G.

(2017). Racial and geographic differences in breastfeeding—United States, 2011–2015. MMWR. Morbidity and Mortality Weekly Report, 66(27), 723–727.

Baby-Friendly USA. (2018). One million babies born each year in Baby-Friendly Designated facilities. Retrieved from https://tinyurl.com/y4ec8n4g

Bartick

M. C.

Schwarz

E. B.

Green

B. D.

Jegier

B. J.

Reinhold

A. G.

Colaizy

T. T.

… Stuebe

A. M.

(2017). Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Maternal and Child Nutrition, 13(1). doi: 10.1111/mcn.12366

Baumgartel

K. L.

Spatz

D. L.

, & American Academy of Nursing Expert Breastfeeding Panel. (2013). WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children): policy versus practice regarding breastfeeding. Nursing Outlook, 61(6), 466–470.

Bind

M. A.

(2019). Causal modeling in environmental health. Annual Review of Public Health, 40(1), 23–43.

10.

Bridges

(2016). The faces of breastfeeding support: Experiences of mothers seeking breastfeeding support online. Breastfeeding Review, 24(1), 11–20.

11.

Bridges

Howell

Schmied

(2018). Exploring breastfeeding support on social media. International Breastfeeding Journal, 13(1), 1–9.

12.

Centers for Disease Control and Prevention. (2018). Breastfeeding report card. Retrieved from https://www.cdc.gov/breastfeeding/data/reportcard.htm

13.

Centers for Disease Control and Prevention, National Immunization Survey. (2017). Breastfeeding among U.S. children born between 2009 and 2015. Retrieved from https://tinyurl.com/y6uhs9z7

14.

Cisco

(2017). Who Supports Breastfeeding Mothers? Human Nature, 28(2), 231–253.

15.

Comen

(2018). The fastest growing (and shrinking) states: A closer look. 24/7 Wall Street. Retrieved from https://tinyurl.com/yaocek7g

16.

DeVane-Johnson

Woods-Giscombe

Thoyre

Fogel

Williams

(2017). Integrative literature review of factors related to breastfeeding in African American women: Evidence for a potential paradigm shift. Journal of Human Lactation, 33(2), 435–447.

17.

Dubin

(2009). Spatial weights. In Fotheringham

A. S.

Rogerson

P. A.

(Eds.), The Sage handbook of spatial analysis (pp. 125–158). London, England: Sage.

18.

Dunn

Kalich

Fedrizzi

Phillips

(2015). Barriers and contributors to breastfeeding in WIC mothers: A social ecological perspective. Breastfeeding Medicine, 10(10), 493–501.

19.

Dykes

MacEachren

A. M.

Kraak

M. J.

(2005). Advancing geovisualization. In Exploring geovisualization (pp. 691–703). Amsterdam, the Netherlands: Elsevier.

20.

Edsall

R. M.

(2003). The parallel coordinate plot in action: Design and use for geographic visualization. Computational Statistics & Data Analysis, 43(4), 605–619.

21.

Esri. (2015). Esri demographics. Retrieved from http://doc.arcgis.com/en/esri-demographics/data/us-intro.htm

22.

Fabrey

L. J.

Chuang

(2013). Test analysis report, IBLCE certification examination. Retrieved from https://tinyurl.com/ybc6xfba

23.

Fabrey

L. J.

Chuang

(2015). Test analysis report, IBLCE certification examination. Retrieved from https://tinyurl.com/y88ktlkn

24.

Gibbs

B. G.

Forste

(2014). Socioeconomic status, infant feeding practices and early childhood obesity. Pediatric Obesity, 9(2), 135–146.

25.

Grubesic

T. H.

Durbin

K. M.

(2016). Community rates of breastfeeding initiation: A geospatial analysis of Kentucky. Journal of Human Lactation, 32(4), 601–610.

26.

Grubesic

T. H.

Durbin

K. M.

(2017). Breastfeeding support: A geographic perspective on access and equity. Journal of Human Lactation, 33(4), 770–780.

27.

Grubesic

T. H.

Wei

Murray

A. T.

(2014). Spatial clustering overview and comparison: Accuracy, sensitivity, and computational expense. Annals of the Association of American Geographers, 104(6), 1134–1156.

28.

Hawkins

S. S.

Stern

A. D.

Baum

C. F.

Gillman

M. W.

(2014). Compliance with the Baby-Friendly Hospital Initiative and impact on breastfeeding rates. Archives of Disease in Childhood—Fetal and Neonatal Edition, 99(2), F138–F143.

29.

Healthy People 2020. (2011). Office of Disease Prevention and Health Promotion. Retrieved from https://www.healthypeople.gov/

30.

Jin

S. V.

Phua

Lee

K. M.

(2015). Telling stories about breastfeeding through Facebook: The impact of user-generated content (UGC) on pro-breastfeeding attitudes. Computers in Human Behavior, 46, 6–17.

31.

Johnson

Kirk

Rosenblum

K. L.

Muzik

(2015). Enhancing breastfeeding rates among African American women: A systematic review of current psychosocial interventions. Breastfeeding Medicine, 10(1), 45–62.

32.

Johnson

A. M.

Kirk

Rooks

A. J.

Muzik

(2016). Enhancing breastfeeding through healthcare support: Results from a focus group study of African American mothers. Maternal and Child Health Journal, 20(Suppl. 1), 92–102.

33.

Johnson

(2017). These are the youngest states in America. Time. Retrieved from https://tinyurl.com/y7qzocll

34.

Kitano

Nomura

Kido

Murakami

Ohkubo

Ueno

Sugimoto

(2016). Combined effects of maternal age and parity on successful initiation of exclusive breastfeeding. Preventive Medicine Reports, 3, 121–126.

35.

Lee

C. H. M.

O’leary

Kirk

Lower

T. A.

(2018). Breastfeeding outcomes in Washington State: Determining the effect of Loving Support peer counseling program and characteristics of participants at WIC agencies. Journal of Nutrition Education and Behavior, 50(4), 379–387.

36.

Linnecar

Gupta

Dadhich

Bidla

(2014). Formula for disaster: Weighing the impact of formula feeding vs breastfeeding on environment. Retrieved from http://www.gifa.org/wp-content/uploads/2015/01/FormulaForDisaster.pdf

37.

Lutter

C. K.

Morrow

A. L.

(2013). Protection, promotion, and support and global trends in breastfeeding. Advanced Nutrition, 4(2), 213–219.

38.

Mannel

R. S.

(2006). Staffing for hospital lactation programs: Recommendations from a tertiary care teaching hospital. Journal of Human Lactation, 22(4), 409–417.

39.

Marinelli

(2018). An interview with La Leche League founders Marian Tompson and Mary Ann Kerwin, JD. Journal of Human Lactation, 34(1), 14–19.

40.

Neelon

S. B.

Duncan

D. T.

Burgoine

Mayhew

Platt

(2015). Promoting breastfeeding in child care through state regulation. Maternal and Child Health Journal, 19(4), 745–754.

41.

Nnebe-Agumadu

U. H.

Racine

E. F.

Laditka

S. B.

Coffman

M. J.

(2016). Associations between perceived value of exclusive breastfeeding among pregnant women in the United States and exclusive breastfeeding to three and six months postpartum: A prospective study. International Breastfeeding Journal, 11(1), 8.

42.

Panzera

A. D.

Castellanos-Brown

Paolicelli

Morgan

Potter

Berman

(2017). The impact of federal policy changes and initiatives on breastfeeding initiation rates and attitudes toward breastfeeding among WIC participants. Journal of Nutrition Education and Behavior, 49(7), S207–S211.

43.

PRNewswire. (2018). Global baby food and infant formula market 2018–2023: Market forecast to grow from $50Bn in 2017, to $69Bn during 2018–2023. Research and Markets. Retrieved from https://tinyurl.com/yab63wu7

44.

Pugh

L. C.

Serwint

J. R.

Frick

K. D.

Nanda

J. P.

Sharps

P. W.

Spatz

D. L.

Milligan

R. A.

(2010). A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. Academic Pediatrics, 10(1), 14–20.

45.

Reis-Reilly

Fuller-Sankofa

Tibbs

(2018). Breastfeeding in the community: Addressing disparities through policy, systems, and environmental changes interventions. Journal of Human Lactation, 34(2), 262–271.

46.

Riley

Schoeny

Rogers

Asiodu

I. V.

Bigger

H. R.

Meier

P. P.

Patel

A. L.

(2016). Barriers to human milk feeding at discharge of very low–birthweight infants: Evaluation of neighborhood structural factors. Breastfeeding Medicine, 11(7), 335–342.

47.

Rollins

N. C.

Bhandari

Hajeebhoy

Horton

Lutter

C. K.

Martines

J. C.

, … the Lancet Breastfeeding Series Group. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet, 387(10017), 491–504.

48.

Ruffin

S. D.

Renaud

(2015). Prenatal education, significant other support and demographic determinants of breastfeeding within a rural community. Online Journal of Rural Nursing and Health Care, 15(2). Retrieved from https://rnojournal.binghamton.edu/index.php/RNO/article/view/372

49.

Sipsma

H. L.

Jones

Nickel

N. C.

(2017). Hospital practices to promote breastfeeding: The effect of maternal age. Birth, 44(3), 272–280.

50.

Tapper

(2012). La Leche League Canada rejects breastfeeding dad’s bid to become lactation coach. The Star. Retrieved from https://tinyurl.com/ydh83kzz

51.

Tapper

(2014). Transgender man can be breastfeeding coach. The Star. Retrieved from https://tinyurl.com/y9f3ldy3

52.

United States Census Bureau. (2015). Tiger products. Retrieved from https://www.census.gov/geo/maps-data/data/tiger.html

53.

Uscher-Pines

Mehrotra

Bogen

D. L.

(2017). The emergence and promise of telelactation. American Journal of Obstetrics and Gynecology, 217(2), 176–178.

54.

Victora

C. G.

Bahl

Barros

A. J.

França

G. V.

Horton

Krasevec

, … Group, T. L. B. S. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet, 387(10017), 475–490.

55.

Yourkavitch

Kane

J. B.

Miles

(2018). Neighborhood disadvantage and neighborhood affluence: Associations with breastfeeding practices in urban areas. Maternal and Child Health Journal, 22(4), 546–555.