Factors Influencing Exclusive Breastfeeding Up to 6 Months Among Underserved Immigrant Women in New York City

Abstract

Background:

Exclusive breastfeeding for an infant’s first 6 months is recommended for maternal and infant health benefits. Despite rising breastfeeding rates in the United States, the 6-month exclusive breastfeeding rate remains low, particularly among underserved women.

Research Aim:

This study aimed to identify factors influencing exclusive breastfeeding rates during the first 6 months postpartum in a public community hospital serving underserved immigrant populations in New York City.

Method:

This retrospective cohort study analyzed electronic medical records of 1,510 mother–infant dyads who gave birth in 2021. Data were examined over 6 months postpartum to assess breastfeeding initiation, continuation, and associated factors. Descriptive statistics and multivariate logistic regression analyses were conducted.

Results:

The sample was predominantly composed of low-income women (80.3%), Medicaid recipients (94.4%), non-English speakers (63.7%), and Hispanic/Latino individuals (62.5%). Exclusive breastfeeding rates were 18.5% at discharge, 37.2% at 1 month, and 24.6% at 6 months. Maternal, newborn, and hospital-related factors were identified as key determinants. Among maternal factors, age, ethnicity, marital status, mode of delivery, and prior breastfeeding experience predicted adherence. Higher birth weight and elevated bilirubin levels were positively associated with exclusive breastfeeding, while neonatal intensive care unit admission was negatively associated. Postpartum lactation consultation was also a significant hospital-level factor.

Conclusion:

Exclusive breastfeeding rates in this underserved, immigrant population fell below national averages and declined over time. Key maternal, newborn, and hospital-related factors shaped breastfeeding outcomes, revealing critical gaps in lactation support and access to care. Targeted, culturally responsive interventions are essential to improve breastfeeding equity.

Keywords

breastfeeding exclusive breastfeeding health disparity immigrant women retrospective chart review underserved populations

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References

Alexander

Hadler

Hinterland

King

Krauss

Nudelman

Sood

Warner

Wiewel

(2025). The health of immigrants in New York City. New York City Department of Health and Mental Hygiene. https://www.nyc.gov/assets/doh/downloads/pdf/episrv/immigrant-health-2025.pdf

American Academy of Pediatrics. (2022, May 31). Newborn and infant breastfeeding. https://www.aap.org/en/patient-care/newborn-and-infant-nutrition/newborn-and-infant-breastfeeding/#:~:text=For%20the%20best%20health%20outcomes,and%20beyond%20as%20mutually%20desired

Bai

D. L.

Fong

D. Y.

Tarrant

(2015). Previous breastfeeding experience and duration of any and exclusive breastfeeding among multiparous mothers. Birth, 42(1), 70–77. https://doi.org/10.1111/birt.12152

Bartick

Schwarz

Green

Jegier

Reinhold

Colaizy

Bogen

Schaefer

Stuebe

(2016). Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Maternal & Child Nutrition, 13(1), e12366. https://doi.org/10.1111/mcn.12366

Bich

Hoa

Vui

Nghia

Målqvist

(2016). Father’s involvement and its effect on early breastfeeding practices in Vietnam. Maternal & Child Nutrition, 12(4), 768–777. https://doi.org/10.1111/mcn.12207

Bich

Long

T. K.

Hoa

D. P.

(2019). Community-based father education intervention on breastfeeding practice—Results of a quasi-experimental study. Maternal & Child Nutrition, 15(Suppl. 1), Article e12705. https://doi.org/10.1111/mcn.12705

Brownell

Howard

C. R.

Lawrence

R. A.

Dozier

A. M.

(2012). Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. The Journal of Pediatrics, 161(4), 608–614. https://doi.org/10.1016/j.jpeds.2012.03.035

Centers for Disease Control and Prevention. (2022). Breastfeeding benefits. https://www.cdc.gov/breastfeeding/features/breastfeeding-benefits.html

Centers for Disease Control and Prevention. (2024a). Breastfeeding among U.S. children born 2014–2021, CDC NIS-Child. https://www.cdc.gov/breastfeeding-data/survey/results.html

10.

Centers for Disease Control and Prevention (2024b). Rates of any and exclusive breastfeeding by socio–demographics among children born in 2021. https://www.cdc.gov/breastfeeding-data/modules/2021-rates-any-exclusive-bf-socio-dem.html

11.

Chaplin

Kelly

Kildea

(2016). Maternal perceptions of breastfeeding difficulty after caesarean section with regional anaesthesia: A qualitative study. Women and Birth, 29(2), 144–152. https://doi.org/10.1016/j.wombi.2015.09.005

12.

Chen

Yan

Gao

Xiang

Zeng

Liu

Sha

(2018). Influences of cesarean delivery on breastfeeding practices and duration: A prospective cohort study. Journal of Human Lactation, 34(3), 526–534. https://doi.org/10.1177/089033441774143

13.

Chen

Cohen

Chen

(2010). How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics—Simulation and Computation, 39(4), 860–864. https://doi.org/10.1080/03610911003650383

14.

Chetwynd

Wasser

Poole

(2019). Breastfeeding support interventions by international board certified lactation consultants: A systemic review and meta-analysis. Journal of Human Lactation, 35(3), 424–440. https://doi.org/10.1177/0890334419851482

15.

Chien

L. Y.

Tai

C. J.

(2007). Effect of delivery method and timing of breastfeeding initiation on breastfeeding outcomes in Taiwan. Birth, 34(2), 123–130. https://doi.org/10.1111/j/1523-536x.2007.00158.x

16.

Coo

García

Mira

Valdés

(2020). The role of perinatal anxiety and depression in breastfeeding practices. Breastfeeding Medicine, 15(8), 495–500. https://doi.org/10.1089/bfm.2020.0091

17.

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.

18.

Daou

Tamim

Nabulsi

(2020). Assessing the impact of professional lactation support frequency, duration and delivery form on exclusive breastfeeding in Lebanese mothers. PLoS One, 15(9), Article e0238735. https://doi.org/10.1371/journal.pone.0238735

19.

Ding

Wen

Chen

Vinturache

Zhang

(2024). Prevalence of exclusive breastfeeding among US children. JAMA Network Open, 7(9), Article e2436644. https://doi.org/10.1001/jamanetworkopen.2024.36644

20.

Eidelman

A. I.

Schanler

R. J.

Johnston

Landers

Noble

Szucs

Viehmann

(2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841. https://doi.org/10.1542/peds.2011-3552

21.

Erbaydar

N. P.

Erbaydar

(2020). Relationship between caesarean section and breastfeeding: Evidence from the 2013 Turkey demographic and health survey. BMC Pregnancy Childbirth, 20(1), 55. https://doi.org/10.1186/s12884-020-2732-6

22.

Flaherman

V. J.

McKean

Caban

M. D.

(2013). Higher birth weight improves rates of exclusive breastfeeding through 3 months. Infant, Child, & Adolescent Nutrition, 5(4), 200–203. https://doi.org/10.1177/1941406413495089

23.

Gavine

Shinwell

S. C.

Buchanan

Farre

Wade

Lynn

Marshall

Cumming

S. E.

Dare

McFadden

(2022). Support for healthy breastfeeding mothers with healthy term babies (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001141.pub6

24.

Gertz

Defranco

(2019). Predictors of breastfeeding non-initiation in the NICU. Maternal & Child Nutrition, 15(3), Article e12797. https://doi.org/10.1111/mcn.12797

25.

Hamilton

B. E.

Martin

J. A.

Osterman

M. J. K.

(2022). Births: Provisional data for 2021 (Vital Statistics Rapid Release, No. 20). National Center for Health Statistics. https://dx-doi-org-s.web.bisu.edu.cn/10.15620/cdc:116027

26.

Hamner

Beauregard

Nelson

Perrine

(2021). Meeting breastfeeding intentions differ by race/ethnicity, Infant and Toddler Feeding Practices Study-2. Maternal & Child Nutrition, 17(2), Article e13093. https://doi.org//10.1111/mcn.13093

27.

Hobbs

A. J.

Mannion

C. A.

McDonald

S. W.

Brockway

Tough

S. C.

(2016). The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth, 16, 90. https://doi.org/10.1186/s12884-016-0876-1

28.

Hoyt-Austin

A. E.

Kair

L. R.

Larson

I. A.

Stehel

E. K.

(2022). Academy of breastfeeding medicine clinical protocol #2: Guidelines for birth hospitalization discharge of breastfeeding dyads, Revised 2022. Breastfeeding Medicine, 17(3), 197–206. https://doi.org/10.1089/bfm.2022.29203.aeh

29.

Huang

Ouyang

Redding

S. R.

(2019). Previous breastfeeding experience and its influence on breastfeeding outcomes in subsequent births: A systematic review. Women and Birth, 32(4), 303–309. https://doi.org/10.1016/j.wombi.2018.09.003

30.

Jalal

Dolatian

Mahmoodi

Aliyari

(2017). The relationship between psychological factors and maternal social support to breastfeeding process. Electronic Physician, 9(1), 3561–3569. https://doi.org/10.19082/3561

31.

Jikijela

T. P.

James

Sonti

B. S. I.

(2018). Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay. Curationis, 41(1), e1–e9. https://doi.org/10.4102/curationis.v41i1.1804

32.

Kay

M. C.

Cholera

Flower

K. B.

Yin

H. S.

Rothman

R. L.

Sanders

L. M.

Delamater

A. M.

Perrin

E. M.

(2020). Are low-income, diverse mothers able to meet breastfeeding intentions after 2 months of breastfeeding? Breastfeeding Medicine, 15(7), 435–442. https://doi.org/10.1089/bfm.2020.0025

33.

Koksal

Acikgoz

Çakirli

(2022). The effect of a father’s support on breastfeeding: A systematic review. Breastfeeding Medicine, 17(9), 711–722. https://doi.org/10.1089/bfm.2022.0058

34.

Kovaric

Cowperthwaite

McDaniel

C. E.

Thompson

(2020). Supporting breastfeeding in infants hospitalized for jaundice. Hospital Pediatrics, 10(6), 502–508. https://doi.org/10.1542/hpeds.2020-0056

35.

Wan

Zhu

(2021). Breastfeeding after a cesarean section: A literature review. Midwifery, 103, 103–117. https://doi.org/10.1016/j.midw.2021.103117

36.

Perrine

Anstey

Chen

MacGowan

Elam-Evans

(2019). Breastfeeding trends by race/ethnicity among US children born from 2009 to 2015. JAMA Pediatrics, 173(12), Article e193319. https://doi.org//10.1001/jamapediatrics.2019.3319

37.

Mallick

Shenassa

(2024). Variation in breastfeeding initiation and duration by mode of childbirth: A prospective, population-based study. Breastfeeding Medicine, 19(4), 262–274. https://doi.org/10.1089/bfm.2023.0180

38.

Maru

Patil

Carroll-Bennett

Baum

Bohn-Hemmerdinger

Ditchik

Scanlon

M. L.

Krishnan

Bogaert

Woodbury

Maru

Noble

Wasserman

Brown

Vreeman

Masci

(2020). Universal screening for SARS-CoV-2 infection among pregnant women at Elmhurst Hospital Center, Queens, New York. PLoS One, 15(12), Article e0238409. https://doi.org/10.1371/journal.pone.0238409

39.

Mercado

Vittner

McGrath

(2019). What is the impact of NICU-dedicated lactation consultants? An evidence-based practice brief. Advances in Neonatal Care, 19(5), 383–393. https://doi.org/10.1097/ANC.0000000000000602

40.

New York State Department of Health. (2025). Breastfeeding disparities report. https://www.health.ny.gov/community/pregnancy/breastfeeding/docs/2025_breastfeeding_disparities_report.pdf

41.

Ogbo

F. A.

Akombi

B. J.

Ahmed

K. Y.

Rwabilimbo

A. G.

Ogbo

A. O.

Uwaibi

N. E.

Ezeh

O. K.

Agho

K. E.

, & On Behalf of the Global Maternal and Child Health Research Collaboration GloMACH. (2020). Breastfeeding in the community—How can partners/fathers help? A systematic review. International Journal of Environmental Research and Public Health, 17(2), Article 413. https://doi.org/10.3390/ijerph17020413

42.

Ogbuanu

Glover

Probst

Liu

Hussey

(2011). The effect of maternity leave length and time or return to work on breastfeeding. Pediatrics, 127(6), e1414–e1427. https://doi.org/10.1542/peds.2010-0459

43.

Patel

(2016). The effectiveness of lactation consultants and lactation counselors on breastfeeding outcomes. Journal of Human Lactation, 32(3), 530–541. https://doi.org/10.1177/0890334415618668

44.

Peahl

A. F.

Howell

J. D.

(2020). The evolution of prenatal care delivery guidelines in the United States. American Journal of Obstetrics and Gynecology, 224(4), Article 339. https://doi.org/10.1016/j.ajog.2020.12.016

45.

Phillips

Brett

Mendola

(2011). Previous breastfeeding practices and duration of exclusive breastfeeding in the United States. Maternal and Child Health Journal, 15(8), 1210–1216. https://doi.org/10.1007/s10995-010-0694-4

46.

Ponnapakkam

A. P.

Stine

C. N.

Ahmad

K. A.

Gallup

M. C.

Delle Donne

A. J.

Kathen

C. M.

Wade

J. K.

Molina

B. C.

Koslow

E. A.

Carr

N. R.

(2020). Evaluating the effects of a neonatal hypoglycemia bundle on NICU admission and exclusive breastfeeding. Journal of Perinatology, 40(2), 344–351. https://doi.org/10.1038/s41372-019-0455-1

47.

Prior

Santhakumaran

Gale

Philipps

L. H.

Modi

Hyde

M. J.

(2012). Breastfeeding after cesarean delivery: A systematic review and meta-analysis of world literature. American Journal of Clinical Nutrition, 95(5), 1113–1135. https://doi.org/10.3945/ajcn.111.030254

48.

Ragusa

Marranzano

La Rosa

V. L.

Giorgianni

Commodari

Quattrocchi

Cacciola

Guardabasso

(2021). Factors influencing uptake of breastfeeding: The role of early promotion in the maternity hospital. International Journal of Environmental Research and Public Health, 18(9), Article 4783. https://doi.org/10.3390/ijerph18094783

49.

Sharma

Chowdhury

Taneja

Mazumder

Bhatia

Ghosh

Karantha

S. C.

Dhabhai

Chellani

Bahl

Bhandari

(2023). Breastfeeding practices based on the gestational age and weight at birth in the first six months of life in a population-based cohort of infants from North India. Frontiers in Pediatrics, 11, Article 1127885. https://doi.org/10.3389/fped.2023.1127885

50.

Sipsma

Jones

Nickel

(2017). Hospital practices to promote breastfeeding: The effect of maternal age. Birth, 44(3), 272–280. https://doi.org/10.1111/birt.12284

51.

Sipsma

Magriples

Divney

Gordon

Gabzdyl

Kershaw

(2019). Breastfeeding behaviors among recent immigrant mothers: A systematic review. Maternal and Child Health Journal, 23(5), 661–674. https://doi.org/10.1007/s10995-018-2665-2

52.

Sokou

Parastatidou

Ioakeimidis

Tavoulari

E. F.

Makrogianni

Isaakidou

Iacovidou

Konstantinidi

(2022). Breastfeeding in neonates admitted to an NICU: 18-month follow-up. Nutrients, 14(18), 3841. https://doi.org/10.3390/nu14183841

53.

Song

J. T.

Kinshella

M. W.

Kawaza

Goldfarb

D. M.

(2023). Neonatal intensive care unit interventions to improve breastfeeding rates at discharge among preterm and low birth weight infants: A systematic review and meta-analysis. Breastfeeding Medicine, 18(2), 97–106. https://doi.org/10.1089/bfm.2022.0151

54.

Spatz

D. L.

Rodríguez

S. Á.

Benjilany

Finderle

von Gartzen

Yates

Brumley

(2024). Having enough milk to sustain a lactation journey: A call to action. Nursing for Women’s Health, 28(4), 256–263. https://doi.org/10.1016/j.nwh.2024.02.007

55.

Standish

Parker

(2022). Social determinants of breastfeeding in the United States. Clinical Therapeutics, 44(2), 186–192. https://doi.org/10.1016/j.clinthera.2021.11.010

56.

Ouyang

(2016). Father’s role in breastfeeding promotion: Lessons from a quasi-experimental trial in China. Breastfeeding Medicine, 11, 144–149. https://doi.org/10.1089/bfm.2015.0144

57.

Tully

K. P.

Ball

H. L.

(2014). Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth. Midwifery, 30(6), 712–719. https://doi.org/10.1016/j.midw.2013.10.014

58.

U.S. Census Bureau. (2023a). American Community Survey 5-year estimates (2018–2022): Selected social characteristics (Table DP02), ZIP Code Tabulation Area 11373 (Elmhurst, NY). https://data.census.gov/cedsci/table?q=11373%20DP02&tid=ACSDP5Y2022.DP02

59.

U.S. Census Bureau. (2023b, August 10). ZIP code tabulation areas (ZCTAs). https://www.census.gov/programs-surveys/geography/guidance/geo-areas/zctas.html

60.

Uscher-Pines

Mehrotra

Bogen

(2017). The emergence and promise of telelactation. American Journal of Obstetrics and Gynecology, 217(2), 176–178.e1. https://doi.org/10.1016/j.ajog.2017.04.043

61.

U.S. Department of Health and Human Services. (2025, January 21). Social determinants of health. Healthy People 2030. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health

62.

Wen

Kong

Liu

Wei

(2020). An exploration of the breastfeeding behaviors of women after cesarean section: A qualitative study. International Journal of Nursing Sciences, 7(4), 419–426. https://doi.org/10.1016/j.ijnss.2020.07.008

63.

Wouk

Chetwynd

Vitaglione

Sullivan

(2017). Improving access to medical lactation support and counseling: Building the case for Medicaid reimbursement. Maternal and Child Health Journal, 21(4), 836–844. https://doi.org/10.1007/s10995-016-2175-x