Black infants had over twice the deaths of whites attributable to lack of optimal breastfeeding, a new study published in the Journal of Pediatrics shows. Black infants also had over three times the rate of necrotizing enterocolitis, a devastating disease of preterm infants, attributable to suboptimal rates of feeding with their mother’s own milk.
It is recommended that women breastfeed each child exclusively for the first six months of life, followed by continued breastfeeding while complementary foods are introduced for at least the first year of life. The authors defined this practice as “optimal breastfeeding.” They defined breastfeeding for a shorter period of time as "suboptimal breastfeeding." White women initiate breastfeeding at much higher rates than black women and slightly higher rates than Hispanic women; moreover, white women breastfeed longer and have higher rates of exclusive breastfeeding. This is the first study to show how these disparities translate into differences in health outcomes.
Two common diseases of infancy merit particular concern for black and Hispanic infants: ear infections and gastrointestinal infections. Compared with white infants, ear infections due to suboptimal breastfeeding were 1.7 times more common in black infants and 1.4 times as common in Hispanics; gastrointestinal infections due to suboptimal breastfeeding were about 1.3-1.4 times as common among both black and Hispanic infants.
Ear infections and gastrointestinal infections can translate into significant economic insecurity for parents who must miss work to care for sick children; that's important because Department of Labor statistics show that black and Hispanic mothers are more likely to be heads of households and to have low-wage jobs that lack paid sick leave.
“If mom can’t go to work, she’s not getting paid. This may spell the difference between making rent that month, keeping the lights on or paying for basic needs,” said lead author Melissa Bartick, assistant professor of medicine at Cambridge Health Alliance and Harvard Medical School. “When I first saw our results, I cried.”
The study also found differences in maternal health outcomes as a result of suboptimal breastfeeding. For both hypertension and type 2 diabetes, there was a 1.4-fold higher rate for black women attributable to suboptimal breastfeeding, compared with white women.
"These lives matter,” said study co-author Eleanor Bimla Schwarz, professor of general medicine at UC Davis Health System. “Breastfeeding mothers need our full support as a community, both in initiating and sustaining breastfeeding.”
The researchers used computer modeling to simulate hypothetical cohorts of black, white and Hispanic women and the children they bore, based on current literature linking disease risk and breastfeeding.
The study, titled “Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs,” is available online. The work was funded by the W.K. Kellogg Foundation.
In addition to Bartick and Bimla Schwarz, study authors were Briana Jegier of D'Youville College in Buffalo, Brittany Green of the University of Cincinnati, Arnold Reinhold of the Alliance for the Prudent Use of Antibiotics in Boston and Alison Stuebe of the University of North Carolina.
For more information about UC Davis Health System, visit healthsystem.ucdavis.edu.