For many years, since we have been keeping track of breastfeeding rates in the USA, we’ve known that certain racial/ethnic groups have higher breastfeeding rates than others. We also know that mothers and babies who breastfeed have better health outcomes compared to those who have not breastfed. This research team simulated populations in order to compare health outcomes between non-Hispanic Blacks, non-Hispanic Whites, and Hispanics, based on their breastfeeding rates.
J Pediatr. 2016 Nov 10. pii: S0022-3476(16)31096-4. doi: 10.1016/j.jpeds.2016.10.028. [Epub ahead of print]
Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs
Bartick MC1, Jegier BJ2, Green BD3, Schwarz EB4, Reinhold AG5, Stuebe AM6.
Read Abstract at PubMed
Abstract
OBJECTIVE:
To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs).
STUDY DESIGN:
Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration.
RESULTS:
Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9).
CONCLUSIONS:
Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.
This is a first-of-its kind study, modeling health consequences of lower breastfeeding rates among Black and Hispanic populations. In addition to higher rates of disease, the costs of medical care were calculated to be higher among Black and Hispanic dyads as compared to White dyads, based on lower breastfeeding rates. The authors point out that increased rates of illness in infants often leads to more missed days at work for the mother. Black and Hispanic women are more likely to have lower-paying jobs, thus at higher risk for economic hardship when missing work as compared to women with higher paying jobs.
One dilemma is that women working in lower paying jobs often have less autonomy and flexibility at work, which means that they might have a harder time taking pump breaks at work, or affording a high quality double electric pump to maintain lactation. In addition, many women who earn low wages work more than 1 job, leading to more time away from the infant, and more difficulty sustaining lactation.
Simply improving breastfeeding initiation among Black and Hispanic dyads will not be enough to decrease the health and medical cost disparities calculated in this study. We have a long way to go to improve educational opportunities for minority families, so that they are in positions of greater economic control. Until we decrease the disparity in educational opportunities and wages between racial groups, we will continue to see disparity in breastfeeding rates, maternal child disease and health care costs.