Racial/Ethnic Variation in Breastfeeding Across the US: A Multilevel Analysis from the National Survey of Children’s Health, 2007

We examined whether differences across states in race/ethnicity-specific breastfeeding rates are due solely to state differences
in individual factors associated with breastfeeding or additionally, certain state “contextual” factors. Using data from the
2007 National Survey of Children’s Health, multilevel models examined whether state variability in race/ethnicity specific
breastfeeding initiation and duration to 6 months were explained by (1) individual sociodemographic characteristics of women
in states, and (2) an aggregate state measure of the availability of evidence-based maternity care services related to breastfeeding.
Observed variability of race/ethnicity-specific breastfeeding rates was only minimally reduced after adjusting for sociodemographic
characteristics (Median Odds Ratios (MOR), breastfeeding initiation: non-Hispanic White = 1.46, non-Hispanic Black = 2.26;
Hispanic = 1.89. MOR, breastfeeding for 6 months: non-Hispanic White = 1.36, non-Hispanic Black = 1.84; Hispanic = 1.56).
Overall variability in the degree of state gaps changed little in adjusted models (breastfeeding initiation: non-Hispanic
Black σ² = 0.74, se 0.28, Hispanic σ² = 0.45, se 0.11; breastfeeding to 6-months: non-Hispanic Black σ² = 0.41, se 0.10, Hispanic σ² = 0.22, se 0.05). The measure of maternity care services was positively associated with breastfeeding overall but generally
did not explain a substantial portion of between-state variability nor the overall variability in racial/ethnic gaps. Contextual
sources of variation in state breastfeeding practices and disparities remain poorly understood. Differences in the socioeconomic
makeup of states do not fully explain variability. The association of state breastfeeding rates and disparities with relevant
policy and practice factors should be further investigated.