Abstract
We conduct a comparative analysis of breastfeeding behavior between military and civilian-affiliated mothers. Our focus is on African American mothers among whom breastfeeding rates are lowest. The military context may mitigate conditions associated with low breastfeeding prevalence by (a) providing stable employment and educational opportunities to populations who face an otherwise poor labor market and (b) providing universal healthcare that includes breastfeeding consultation. Using pregnancy risk assessment monitoring system (PRAMS) data for which we received special permission from each state to flag military affiliation, we analyze civilians and military affiliate in breastfeeding initiation using logistic regression and breastfeeding duration using Cox proportional hazard analysis. We find that breastfeeding is more prevalent among all women in the military setting and that the black–white gap in breastfeeding duration common among civilians is significantly reduced among military affiliates. Breastfeeding is a crucial component of maternal and child health and eliminating racial disparities in its prevalence is a public health priority. This study is the first to identify the military as an important institutional context that deserves closer examination to glean potential policy implications for civilian society.
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Notes
We were unable to identify whether women still had military insurance as of the survey date using the well baby care insurance variable because it was not included in phase 5 and had substantial missing values in phases 3 and 4. We were, however, able to determine the opposite scenario, where women had military insurance for their prenatal care but were no longer affiliated with the military at birth. This affected 279 women. In separate analyses using a dummy for previous military affiliation, we found no significant relationship to the breastfeeding outcomes analyzed in this paper.
Each 4-, 8-, and 16-week period measurement in the figure excludes individuals for whom no data was available because they received the survey before their infant was that old. In the multivariate analyses we account for these individuals using right censorship.
A larger percentage of Asians in the military are Filipino compared to in the civilian population [28] and this is also the case in our data. While we can only speculate, recent research has shown that infant formula lobbying in the Philippines has been linked to lowered breastfeeding rates among Filipino women [29].
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Acknowledgments
We acknowledge grant funding from NSF (SES-0751505). Jennifer Lundquist is the PI on this grant. We would like to thank Jessica Looze for her contribution to this project.
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Lundquist, J., Xu, Z., Barfield, W. et al. Do Black–White Racial Disparities in Breastfeeding Persist in the Military Community?. Matern Child Health J 19, 419–427 (2015). https://doi.org/10.1007/s10995-014-1524-x
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DOI: https://doi.org/10.1007/s10995-014-1524-x