Associations Between Maternity Care Practices and 2-Month Breastfeeding Duration Vary by Race, Ethnicity, and Acculturation

  • Rachel A. SebastianEmail author
  • Eirian Coronado
  • Maria D. Otero
  • Courtney R. McKinney
  • Mary M. Ramos


Objectives This study examines the associations between specific maternity care practices and breastfeeding duration for Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White women. Methods We analyzed data from the 2012–2014 New Mexico Pregnancy Risk Assessment Monitoring System. We used survey language as a proxy measure of acculturation and categorized women as Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White. We conducted bivariate analyses to compare rates of breastfeeding at 2 months and experiences of maternity care practices and logistic regression analysis to estimate the effects of these practices on breastfeeding duration for each group. Results Hispanic women were less likely than non-Hispanic women to breastfeed for at least 2 months (67.9% vs. 76.6%; p = 0.000); however, this varied significantly by acculturation level: 78.1% of Spanish-speaking Hispanic women compared to 66.1% of English-speaking Hispanic women breastfed for at least 2 months (p = 0.000). The effects of specific maternity care practices on duration varied across groups. Among non-Hispanic White, Native American, and English-speaking Hispanic women, breastfeeding while at the hospital had the strongest effect (AOR 2.09, 95% CI 1.67–2.61; AOR 2.71, 95% CI 2.08–3.52; and AOR 1.99, 95% CI 1.76–2.25, respectively). Among Spanish-speaking Hispanic women, being encouraged to breastfeed on demand had the strongest effect (AOR 5.179, 95% CI 3.86–6.94). Conclusions for Practice The effects of maternity care practices on breastfeeding duration vary by race, ethnicity, and acculturation level. Health care systems must acknowledge the diversity of their patient populations when seeking to develop and implement breastfeeding-friendly practices.


Breastfeeding duration Race and ethnicity Acculturation Maternity care practices Baby-Friendly Hospital Initiative 



The study was supported by W.K. Kellogg Foundation (Grant No. P3034276) and New Mexico Human Services Department (Grant No. 14-630-8000-0008 A2).


  1. AAP. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e826–e841.CrossRefGoogle Scholar
  2. Ahluwalia, I. B., D’Angelo, D., Morrow, B., & McDonald, J. A. (2012). Association between acculturation and breastfeeding among hispanic women: Data from the Pregnancy Risk Assessment and Monitoring System. Journal of Human Lactation, 28(2), 167–173.CrossRefGoogle Scholar
  3. Ahluwalia, I. B., Morrow, B., D’Angelo, D., & Li, R. (2012). Maternity care practices and breastfeeding experiences of women in different racial and ethnic groups: Pregnancy Risk Assessment and Monitoring System (PRAMS). Maternal and Child Health Journal, 16, 1672–1678.CrossRefGoogle Scholar
  4. Anstey, E. H., Chen, J., Elam-Evans, L. D., & Perrine, C. G. (2017). Racial and geographic differences in breastfeedingUnited States, 2011–2015. Retrieved November 14, 2017 from
  5. CDC. (2017). CDC National Immunization Survey: Breastfeeding among US children born 2002–2013. Retrieved May 3, 2017 from
  6. CDC PRAMS. Retrieved November 14, 2017 from
  7. Chantry, C. J., Dewey, K. G., Peerson, J. M., Wagner, E. A., & Nommsen-Rivers, L. A. (2014). In-hospital formula use increases early breastfeeding Cessation among first-time mothers intending to exclusively breastfeed. Journal of Pediatrics, 164(6), 1339–1345.CrossRefGoogle Scholar
  8. Chapman, D. J., & Perez-Escamilla, R. (2013). Acculturative type is associated with breastfeeding duration among low-income Latinas. Maternal and Child Nutrition, 9, 188–198.CrossRefGoogle Scholar
  9. Gibson, M. V., Diaz, V. A., Mainous, A. G., & Geesey, M. E. (2005). Prevalence of breastfeeding and acculturation in Hispanics: Results from NHANES 1999–2000 study. Birth, 32(2), 93–98.CrossRefGoogle Scholar
  10. Gill, S. L. (2009). Breastfeeding by Hispanic women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(2), 244–252.CrossRefGoogle Scholar
  11. Gorman, J. R., Madlensky, L., Jackson, D. J., Ganiats, T. G., & Boies, E. (2007). Early postpartum breastfeeding and acculturation among Hispanic women. Birth, 34(4), 308–315.CrossRefGoogle Scholar
  12. Harley, K., Stamm, N. L., & Eskenazi, B. (2007). The effect of time in the U.S. on the duration of breastfeeding in women of Mexican descent. Maternal and Child Health Journal, 11(2), 119–125.CrossRefGoogle Scholar
  13. Hawkins, S. S., Gillman, M. W., Shafer, E. F., & Cohen, B. B. (2014). Acculturation and maternal health behaviors: Findings from the Massachusetts birth certificate. American Journal of Preventive Medicine, 47(2), 150–159.CrossRefGoogle Scholar
  14. Healthy People 2020. Maternal, infant, and child health objectives. Retrieved September 21, 2017 from
  15. Henninger, M. L., Irving, S. A., Kauffman, T. L., Kurosky, S. K., Rompala, K., Thompson, M. G., … Naleway, A. L. (2017). Predictors of breastfeeding initiation and maintenance in an Integrated Healthcare setting. Journal of Human Lactation, 33(2), 256–266.CrossRefGoogle Scholar
  16. IBM Corp. (2015). IBM SPSS statistics for Windows (Version 23.0). Armonk: IBM Corp.Google Scholar
  17. Ip, S., Chung, M., Ramen, G., Chew, P., Magula, N., DeVine, D., … Lau, J. (2007). Breastfeeding and maternal and child health outcomes in developed countries. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  18. Jones, J. R., Kogan, M. D., Singh, G. K., Dee, D. L., & Grummer-Strawn, L. M. (2011). Factors associated with exclusive breastfeeding in the United States. Pediatrics, 128(6), 1117–1125.CrossRefGoogle Scholar
  19. Li, R., Darling, N., Maurice, E., Barker, L., & Grummer-Strawn, L. M. (2005). Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 National Immunization Survey. Pediatrics, 115(1), e31–e37.Google Scholar
  20. Lind, J. N., Perrine, C. G., Li, R., Scanlon, K. S., & Grummer-Strawn, L. M. (2014). Racial disparities in access to maternity care practices that support breastfeedingUnited States, 2011. Retrieved October 12, 2017 from
  21. McKinney, C. O., Hahn-Holbrook, J., Chase-Lansdale, P. L., Ramey, S. L., Krohn, J., Reed-Vance, M., … Shalowitz, M. U. (2016). Racial and ethnic differences in breastfeeding. Pediatrics, 138(2), 1–11.CrossRefGoogle Scholar
  22. Merewood, A., Brooks, D., Bauchner, H., MacAuley, L., & Mehta, S. D. (2006). Maternal birthplace and breastfeeding initiation among term and preterm infants: A statewide assessment for Massachusetts. Pediatrics, 118(4), e1048–e1054.CrossRefGoogle Scholar
  23. New Mexico PRAMS. Retrieved November 14, 2017 from
  24. Petrova, A., Hegyi, T., & Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with in-hospital feeding modality. Breastfeeding Medicine, 2(2), 92–98.CrossRefGoogle Scholar
  25. Singh, G. K., Kogan, M. D., & Dee, D. L. (2007). Nativity/immigrant status, race/ethnicity, and socioeconomic determinants of breastfeeding initiation and duration in the United States, 2003. Pediatrics, 119(Supplement 1), S38–S46.CrossRefGoogle Scholar
  26. Sparks, P. J. (2011). Racial/ethnic differences in breastfeeding duration among WIC-eligible families. Women’s Health Issues, 21(5), 374–382.CrossRefGoogle Scholar
  27. Sussner, K. M., Lindsay, A. C., & Peterson, K. E. (2008). the influence of acculturation on breast-feeding initiation and duration in low-income women in the US. Journal of Biosocial Science, 40(5), 673–696.CrossRefGoogle Scholar
  28. Sutherland, T., Pierce, C. B., Blomquist, J. L., & Handa, V. L. (2012). Breastfeeding practices among first-time mothers and across multiple pregnancies. Maternal and Child Health Journal, 16(8), 1665–1671.CrossRefGoogle Scholar
  29. Wambach, K., Domian, E. W., Page-Goertz, S., Wurtz, H., & Hoffman, K. (2016). Exclusive breastfeeding experiences among Mexican American women. Journal of Human Lactation, 32(1), 103–111.CrossRefGoogle Scholar
  30. WHO/UNICEF. (1989). Protecting, promoting, and supporting breastfeeding: The special role of maternity services. Geneva: World Health Organization.Google Scholar
  31. WHO/UNICEF. (1998). Evidence for the ten steps to successful breastfeeding. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rachel A. Sebastian
    • 1
    Email author
  • Eirian Coronado
    • 2
  • Maria D. Otero
    • 3
  • Courtney R. McKinney
    • 4
  • Mary M. Ramos
    • 5
  1. 1.Child Policy Research Consulting, LLCFort WrightUSA
  2. 2.New Mexico Department of HealthSanta FeUSA
  3. 3.Nuestra Salud, LLCAlbuquerqueUSA
  4. 4.Department of PediatricsUniversity of New Mexico School of MedicineAlbuquerqueUSA
  5. 5.Division of Adolescent Medicine, Department of PediatricsUniversity of New Mexico School of MedicineAlbuquerqueUSA

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