Skip to main content

Breastfeeding Initiation and Continuation Among Sexual Minority Women



Identify disparities in breastfeeding initiation and continuation among sexual minority women (SMW) and determine if known risk factors explain any observed disparities.


We used data from the 2006 to 2017 National Survey of Family Growth female pregnancy questionnaire. We measured sexual orientation using self-reported sexual identity and histories of same-sex sexual experiences reported by women (heterosexual-WSM [women who only reported sex with men]; heterosexual-WSW [women who reported sex with women]; bisexual, and lesbian. In total, we had 18,696 births that occurred within the last 10 years and used logistic and multinomial regression models to assess sexual orientation disparities in breastfeeding initiation and duration that clustered on women to account for potential multiple births to a woman.


Compared to heterosexual-WSM, infants born to lesbian-identified women had decreased odds of ever being breastfed (OR 0.55, 95% CI 0.30, 0.99) and a decreased relative risk of being breastfed more than 6 months (RRR 0.46, 95% CI 0.22, 0.97). Infants of heterosexual-WSW had an increased odds of ever breastfeeding (OR 1.40, 95% CI 1.12, 1.74) and increased relative risk of breastfeeding more than 6 months (RRR 1.32, 95% CI 1.02, 1.69).


Our results show that infants born to lesbian-identified women were less likely to be breastfed than those born to their heterosexual counterparts, even after adjusting for several factors associated with breastfeeding behaviors. We found no differences in breastfeeding between bisexual women and heterosexual-WSM. Understanding and addressing the barriers sexual minority women face for breastfeeding is critical for ensuring maternal and child health equity.

This is a preview of subscription content, access via your institution.

Data Availability

NSFG data are publicly available.

Code Availability

Available upon request.


  1. Balogun, O. O., O’Sullivan, E. J., McFadden, A., Ota, E., Gavine, A., Garner, C. D., Renfrew, M. J., & MacGillivray, S. (2016). Interventions for promoting the initiation of breastfeeding. Cochrane Database, 11, CD001688.

    Article  Google Scholar 

  2. Beaulieu-Prevost, D., & Fortin, M. (2015). The measurement of sexual orientation: Historical background and current practices. Sexologies, 24(1), e15–e19.

    Article  Google Scholar 

  3. Burks, A. C., Cramer, R. J., Henderson, C. E., Stroud, C. H., Crosby, J. W., & Graham, J. (2018). Frequency, nature, and correlates of hate crime victimization experiences in an urban sample of lesbian, gay, and bisexual community members. Journal of Interpersonal Violence, 33(3), 402–420.

    Article  PubMed  Google Scholar 

  4. Campbell, A. G., & Miranda, P. Y. (2018). Breastfeeding trends among very low birth weight, low birth weight, and normal birth weight infants. Journal of Pediatrics, 200, 71–78.

    Article  Google Scholar 

  5. Castelli, C., Perrin, J., Thirion, X., Comte, F., Gamerre, M., & Courbiere, B. (2015). Maternal factors influencing the decision to breastfeed newborns conceived with IVF. Breastfeeding Medicine, 10(1), 26–30.

    Article  PubMed  Google Scholar 

  6. Celi, A. C., Rich-Edwards, J. W., Richardson, M. K., Kleinman, K. P., & Gillman, M. W. (2005). Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation. Archives of Pediatrics & Adolescent Medicine, 159(3), 255–260.

    Article  Google Scholar 

  7. Centers for Disease Control and Prevention. (2018). National Survey of Family Growth—Questionnaires, Datasets, and Related Documentation.

  8. Charlton, B. M., Everett, B. G., Light, A., Jones, R. K., Janiak, E., Gaskins, A. J., Chavarro, J. E., Moseson, H., Sarda, V., & Austin, S. B. (2019). Sexual orientation differences in pregnancy and abortion across the lifecourse. Women’s Health Issues, 30(2), 65–72.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Conron, K. J., Goldberg, S. K., & Halpern, C. T. (2018). Sexual orientation and sex differences in socioeconomic status: A population-based investigation in the National Longitudinal Study of Adolescent to Adult Health. Journal of Epidemiology and Community Health, 72(11), 1016–1026.

    Article  PubMed  Google Scholar 

  10. Dilmaghani, M. (2018). Sexual orientation, labour earnings, and household income in Canada. Journal of Labor Research, 39(1), 41–55.

    Article  Google Scholar 

  11. Everett, B. G., & Mollborn, S. (2014). Examining sexual orientation disparities in unmet medical needs among men and women. Population Research and Policy Review, 33(4), 553–577.

    Article  PubMed  Google Scholar 

  12. Everett, B. G., McCabe, K. F., & Hughes, T. L. (2017). Sexual orientation disparities in mistimed and unwanted pregnancy among adult women. Perspectives on Sexual and Reproductive Health, 49(3), 157–165.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Everett, B. G., Kominiarek, M. A., Mollborn, S., Adkins, D. E., & Hughes, T. L. (2019). Sexual orientation disparities in pregnancy and infant outcomes. Maternal and Child Health Journal, 23(1), 72–81.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Everett, B. G., Mollborn, S., Jenkins, V., Limburg, A., & Diamond, L. M. (2020). Racial/ethnic differences in unwanted births: Moderation by sexual orientation. Journal of Marriage and Family, 82(4), 1234–1249.

    Article  PubMed  Google Scholar 

  15. Goldberg, A. E., Gartrell, N. K., & Gates, G. (2014). Research report on LGB-parent families (pp. 57–88). The Williams Institute.

    Book  Google Scholar 

  16. Gonzales, G., Quinones, N., & Attanasio, L. (2019). Health and access to care among reproductive-age women by sexual orientation and pregnancy status. Women’s Health Issues, 29(1), 8–16.

    Article  PubMed  Google Scholar 

  17. Hackman, N. M., Schaefer, E. W., Beiler, J. S., Rose, C. M., & Paul, I. M. (2014). Breastfeeding outcome comparison by parity. Breastfeeding Medicine, 10(3), 156–162.

    Article  PubMed  Google Scholar 

  18. Hatzenbuehler, M. L. (2014). Structural stigma and the health of lesbian, gay, and bisexual populations. Current Directions in Psychological Science, 23(2), 127–132.

    Article  Google Scholar 

  19. Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Heck, K. E., Braveman, P., Cubbin, C., Chávez, G. F., & Kiely, J. L. (2006). Socioeconomic status and breastfeeding initiation among California mothers. Public Health Reports, 121(1), 51–59.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hsieh, N., & Ruther, M. (2016). Sexual minority health and health risk factors: Intersection effects of gender, race, and sexual identity. American Journal of Preventive Medicine, 50(6), 746–755.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hughto, J. M. W., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health. A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222–231.

    Article  Google Scholar 

  23. Keddem, S., Frasso, R., Dichter, M., & Hanlon, A. (2018). The association between pregnancy intention and breastfeeding. Journal of Human Lactation, 34(1), 97–105.

    Article  PubMed  Google Scholar 

  24. McKinney, C. O., Hahn-Holbrook, J., Chase-Lansdale, P. L., Ramey, S. L., Krohn, J., Reed-Vance, M., Raju, T. N. K., Shalowitz, M. U., & Network, on behalf of the C. C. H. R. (2016). Racial and ethnic differences in breastfeeding. Pediatrics, 138(2), e20152388.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mirkovic, K. R., Perrine, C. G., & Scanlon, K. S. (2016). Paid maternity leave and breastfeeding outcomes. Birth, 43(3), 233–239.

    Article  PubMed  Google Scholar 

  26. Nagulesapillai, T., McDonald, S., Fenton, T., Mercader, H., & Tough, S. (2013). Breastfeeding difficulties and exclusivity among late preterm and term infants: Results from the All Our Babies study. Canadian Journal of Public Health, 104(4), e351–e356.

    Article  PubMed  PubMed Central  Google Scholar 

  27. National Research Council. (2011). The health of lesbian, gay, bisexual and transgender people: Building a foundation for better understanding. Washington, DC: Institute of Medicine, 10, 13128.

    Google Scholar 

  28. Reczek, C. (2020). Sexual- and gender-minority families: A 2010 to 2020 decade in review. Journal of Marriage and Family, 82(1), 300–325.

    Article  PubMed  Google Scholar 

  29. Thulier, D., & Mercer, J. (2009). Variables associated with breastfeeding duration. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(3), 259–268.

    Article  Google Scholar 

  30. Wallenborn, J. T., Masho, S. W., & Ratliff, S. (2017). Paternal pregnancy intention and breastfeeding duration: Findings from the National Survey of Family Growth. Maternal and Child Health Journal, 21(3), 554–561.

    Article  PubMed  Google Scholar 

  31. Wolff, M., Wells, B., Ventura-DiPersia, C., Renson, A., & Grov, C. (2017). Measuring sexual orientation: A review and critique of U.S. data collection efforts and implications for health policy. Annual Review of Sex Research Special Issues, 54(4–5), 507–531.

    Article  Google Scholar 

  32. Wood, N. K., Woods, N. F., Blackburn, S. T., & Sanders, E. (2016). Interventions that enhance breastfeeding initiation, duration, and exclusivity. The American Journal of Maternal/Child Nursing, 41(5), 299–307.

    Article  Google Scholar 

  33. Zanardo, V., Svegliado, G., Cavallin, F., Giustardi, A., Cosmi, E., Litta, P., & Trevisanuto, D. (2010). Elective cesarean delivery: Does it have a negative effect on breastfeeding? Birth, 37(4), 275–279.

    Article  PubMed  Google Scholar 

Download references


Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD091405 and the University of Colorado Population Center (Grant R24 HD066613) through administrative and computing support.

Author information




The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Corresponding author

Correspondence to Virginia Jenkins.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was exempt from IRB review because it used secondary, publicly available NSFG data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jenkins, V., Everett, B.G., Steadman, M. et al. Breastfeeding Initiation and Continuation Among Sexual Minority Women. Matern Child Health J 25, 1757–1765 (2021).

Download citation


  • Breastfeeding
  • Sexual minority women
  • NSFG
  • Infant health
  • Sexual orientation
  • Health disparities