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.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
NSFG data are publicly available.
Available upon request.
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. https://doi.org/10.1002/14651858.CD001688.pub3
Beaulieu-Prevost, D., & Fortin, M. (2015). The measurement of sexual orientation: Historical background and current practices. Sexologies, 24(1), e15–e19. https://doi.org/10.1016/j.sexol.2014.05.006
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. https://doi.org/10.1177/0886260515605298
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. https://doi.org/10.1016/j.jpeds.2018.04.039
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. https://doi.org/10.1089/bfm.2014.0078
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. https://doi.org/10.1001/archpedi.159.3.255
Centers for Disease Control and Prevention. (2018). National Survey of Family Growth—Questionnaires, Datasets, and Related Documentation. https://www.cdc.gov/nchs/nsfg/nsfg_questionnaires.htm
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. https://doi.org/10.1016/j.whi.2019.10.007
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. https://doi.org/10.1136/jech-2017-209860
Dilmaghani, M. (2018). Sexual orientation, labour earnings, and household income in Canada. Journal of Labor Research, 39(1), 41–55. https://doi.org/10.1007/s12122-017-9249-4
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. https://doi.org/10.1007/s11113-013-9282-9
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. https://doi.org/10.1363/psrh.12032
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. https://doi.org/10.1007/s10995-018-2595-x
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. https://doi.org/10.1111/jomf.12656
Goldberg, A. E., Gartrell, N. K., & Gates, G. (2014). Research report on LGB-parent families (pp. 57–88). The Williams Institute. https://doi.org/10.1016/B978-0-12-800285-8.00003-0
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. https://doi.org/10.1016/j.whi.2018.10.006
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. https://doi.org/10.1089/bfm.2014.0119
Hatzenbuehler, M. L. (2014). Structural stigma and the health of lesbian, gay, and bisexual populations. Current Directions in Psychological Science, 23(2), 127–132. https://doi.org/10.1177/0963721414523775
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. https://doi.org/10.2105/AJPH.2012.301069
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. https://doi.org/10.1177/003335490612100111
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. https://doi.org/10.1016/j.amepre.2015.11.016
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. https://doi.org/10.1016/j.socscimed.2015.11.010
Keddem, S., Frasso, R., Dichter, M., & Hanlon, A. (2018). The association between pregnancy intention and breastfeeding. Journal of Human Lactation, 34(1), 97–105. https://doi.org/10.1177/0890334417725032
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. https://doi.org/10.1542/peds.2015-2388
Mirkovic, K. R., Perrine, C. G., & Scanlon, K. S. (2016). Paid maternity leave and breastfeeding outcomes. Birth, 43(3), 233–239. https://doi.org/10.1111/birt.12230
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. https://doi.org/10.17269/cjph.104.3803
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.
Reczek, C. (2020). Sexual- and gender-minority families: A 2010 to 2020 decade in review. Journal of Marriage and Family, 82(1), 300–325. https://doi.org/10.1111/jomf.12607
Thulier, D., & Mercer, J. (2009). Variables associated with breastfeeding duration. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(3), 259–268. https://doi.org/10.1111/j.1552-6909.2009.01021.x
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. https://doi.org/10.1007/s10995-016-2139-1
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. https://doi.org/10.1080/00224499.2016.1255872
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. https://doi.org/10.1097/NMC.0000000000000264
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. https://doi.org/10.1111/j.1523-536X.2010.00421
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.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was exempt from IRB review because it used secondary, publicly available NSFG data.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
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). https://doi.org/10.1007/s10995-021-03218-z
- Sexual minority women
- Infant health
- Sexual orientation
- Health disparities