Immigrant women participating in a multisite, longitudinal study were more likely than their U.S.-born counterparts to breast-feed, but the longer foreign-born women lived in the United States, the less likely they were to breast-feed.1 Similar associations were found between fathers' place of birth and the odds that an infant was breast-fed. In addition, the findings partly contradict the so-called Hispanic paradox—the well-documented observation that Hispanics tend to have unexpectedly good health outcomes, given their socioeconomic status—in that U.S.- born Hispanics breast-fed at rates similar to those among U.S.-born non-Hispanics.
The data came from a survey conducted among women who gave birth in 1998–2000 at 75 hospitals in 15 states and the fathers of their infants. To examine immigration status and ethnicity as determinants of breast- feeding, analysts used information collected from 4,207 mothers and 3,013 fathers just after the birth and in follow-up interviews about a year later. They used logistic regression to identify characteristics associated with the likelihood that a woman had breast-fed the infant at all and, if she had, whether she had done so for at least six months.
At baseline, women in the sample were 25 years old, on average; the majority were single, had at least a high school education and had been employed at some time during the year preceding the birth. Twenty-seven percent were Hispanic, 22% were white and 47% were black; 15% said that their baby's father was not of their race. Eight in 10 of the women were U.S.-born; immigrants had lived in the United States for an average of almost 10 years. For 39% of the women, this birth was their first; overall, 82% had seen a physician during the first trimester of pregnancy, and 19% had smoked while pregnant. Nine percent had had a low-birth-weight infant. Fifty-seven percent of the women breast-fed at all during the follow-up period; 36% of this group breast-fed for at least six months. The fathers in the sample were, on average, 28 years old at baseline; two-thirds had a high school or higher education.
The first set of multivariate analyses indicated that U.S.-born women were significantly less likely than immigrants to breast-feed at all (odds ratio, 0.2) and to do so for six months or more (0.3). Furthermore, for every year that an immigrant woman lived in the United States, her odds of breast-feeding declined by 4% and her odds of doing so for at least six months declined by 3%. White and Hispanic women did not differ on either breast-feeding measure; blacks, however, were significantly less likely than Hispanics to breast-feed at all.
Other findings were consistent with results of earlier research. The odds of breast-feeding were elevated for women having a first birth; those who had, or whose baby's father had, more than a high school education; and those who had visited a physician during the first trimester of pregnancy. Single women and smokers had reduced odds of breast-feeding, and the likelihood of breast-feeding declined as maternal age increased. The likelihood of breast-feeding for at least six months was similarly associated with marital status, mother's education and smoking; however, first-time mothers had reduced odds of breast-feeding for six months or more, as did women whose infant had a low birth weight.
A second set of regression analyses, controlling for fathers' place of birth rather than mothers', indicated that infants whose fathers were U.S.-born were less likely than others to be breast-fed (odds ratio, 0.2) and to be breast-fed for six months or more (0.5). For each year that a foreign-born man had lived in the United States, his baby's odds of being breast-fed at all and for at least six months were reduced (by 5% and 2%, respectively).
In an examination of breast-feeding rates (adjusted for all of the characteristics included in the multivariate analysis), the analysts found that 89% of immigrants and 52% of U.S.-born women breast-fed at all; within each group, rates among Mexicans, other Hispanics and non-Hispanics were statistically indistinguishable. Overall, 54% of foreign-born and 30% of U.S.-born women who breast-fed did so for at least six months, and these rates varied by ethnicity: Among immigrants, non-Hispanics had a significantly lower rate (40%) than either Hispanic group (59% for each); among U.S.-born women, non-Hispanics (32%) had a significantly higher rate than non-Mexican Hispanics (21%).
The analysts acknowledge that their data do not permit them to identify causal mechanisms underlying the differences they found in breast-feeding behaviors, which they suspect are attributable to differences in cultural norms. However, they conclude that their findings leave no doubt "that [two] populations, Hispanics born in the United States and fathers, should not be overlooked in breast- feeding promotion efforts."—D. Hollander
REFERENCE
1. Gibson-Davis CM and Brooks-Gunn J, Couples' immigration status and ethnicity as determinants of breastfeeding, American Journal of Public Health, 2006, 96(4): 641–646.