Abstract
Breastfeeding disparities before and during the COVID-19 pandemic: Race, maternal age, and insurance type
APHA 2022 Annual Meeting and Expo
Although the World Health Organization recommends exclusive breastfeeding for at least six months after birth, there are well-documented disparities in rates of continued breastfeeding. Existing research regarding breastfeeding during COVID-19 has raised concerns that the pandemic may have further exacerbated these disparities. The present study aimed to assess disparities in breastfeeding before and during the COVID-19 pandemic; specifically, this study examined demographics that have been associated with disproportionate burdens during the pandemic, such as race and insurance type. Participants included individuals who gave birth in one of 8 medical centers across North Carolina from either September 1st, 2019, to October 31st, 2019 (pre-COVID: n = 1,252) or from April 1st, 2020, to May 31st, 2020, (during COVID: n = 1,318), and who reported whether they were breastfeeding at either a three-month or six-month postnatal follow-up (N = 2,570). Survival analyses utilizing Kaplan-Meier curves and Cox regression models assessed time to breastfeeding cessation. Overall, individuals were followed for an average of 181 days after giving birth (range: 60 – 212 days). Of the 1,170 individuals who responded at three-month follow-up, 67% reported continued breastfeeding; 2,280 individuals responded at six-month follow-up, and 49% reported continued breastfeeding at this time point. Across all individuals, being Black, younger maternal age, and not having commercial insurance were all independently associated with lower rates of continued breastfeeding at both three-month and six-month follow-up (all p < .05). These disparities were consistent across all time points and did not interact with the presence of the COVID-19 pandemic (being Black: p = .07; maternal age: p = .89; having commercial insurance: p = .41). The present results contradict previous concerns that the COVID-19 pandemic might have exacerbated breastfeeding disparities, but nevertheless, these findings also highlight the continued need to eliminate existing gaps.