A nationwide analysis led by University of California, Riverside professor Tony Grubesic reveals significant geographic disparities in breastfeeding initiation rates across the United States, according to a July 20 report. The study, published July 15 in PLOS Global Public Health, suggests that locally tailored infant health strategies may be more effective than national efforts.
The research found that race, education level, and whether residents live in urban or rural communities consistently influence breastfeeding initiation rates. However, local conditions such as disability rates, the number of female-headed households, and women's participation in the workforce also played important roles. These factors created distinct geographic pockets where breastfeeding initiation rates differed from surrounding areas.
The mapping of these patterns could help public health officials allocate resources more effectively. The study identified many communities across Appalachia and the Gulf Coast as priorities for additional support, while counties in California, the Pacific Northwest, and the Northeast generally reported higher breastfeeding initiation rates.
Breastfeeding initiation refers to whether a newborn receives breast milk before leaving the birth facility. Health experts say this practice improves infant health by reducing risks of infant mortality and chronic diseases for both infants and mothers.
The study recommends strategies such as increasing access to lactation consultants in hospitals, supporting groups like La Leche League, and expanding eligibility for federal nutrition programs by removing income restrictions for mothers seeking breastfeeding support. Grubesic said national averages conceal important local differences: "By providing a comprehensive county-level analysis, this manuscript deepens our understanding of the structural and geographic barriers to breastfeeding initiation, which remains one of the most effective preventive health measures for reducing infant mortality and protecting mothers against chronic diseases," he added. "Furthermore, the study demonstrates that applying advanced spatial statistical modeling significantly outperforms traditional statistical methods, offering public health officials a precise data-driven roadmap for deploying cost-effective community interventions where they are needed most."
Researchers analyzed data from approximately 95.8% of U.S. counties using CDC data combined with California newborn screening information from infants born in 2018 and 2019. They found county-level variation ranging from about 22% to over 90%. Instead of conventional methods assuming uniform influences across regions, they used multiscale geographically weighted regression (MGWR) to identify specific social and demographic factors affecting each locality.
Findings confirmed broad regional trends—higher rates along the West Coast and Northeast; lower ones clustered along portions of Appalachia and Gulf Coast—as well as localized differences related to Hispanic populations or female-headed households.
