Disparities in Breastfeeding Initiation Among African American and Black Immigrant WIC Recipients in the District of Columbia, 2007-2019

Objectives. To estimate differences in breastfeeding initiation (BFI) rates between African Americans and Black immigrants enrolled in the District of Columbia Special Supplemental Nutrition Program for Women, Infants and Children (WIC) between 2007 and 2019. Methods. We used data collected as part of routine WIC program activities for first-time mothers (n = 38142). Using multivariable logistic regression models, we identified determinants of BFI for African Americans, Black immigrants, non-Hispanic Whites, and Hispanics. To assess the trend in BFI over time, we calculated the average of the annual percentage changes. Results. Compared with African Americans, Black immigrants had a 2.7-fold higher prevalence and Hispanics had a 5.8-fold higher prevalence of BFI. The average of the annual percentage changes was 0.85 for Hispanics, 3.44 for Black immigrants, 4.40 for Non-Hispanic Whites, and 4.40 for African Americans. African Americans had the only statistically significant change (P < .05). Disparities in BFI persisted over the study period, with African Americans demonstrating the lowest rates each year. Conclusions. Significant differences exist in BFI between Black immigrants and African Americans. Combining African Americans and Black immigrants masks important differences, overestimates rates among African Americans, and may lead to missed opportunities for targeting interventions and policies to improve breastfeeding.

Automated summary

Significant differences in breastfeeding initiation rates exist between African Americans and Black immigrants. Combining these two groups masks important differences and may lead to missed opportunities for improving breastfeeding.