Bottle-feeding disparities: Prevalence, predictors, consequences

Feeding disparities contribute to health disparities for infants, highlighting the need to improve breastfeeding rates in populations with substantially lower rates. Although public health efforts have been successful in increasing knowledge about the health benefits of breastfeeding, this knowledge has not been equitably translated to practice. Despite increases in the U.S. breastfeeding rate, disparities are evident across a variety of sociodemographic factors, including but not limited to race/ethnicity, socioeconomic status, employment characteristics, and women's participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Decreasing breastfeeding disparities must remain a public health priority; however, in this chapter we argue that a lack of education and support surrounding feeding practices that are unique to bottle-feeding (e.g., adding infant cereal to formula, bottle to bed, food to soothe) is one underlying mechanism for health disparities typically attributed to differences in breastfeeding. In the past decade, the breastfeeding literature has shifted in ways that highlight the need to better understand bottle-feeding practices in the context of factors that contribute to breastfeeding disparities. We will first provide an overview of the prevalence of breastfeeding disparities among different population groups and the potential contribution of these differences to health disparities in the U.S. Second, we will review the literature on factors contributing to disparities in breastfeeding intentions, initiation, and duration, and suboptimal bottle-feeding practices: (1) sociocultural contexts in which women live, (2) sources of information and support that influence feeding decisions, (3) conflicting advice from health care professionals, and (4) practical considerations that are barriers to breastfeeding. Next, we will provide an overview of interventions that target decreasing breastfeeding disparities and we will identify the need to incorporate issues related specifically to bottle-feeding. Finally, we will discuss future directions for infant feeding research with a focus on how to best translate these findings to interventions and clinical practice to effectively reduce infant health disparities among at-risk groups.