Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs

Melissa C. Bartick, Briana J. Jegier, Brittany D. Green, Eleanor Schwarz, Arnold G. Reinhold, Alison M. Stuebe

Research output: Contribution to journalArticle

39 Scopus citations


Objective To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs). Study design Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration. Results Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9). Conclusions Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.

Original languageEnglish (US)
Pages (from-to)49-55
Number of pages7
JournalJournal of Pediatrics
StatePublished - Feb 1 2017



  • breast feeding
  • diarrhea, infantile
  • health status disparities
  • infant mortality
  • minority health
  • otitis media

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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