Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity - United States, 2020-2021

Introduction Although breastfeeding is the ideal source of nutrition for most fants, racial and ethnic disparities exist in its initiation. Surveil-lance rates based on aggregated data can challenge the understand-ing and monitoring of effective, culturally appropriate interven-tions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initi-ation rates by disaggregation of data to finer subgroups of race and ethnicity. Methods We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate wheth- er an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross- tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated cat- egories. Results The overall prevalence of breastfeeding initiation was 84.0%, ran- ging from 74.5% (mothers identifying as Black) to 94.0% (moth- ers identifying as Japanese). The aggregated prevalence of breast- feeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Conclusion Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggrega- tion of racial and ethnic data unmasked differences that could re- flect variations in cultural practices or systemic barriers to breast- feeding. Understanding why these differences exist could guide public health practitioners' efforts to improve and tailor breast- feeding support.