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J Pediatr. 2017 Feb;181:49-55.e6. doi: 10.1016/j.jpeds.2016.10.028. Epub 2016 Nov 10.

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

Author information

  • 1Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA. Electronic address:
  • 2Department of Health Services Administration, D'Youville College, Buffalo, NY.
  • 3Department of Operations Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH.
  • 4Department of Medicine, University of California, Davis, Davis, CA.
  • 5Alliance for the Prudent Use of Antibiotics, Boston, MA.
  • 6Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, NC.



To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs).


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.


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).


Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.


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

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