High education and increased parity are associated with breast-feeding initiation and duration among Australian women

Objective: Breast-feeding is associated with positive maternal and infant health and development outcomes. To assist identifying women less likely to meet infant nutritional guidelines, we investigated the role of socio-economic position and parity on initiation of and sustaining breast-feeding for at least 6 months. Design: Prospective cohort study. Setting: Australia. Subjects: Parous women from the Australian Longitudinal Study on Women's Health (born 1973-78), with self-reported reproductive and breast-feeding history (N 4777). Results: While 89% of women (83% of infants) had ever breast-fed, only 60% of infants were breast-fed for at least 6 months. Multiparous women were more likely to breast-feed their first child (similar to 90% v. similar to 71% of primiparous women), and women who breast-fed their first child were more likely to breast-feed subsequent children. Women with a low education (adjusted OR (95% CI): 2.09 (1.67, 2.62)) or a very low-educated parent (1.47 (1.16, 1.88)) had increased odds of not initiating breast-feeding with their first or subsequent children. While fewer women initiated breast-feeding with their youngest child, this was most pronounced among high-educated women. While similar to 60% of women breast-fed their first, second and third child for at least 6 months, low-educated women (first child, adjusted OR (95% CI): 2.19 (1.79, 2.68)) and women with a very low (1.82 (1.49, 2.22)) or low-educated parent (1.69 (1.33, 2.14)) had increased odds of not breast-feeding for at least 6 months. Conclusions: A greater understanding of barriers to initiating and sustaining breast-feeding, some of which are socio-economic-specific, may assist in reducing inequalities in infant breast-feeding.