Abstract
Introduction
Recent studies demonstrate that structural sexism erodes women’s health and impedes access to healthcare. This study extends this research to examine the relationship between structural sexism and breastfeeding initiation and duration in the United States.
Method
A multifaceted state-level structural sexism index was constructed and merged with responses from the 2016–2021 National Survey of Children’s Health by state and child’s birth year. For children ages six months to 5 years, the prevalence of being ever breastfed and breastfed for at least six months was measured across levels of structural sexism. Multivariable logistic regression analyzed the association of structural sexism with breastfeeding outcomes, net of individual and family characteristics.
Results
Higher levels of structural sexism were associated with lower odds of breastfeeding initiation and lower odds of breastfeeding for at least six months net of family and child characteristics. In addition, sensitivity analyses show that variations in state breastfeeding laws did not explain these differences.
Discussion
This study highlights structural sexism’s role in limiting breastfeeding initiation and duration. Breastfeeding promotions and guidelines should consider the broader context of structural sexism.
Significance
Breastfeeding infants for the first six months of life is recommended for optimal child health, yet recommended population levels still need to be achieved. Understanding the role of structural oppression is critical to improving breastfeeding outcomes in the United States. This study examined the association between structural sexism and breastfeeding initiation and duration among a large population-based sample of children. Children residing in states with higher levels of structural sexism had lower odds of being breastfed and being breastfed for at least six months.
This is a preview of subscription content, log in via an institution to check access.
Data Availability
All data is publicly available.
References
Belanoff, C. M., McManus, B. M., Carle, A. C., McCormick, M. C., & Subramanian, S. V. (2012). Racial/ethnic variation in breastfeeding across the US: A multilevel analysis from the National Survey of Children’s Health, 2007. Maternal and Child Health Journal, 16, 14–26.
Centers for Disease Control and Prevention. (2023). National immunization survey. Retrieved October 23, 2023, https://www.cdc.gov/breastfeeding/data/nis_data/index.htm.
Dennis, C., Shiri, R., Brown, H. K., Santos, H. P., Schmied, V., & Falah-Hassani, K. (2019). Breastfeeding rates in immigrant and non-immigrant women: A systematic review and meta-analysis. Maternal and Child Nutrition, 15(3), e12809. https://doi.org/10.1111/mcn.12809
Hawkins, S. S., Stern, A. D., & Gillman, M. W. (2013). Do state breastfeeding laws in the USA promote breast feeding? Journal of Epidemiology and Community Health, 67(3), 250–256. https://doi.org/10.1136/jech-2012-201619
Homan, P. (2019). Structural sexism and health in the United States: A new perspective on health inequality and the gender system. American Sociological Review, 84(3), 486–516.
Huang, F. L. (2016). Alternatives to multilevel modeling for the analysis of clustered data. The Journal of Experimental Education, 84(1), 175–196.
Huang, Y., Sibley, C. G., & Osborne, D. (2020). Breast is best, but where? hostile sexism underlies men’s opposition to breastfeeding in public. Journal of Social Issues, 76(2), 219–238.
Kogan, M. D., Singh, G. K., Dee, D. L., Belanoff, C., & Grummer-Strawn, L. M. (2008). Multivariate analysis of state variation in breastfeeding rates in the United States. American Journal of Public Health (1971), 98(10), 1872–1880. https://doi.org/10.2105/AJPH.2007.127118
Meek, J. Y., Noble, L., & Section on Breastfeeding. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1), e2022057988. https://doi.org/10.1542/peds.2022-057988
Nagle, A., & Samari, G. (2021). State-level structural sexism and cesarean sections in the United States. Social Science & Medicine, 289, 114406.
Odar Stough, C., Khalsa, A. S., Nabors, L. A., Merianos, A. L., & Peugh, J. (2019). Predictors of exclusive breastfeeding for 6 months in a national sample of US children. American Journal of Health Promotion, 33(1), 48–56. https://doi.org/10.1177/0890117118774208
Pérez-Escamilla, R., Martinez, J. L., & Segura-Pérez, S. (2016). Impact of the baby-friendly hospital initiative on breastfeeding and child health outcomes: A systematic review. Maternal & Child Nutrition, 12(3), 402–417.
Rapp, K. S., Volpe, V. V., & Neukrug, H. (2021). State-level sexism and women’s health care access in the United States: Differences by race/ethnicity, 2014–2019. American Journal of Public Health, 111(10), 1796–1805. https://doi.org/10.2105/AJPH.2021.306455
Smith, P. H., Hausman, B. L., & Labbok, M. H. (2012). Beyond health, beyond choice : Breastfeeding constraints and realities. Rutgers University Press.
Smith-Gagen, J., Hollen, R., Tashiro, S., Cook, D. M., & Yang, W. (2014). The association of state law to breastfeeding practices in the US. Maternal and Child Health Journal, 18, 2034–2043.
StataCorp. (2021a). Stata Survey Data Reference Manual: Release 17 Statistical Software. StataCorp LLC.
StataCorp. (2021b). Stata Statistical Software: Release 17. College Station. StataCorp LLC.
U.S. Census Bureau. (2020). National Survey of Children’s Health, Guide to Multi-Year Analysis. Retrieved March 1, 2023, https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/NSCH-Guide-to-Multi-Year-Estimates.pdf
Whitley, M., & Banks, A. (2022). Work as an understudied driver of racial inequities in breastfeeding. New Solutions: A Journal of Environmental and Occupational Health Policy, 32(3), 189–200.
Acknowledgements
This work was supported in part by the Center for Family and Demographic Research, Bowling Green State University, which has core funding from The Eunice Kennedy Shriver National Institute of Child Health & Human Development (P2CHD050959). This manuscript benefitted from the data compilation assistance of Adrianne Brown, the helpful comments of Dr. Jennifer Karas Montez at the 2023 Population Association of America meetings, and the three anonymous reviewers.
Funding
This work was supported in part by the Center for Family and Demographic Research at Bowling Green State University, which has core funding from The Eunice Kennedy Shriver National Institute of Child Health & Human Development (P2CHD050959).
Author information
Authors and Affiliations
Contributions
Not applicable, one author.
Corresponding author
Ethics declarations
Conflicts of interest
No conflicts of interest.
Ethical Approval
Not required, all data are secondary and publicly available.
Consent to Participate
Not applicable, secondary data.
Consent for Publication
Not applicable, secondary data.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Balistreri, K.S. Structural Sexism and Breastfeeding in the United States, 2016–2021. Matern Child Health J 28, 431–437 (2024). https://doi.org/10.1007/s10995-023-03895-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03895-y