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Breastfeeding Legislation Increases Rates
Study Shows Association, but not Causation, between Breastfeeding Rates and Legislation in the United States
A study published in the October 2008 edition of the American Journal of Public Health found state variations in breastfeeding initiation and duration, where western and northwestern states had the highest rates. Additionally, researchers found that breastfeeding initiation rates were highest in states with multiple pieces of legislation supportive of breastfeeding and lowest among states with no such legislation.
The researchers examined data from the National Survey of Children's Health (NSCH), a nationally representative cross-sectional survey of 102, 353 children aged from birth to 18 years of age. The authors examined two outcomes of breastfeeding: whether the child was ever breastfed and whether the child was breastfed for at least six months. Additionally, the authors divided the 50 states into 4 categories based on amount of and time since breastfeeding legislation passed in the state. Researchers controlled for various possible confounders, including race, income level, primary language spoken in the home, and several maternal factors.
Strengths of this study include the examination of data from a nationally representative dataset and the use of multivariate techniques to examine the association between breastfeeding practices and legislation in all 50 states. A limitation of this study is that since the assessment of breastfeeding is recalled by the parent, there is a potential for error. Additionally, exclusivity of breastfeeding was not assessed in this study. Lastly, causality cannot be determined in this cross-sectional study, as it is unclear if a favorable breastfeeding culture with more pro-breastfeeding legislation is the cause or result of improved breastfeeding practices. The authors illustrate this point by saying, "legislation may be a proxy for a culture more favorable toward breastfeeding.it is impossible to discern from the data whether the impetus for breastfeeding promotion legislation was driven by the prevalence of breastfeeding in a state or vice versa."
Kogan, M.D., et al., Multivariate analysis of state variation in breastfeeding rates in the United States. Am J Public Health, 2008. 98(10): p. 1872-80.