April 2006, Vol 96, No. 4 | American Journal of Public HealthGibson-Davis and Brooks-Gunn | Peer Reviewed | Research and Practice | 641
RESEARCH AND PRACTICE
Objectives: We investigated how couples’ immigration status and ethnicity de-
termined the decision to initiate breastfeeding and to breastfeed at 6 months.
Methods: From data collected on 4207 mothers and 3013 fathers participating
in a longitudinal birth cohort study, we used linear regression and covariate-
adjusted proportions to estimate the determinants of breastfeeding behaviors. The
sample was divided by immigration status (either foreign born or born in the
United States) and further subdivided by ethnicity (Mexican Hispanic, non-Mexican
Hispanic, and non-Hispanic).
Results: Mothers born in the United States had an 85% reduction in the odds of
breastfeeding as compared to foreign-born mothers and a 66% reduction in the
odds of breastfeeding at 6 months. Each additional year of US residency decreased
the odds of breastfeeding by 4%. These differences by immigration status were
seen for Mexicans, other Hispanics, and non-Hispanics.
Conclusion: The Hispanic paradox may extend to other non-Hispanic immi-
grants for breastfeeding behaviors, but may not be true for Hispanic mothers born
in the United States. Low rates of breastfeeding for Hispanic American mothers
indicate that they should not be overlooked by breastfeeding promotion programs.
(Am J Public Health. 2006;96:641–646. doi:10.2105/AJPH.2005.064840)
Couples’ Immigration Status and Ethnicity as
Determinants of Breastfeeding
| Christina M. Gibson-Davis, PhD, and Jeanne Brooks-Gunn, PhD
(also R. Kimbro, S. Lynch, and S. McLanahan,
unpublished data, 2004).
However, beyond the well-documented
finding that non-Hispanic Blacks are less in-
clined to breastfeed,6,9,16little attention has
been paid to the importance of race and eth-
nicity in evaluating breastfeeding behaviors. It
is therefore unknown whether other immi-
grant mothers who are similar in socioeco-
nomic status to Hispanics have comparable
breastfeeding rates27and how differences in
country of origin may influence breastfeeding.
Additionally, although surveys indicate that
Hispanic mothers breastfeed at rates similar
to those of non-Hispanic Whites, those sur-
veys do not distinguish between immigrant
and nonimmigrant Hispanics. As a conse-
quence, it is possible that the Hispanic para-
dox applies only to Hispanic mothers who im-
migrated to this country, but that US-born
Hispanic mothers have breastfeeding rates
commensurate with their lower socioeco-
nomic status.22,27Furthermore, the Hispanic
paradox literature has concentrated on Mexi-
cans, so it is unknown if the paradox applies
to non-Mexican Hispanic mothers.
We used data from a large cohort of moth-
ers to analyze the association between ethnic-
ity and immigration status on breastfeeding
behaviors. Data came from the Fragile Fami-
lies and Child Wellbeing Study,28a longitudi-
nal survey of approximately 4800 new par-
ents conducted in the late 1990s. First, we
analyzed how breastfeeding behaviors differ
by immigration status, examining breastfeed-
ing as a function of nativity, ethnicity, and
years of residency in the United States. Sec-
ond, we compared breastfeeding rates among
mothers who are in 1 of 3 ethnic groups
(Mexican Hispanic, non-Mexican Hispanic, or
non-Hispanic) but differ in terms of their im-
Our study contributes to the breastfeeding
literature in 4 important ways. First, no previ-
ous study has analyzed how immigration status
affects breastfeeding behaviors for Mexican,
non-Mexican Hispanic, and non-Hispanic im-
migrants. Immigrant behaviors are of increas-
ing importance in understanding the well-
being of children, given recent estimates that
nearly 20% of all US children live in immi-
grant households.29Second, we compared the
Breastfeeding is widely regarded as the
optimal feeding strategy on the basis of its
numerous advantages for mother and
child.1–5Despite these benefits, nearly
30% of US infants are never breastfed,
and two thirds of those are not being
breastfed at 6 months, the American
Academy of Pediatricians–recommended
minimum age.5–7Low-income women in
particular are at increased risk of not
breastfeeding.8–14Mothers who are younger
(particularly teenage mothers); those who
had low-birthweight babies; those who par-
ticipate in the Women, Infant, and Children
Special Supplemental Program (WIC); and
those with lower educational status are all
less likely to breastfeed.15,16
Yet socioeconomic status is not completely
determinate of breastfeeding behaviors. For
example, Hispanics, who tend to have low ed-
ucational achievement and household in-
comes, breastfeed at rates higher than their
levels of socioeconomic disadvantage would
indicate. Hispanics have twice the poverty
rates of non-Hispanic White households,1 7yet
similar proportions of Hispanic and White
mothers breastfeed.6Conversely, Hispanics
and non-Hispanic Blacks have comparable
poverty rates,1 7yet the latter are between
27% and 37% less likely to breastfeed.6,16
Rates of breastfeeding among Hispanic moth-
ers appear to be only weakly correlated with
Hispanic breastfeeding behaviors may be
evidence of the “Hispanic paradox,” the phe-
nomenon in which health outcomes of Hispan-
ics are better than their income levels would
indicate in comparison to other populations
with comparable socioeconomic status.18–20
Despite their lack of financial resources, His-
panics have low rates of premature birth and
infant mortality.19,21–24Proponents of the para-
dox believe that low levels of acculturation
may protect some Hispanics from engaging
in damaging American health behaviors24–26
American Journal of Public Health | April 2006, Vol 96, No. 4 646 | Research and Practice | Peer Reviewed | Gibson-Davis and Brooks-Gunn
RESEARCH AND PRACTICE
Hospital and Health Services, and the US Department of
Health and Human Services.
Additional support was provided by National Insti-
tute of Child Health and Human Development Re-
search Network on Child and Family Wellbeing, the
National Institutes of Mental Health–Head Start
Mental Health Research Consortium, the National
Institute of Child Health and Human Development
(grant R01HD046162), the Virginia and Leonard
Marx Family Foundation, and the Bendheim-Thoman
Center for Research on Child Wellbeing (supported
by National Institute of Child Health and Human De-
velopment, grant R01HD369I6) and the Office of
Population Research (supported by National Institute
of Child Health and Human Development, grant
P30HD32030) at Princeton University.
Human Participant Protection
The Fragile Families and Child Wellbeing Survey was
reviewed and approved by the Duke University and the
Columbia University internal review board.
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