Socioeconomic status and rates of breastfeeding in Australia: evidence from three recent national health surveys

Many epidemiological studies of breastfeeding in developed countries have found a relationship between socioeconomic status and duration of breastfeeding.1-5

In a previous study, using data from the 1995 Australian National Health Survey (NHS),6 we demonstrated that a considerable socioeconomic gradient existed in Australia, both for initiation of breastfeeding and for rates of breastfeeding at 6 months.7 At 6 months, 37.4% (95% CI, 32.5%–42.3%) of infants in the most disadvantaged socioeconomic quintile were breastfed, compared with 52.7% (95% CI, 47.8%–57.6%) in the least disadvantaged quintile.

In the past few years, three other national surveys in Australia have included questions about breastfeeding — the 20018 and 2004–059 NHSs and the Longitudinal Study of Australian Children.10

The aim of our study was to establish from national surveys whether the relationship between socioeconomic status and breastfeeding initiation and duration changed in Australia between 1995 and 2004. We did not include the Longitudinal Study of Australian Children in our analysis, as its methodology differed from that of the NHSs.

There was little change in the initiation and duration of breastfeeding between the 1995 and 2004–05 NHSs in Australia (Box 1). The overall breastfeeding initiation rate was 86.0% in 1995 compared with 87.8% in 2004–05. In 1995, the overall proportions of infants breastfeeding at 3, 6 and 12 months were 63.1%, 46.6% and 21.3%, respectively, compared with 64.4%, 50.4% and 23.3% in 2004–05.

However, differences could be seen when the results were broken down into SEIFA categories. For example, in the 1995 NHS, the proportion of infants being breastfed at 6 months was 37.7% in the lowest quintile compared with 53.1% in the highest quintile, whereas in the 2004–05 NHS, the breastfeeding rate at 6 months was 37.1% in the lowest quintile compared with 66.0% in the highest quintile.

In 1995, for each increase in SEIFA quintile, the odds of breastfeeding at 6 months increased by 13% (odds ratio [OR], 1.13 [95% CI, 1.07–1.19]), whereas in 2001, the comparative odds increased by 21% (OR, 1.21 [95% CI, 1.12–1.30]), and in 2004–05, the comparative odds increased by 26% (OR, 1.26 [95% CI, 1.17–1.36]). Similar gradients were observed for breastfeeding at 3 months and 12 months. The widening difference in breastfeeding rates according to SEIFA category between 1995 and 2004–05 is presented graphically in Box 2.

NHSs over a 10-year period indicate that, although overall rates of breastfeeding have remained unchanged between 1995 and 2004–05, the broad figures mask an increasing divide between the highest and lowest socioeconomic groups. Infants in higher socioeconomic groups are more likely to be breastfed than in previous years, but little change has occurred in lower socioeconomic groups.

In general, people with higher incomes are more likely to adopt healthy behaviour such as exercising, eating a healthy diet and quitting smoking.13-15 Lower-income families have less capacity to make such changes. Women from lower-income families are less likely to breastfeed for a number of reasons, including less family support for breastfeeding, less ability to seek help with breastfeeding problems, less flexibility with working arrangements, and concerns about breastfeeding in public.16-19 Moreover, women in lower SEIFA quintiles are more likely to interact socially with women who are less inclined to breastfeed, such as those who are younger, less educated, overweight/obese or smokers.20-22 As formula-fed infants are more likely to become ill and be admitted to hospital, these findings indicate increasing health inequalities in Australian children.23

Policymakers need to act on increasing health inequalities.14 Breastfeeding support and promotion in Australia need to focus on groups with low rates of breastfeeding. Peer support programs have been effective in other countries24,25 and should be trialled in Australia. Peer support involves women who are similar to the women they are supporting — for example, teenage women supporting teenage women. The Australian Breastfeeding Association provides mother-to-mother support, but as the counsellors tend to be middle-class and are trained to provide breastfeeding advice, they are not peer supporters as generally defined.

The previous federal government proposed a “community education campaign on the benefits of breastfeeding”.26 However, the health benefits of breastfeeding are widely known and we believe it would be more useful to conduct a public education campaign aimed at the wider community — not just new parents — which includes promotion of breastfeeding in public in an acceptable way to groups that are currently uncomfortable with this issue.17,27 New mothers need support from their families, communities and workplaces in order to breastfeed. They need Baby Friendly accredited maternity hospitals,28 increased breastfeeding help in the community and paid maternity leave — not simply another government campaign extolling the virtues of breastfeeding.

2 Breastfeeding duration: weighted estimates of proportions of infants breastfeeding at 0–52 weeks in the 1995, 2001 and 2004–05 National Health Surveys (NHSs) in the lowest and highest SEIFA quintiles*

SEIFA = Socio-Economic Indexes for Areas.11 * Lowest quintile has lowest incomes and highest proportion of unskilled workers.