Exclusive breastfeeding (EBF) for the first six months of life is recognized as a foundational early-life behavior that can shape a child’s long-term health trajectory. The World Health Organization recommends exclusive breastfeeding during this period because human milk provides optimal nutrition, immune protection, and developmental benefits for infants while also supporting maternal health. According to the American Academy of Pediatrics, breastfeeding is associated with lower risks of short-term illnesses such as diarrhea, respiratory infections, eczema, and sudden infant death syndrome, as well as reduced risk of later obesity, diabetes, asthma, inflammatory bowel disease, and certain cancers for infants. Mothers who breastfeed also experience important health benefits, including lower risks of hypertension, type 2 diabetes, breast cancer, endometrial cancer, ovarian cancer, and thyroid cancer. Beyond these biological benefits, breastfeeding represents a cost-effective public health strategy with substantial implications for population health and healthcare spending.

Despite these benefits, breastfeeding outcomes in the United States remain uneven. Recent national data show that while many infants initiate breastfeeding, far fewer meet recommendations for exclusive breastfeeding through six months. In 2022, 85.7% of U.S. infants were ever breastfed, yet only 27.9% were exclusively breastfed through six months, as is recommended. Marked disparities also exist across geography, race, age, and socioeconomic status. Infants living in nonmetropolitan areas and in many Southeastern states are less likely to ever breastfeed. Breastfeeding prevalence also differs by race, with lower rates reported among Black families compared with White, Asian, and Hispanic families. Maternal age, educational attainment, and income are also strongly associated with breastfeeding behaviors, as older mothers and those with greater socioeconomic resources are generally more likely to initiate and sustain breastfeeding. 

At our local level, these patterns carry meaningful consequences. In Butler County, Ohio, infants born to women who did not breastfeed at hospital discharge were reported to be 9 times more likely to die in infancy, underscoring the importance of infant feeding practices as a community health issue.

Breastfeeding behavior is shaped by more than individual choice; it is influenced by interacting factors across multiple levels of the Social Ecological Model. At the individual level, race, socioeconomic status, and education can shape access to knowledge and resources. Interpersonally, family attitudes, role models, and pre- and postnatal support systems influence maternal confidence and decision-making. Institutional factors such as workplace policies, parental leave, and healthcare practices can either support or hinder breastfeeding continuation. Community-level influences include access to high-quality maternity care, Baby-Friendly hospitals, media messaging, and local support services. Policy and historical forces also remain relevant, including the legacy of slavery, structural inequities, and the role of programs such as WIC. 

Several barriers remain under-addressed in current research and practice, including the historical exploitation of enslaved Black women as wet nurses, unequal access to trusted information sources, and aggressive formula marketing practices that may disproportionately affect vulnerable communities.

This proposal presentation lays the groundwork for my upcoming Honors Thesis. It establishes the public health significance of breastfeeding disparities, highlights gaps in current understanding, and identifies the multilevel factors that warrant further investigation. Building on this foundation, I plan to conduct and present my Honors Thesis research next year, with a focus on advancing equitable, evidence-based strategies to improve breastfeeding outcomes in underserved communities.

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IRB proposal in development.