Structural Sexism and Breastfeeding in the United States, 2016-2021.

Abstract

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. 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 5years, 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. 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. 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.