Background The UK has one of the lowest breastfeeding rates among high income countries, and there is a steep socio-economic gradient, with initiation and duration lowest among mothers from lower socio-economic and education groups, younger mothers, mothers of white ethnicity, and those living in more deprived areas. Until April 2013, Primary Care Trusts (PCTs) in England reported rates of breastfeeding initiation (since 2004–05), and prevalence at 6–8 weeks after birth (since 2007–08) which allows for analysis of trends over time. The objective of our study was to investigate time trends in breastfeeding rates for all PCTs in England, and to determine whether the trends vary by area profile.
Methods We measured time trends for breastfeeding initiation (2005–06 to 2012–13) and breastfeeding at 6–8 weeks (2008–09 to 2012–13) using annual data on 151 PCTs in England. Risk ratios (RR) for the association between year and breastfeeding were estimated using modified Poisson regression. Interaction tests determined whether the time trends (RRs) varied according to area profile (breastfeeding rate at the start of the study, area deprivation index, and the proportion of teenage mothers, mothers who smoked in pregnancy and mothers in black and minority ethnic groups).
Results The average breastfeeding initiation rate rose from 65.5% in 2005–06 to 72.4% in 2012–13 (average annual increase of 0.9%). There was a significantly higher annual increase in initiation in the most socially deprived PCTs (1.2%) compared with the least deprived PCTs (0.7%) and in PCTs with low baseline (2005–6) breastfeeding initiation (1.4%) compared to those with high baseline initiation (0.6%). Similar trends were observed when PCTs were stratified by the proportion of teenage mothers in the PCT, the proportion who smoked in pregnancy, but not when stratified by ethnicity. Although breastfeeding prevalence at 6–8 weeks also increased significantly over the observed time period (average rate 41.2% in 2008–09, 43.7% in 2012–13; annual increase 0.7%), there was no difference in the average increase when stratified by deprivation profile, ethnicity, teenage motherhood and smoking in pregnancy. However, there was a significantly higher increase in PCTs with low baseline prevalence in 2008–09 (0.8%) compared with PCTs with high baseline prevalence (0.07%).
Conclusion Breastfeeding initiation and prevalence increased more rapidly in areas with low initial breastfeeding, and initiation increased more rapidly in areas with a more disadvantaged population. These data indicate that inequalities in breastfeeding rates have narrowed over time, but sustained efforts are needed to address inequalities.
- maternal and child