Breast-Feeding, Once on the Rise, Is Slowing : Race, Family Income and Education Are Often Factors Behind a Mother’s Decision

The vibrant, heavily publicized resurgence of breast-feeding that first developed as a major national trend in about 1971 has stagnated and the rate at which young mothers under 20 follow the practice has actually dropped, according to a survey by researchers who have monitored the situation since 1955.

And, while breast-feeding is continuing to increase by tiny fractions of a percentage point a year, the big gains of the 1970s have disappeared because breast-feeding among well-educated, comparatively well-to-do women has reached what amounts to the point of market saturation.

Breast-Feeding Programs

Poor, less educated women have proven more difficult to reach for breast-feeding education programs and--more important, perhaps--changes in employer attitudes that would make it possible to realize greater gains in breast-feeding in the workplace have been especially slow to come, according to the chairman of the committee on nutrition of the American Academy of Pediatrics.

The data on the apparent slowing of the breast-feeding renaissance are contained in the 1984 annual survey of infant feeding patterns conducted by Ross Laboratories, a Columbus, Ohio, major manufacturer of prepared formula that has charted baby nutrition patterns for 30 years.

The Ross data, gathered by marketing survey techniques, are universally seen--by organizations ranging from the American Academy of Pediatrics to La Leche League International, a major breast-feeding advocacy group--as the only broadly based, reliable statistics on the subject. The academy has published the Ross figures annually for several years in Pediatrics, the nation’s best-known journal of childhood health.

Stalled at 60-61%

The observations about the apparent reaching of a breast-feeding plateau in the United States are contained in the latest Ross report--published earlier this week in the journal’s December issue. The study compares 1984 with the 28 prior years and finds that, in 1982, 1983 and last year, the proportion of women breast-feeding their babies just after birth has stagnated at between 60% and 61%.

The rate had dropped from after World War II until 1970, when it stood at just 24.9%. In that same year, the use of prepared formula reached its record high of 74.9%. In the years after 1970, breast-feeding enjoyed a resurgence unprecedented in American public health, climbing steeply and steadily until 1982.

In the same period, the use of prepared formula dropped off to 45%. Cow’s milk is given to babies so seldom today that it has not even shown up as a fraction of a percentage point in the last two years. The use of evaporated milk, which accounted for 45.9% of baby feeding in 1955, has remained constant at two-tenths of a percentage point since 1980. The percentage figures add up to more than 100% because many women supplement breast-feeding with some other type of nutrition.

Trend Loses Momentum

In 1983, after the breast-feeding rate appeared to have flattened for two consecutive years, researchers began to consider the possibility that the momentum of the trend toward increasing breast-feeding had been lost. The 1984 figures confirmed the suspicions, the Ross survey team reported.

The survey also found that:

--Since 1982, breast-feeding by hospitalized mothers after they give birth and when babies are two months old has increased a little bit, while breast-feeding of infants 3 to 6 months old has declined slightly.

--There are major regional differences in breast-feeding rates today, with California, Washington, Oregon and Alaska recording the highest rates of all--77.7%--and Tennessee, Kentucky, Alabama and Mississippi having the lowest--45.9%. Rates in New England, the Midwest, the Middle Atlantic states ranged from 50.9% to 58.5%. The Ross survey attributes the high rates in the West to the presence of larger populations of families with incomes of more than $25,000 and greater proportions of college-educated mothers.

--The breast-feeding rate for especially young mothers--those younger than 20--actually declined by 2.5% in the hospital, though that group of mothers registered a slight increase in breast-feeding by the time their babies were 5 or 6 months old.

--Breast-feeding rates were essentially unchanged among white women, but black women showed a 3.5% increase between 1983 and 1984, underscoring conclusions that black and poor women represent the major group where progress remains to be made toward national breast-feeding levels of 90% to 100%. Among white women with babies 5 or 6 months old, breast-feeding actually went down by six-tenths of a percentage point, while black women with babies in that age bracket recorded a 1.5% increase.

Rates Dropped Off

--Rates were lowest for women in households with an income of less than $7,000 a year (36.6%) and where the mother was employed full time. For those full-time working mothers, breast-feeding rates dropped off to 12.3% after six months.

All of the new Ross data represented a major statistical revision in which the researchers began, starting in 1983, to take account of greater racial, ethnic and socioeconomic diversity among women. The revisions caused estimates of the incidence of breast-feeding to decline slightly from earlier measures because of the calculated effects of allowing for greater weighting in the data for minority and poor women.

Because the revision caused changes in reported figures with which some breast-feeding experts have been familiar, the Ross Laboratories team emphasized that, although the rate of increase for breast-feeding has slowed to a virtual standstill, there were still slight gains in the proportion of infants breast-fed in 1984.

The 1984 survey, like its predecessors, was carried out by the company’s marketing department. Working closely with the nation’s practicing pediatricians, Ross researchers mailed questionnaires to 56,894 new mothers, of which 54% returned completed forms. The 1984 survey was similar in size to previous ones.

Breast-feeding had become one of the most heavily reported aspects of 1970s-era changes in the way women perceived childbirth and child rearing. During the period, natural childbirth with fathers present at delivery came to dominate obstetrics and women began a continuing trend to feed their babies with the naturally occurring food, breast milk, which most pediatricians agree is significantly better as a nutrition source than formula or cow’s milk.

Objections Made

Breast milk appears to afford protection against a variety of diseases of infancy--most notably certain types of gastrointestinal disorder that may account for several hundred infant deaths a year. Objections have also been made to the selection of ingredients in some brands of prepared formula, which may unnecessarily contribute to babies’ weights without adding any nutritional benefit.

Before the end of World War II, breast-feeding had been the national norm, but formula came into increased use as advertising and marketing campaigns persuaded women it was less trouble to use and gave their babies better nutrition than the natural product.

Dr. Laurence Finberg, of the State University of New York’s Downstate Medical Center in Brooklyn and chairman of the academy’s nutrition committee, said in a telephone interview Thursday the new breast-feeding survey data come as no surprise. He said the results indicate that dramatic progress in convincing wealthier, better educated women to breast-feed has, in essence, exhausted its potential for gain by persuading the vast majority of women in that group. The survey found 71.8% of women in households with incomes over $25,000 a year and 77.5% of college-educated women breast-fed their babies.

“The better educated group has come along very well,” Finberg said. “Not only is the incidence up, but the duration is much longer. I don’t know if there will be much more success with that group.”

Finberg said his personal ideal would be to have all women breast-feed, but he said a more realistic goal is probably a level of 80% to 90%. “Now, that is not possible,” he said, “unless certain social things occur over and above the willingness of women to breast-feed.

“There has to be provision in the work place or the working woman is going to have too hard a time of it.”

Finberg said employers must reach a more enlightened understanding and accommodation of women who are breast-feeding and that they must provide adequate, sufficiently private, facilities so working mothers can breast-feed, or pump milk for later use while they are at work.

At his own hospital, Finberg said, nurses who also happen to be mothers have converted a lounge to a breast-feeding room, complete with comfortable chairs and breast pumps that can be used by any working mother.

Finberg said he remains optimistic that breast-feeding rates can resume their climb, since what may actually be happening is a mirror image reversal of the historic trend that developed in the 1940s, when poor, less educated women resisted the trend toward greater use of formula for far longer than their richer, better educated counterparts.

Mary Lofton, a spokesman for La Leche League in Franklin Park, Ill., agreed that greater accommodation is necessary in the work place.

Minority Groups

She noted, however, that her organization believes that poor, less educated minority women are not resistant to breast-feeding but that pro-breast feeding groups--which have tended to be largely white and upper class--simply have not adapted their educational methods to get their message to minority groups.

She said she herself was surprised when she made her first visit to a black public health clinic on the South Side of Chicago, expecting to find women there difficult to convince.

“They were as interested as the white suburban women of the 1960s and 1970s,” she said. “They responded very strongly to the idea that they could produce milk for their babies that was superior to artificial formula and that there might be something very special in the relationship that would result.

“Once you get to those mothers, it’s beautiful. They cared.”