Files
Abstract
Background: The CDC and the Dietary Guidelines for Americans recommend exclusive breastfeeding for the first six months, with continued breastfeeding for up to one year or beyond yet in 2019, only 24.9% of US infants were exclusively breastfed for six months. One of the Healthy People 2030 breastfeeding objectives is to increase the percentage of infants exclusively breastfed for the first six months of life to 42.4%. To achieve this goal, the United States must make significant progress over the next five years. But if infants are not exclusively breastfed during this critical period, what are they being fed? One common substitute for breast milk is animal milk, which is often chosen for reasons such as convenience, breastfeeding challenges, infections, or other health issues. However, many mothers are unaware of the potential risks associated with using breast milk substitutes (BMS).Objectives: This study examined the association between sociodemographic characteristics and infant feeding knowledge, breastfeeding laws and legislation awareness, and perceptions of animal milk as an infant feeding alternative among childbearing age women in the United States.
Methods: This study was a cross-sectional online survey hosted on Qualtrics.
Results: Out of the 842 participants with complete data, the majority were over 20 years old, white, married/cohabiting, had a college degree or higher, resided in the Southern US, worked full time, and had an annual household income above $100,000. Sixty-two percent of participants correctly identified the 6-month exclusive breastfeeding recommendation, with knowledge highest among women aged 30–39 (51.1%). Although no significant associations were observed between sociodemographic factors and awareness of this recommendation, other aspects of breastfeeding knowledge, like the necessity of water and nutrient supplements during exclusive breastfeeding, did show significant associations with sociodemographic factors such as age, marital status, and race (p < 0.05). Awareness of breastfeeding laws was varied; participant characteristics such as region, employment status, income, age, marital status, household size, and number of children were significantly associated with legal awareness (p < 0.05). Unemployed participants were less likely to know their workplace pumping rights (OR = 0.55, p = 0.005), while those from households with five or more members had greater awareness (OR = 4.45, p = 0.030). Participants reported two or more animal milks (cow, goat, sheep, camel, and/or buffalo milk) as appropriate for infant feeding. However, for the reason to feed animal milk as an alternative to breast milk to infants, nearly half (44.1%) of the participants gave reasons ranging from unsure, convenience, infant having acid reflux, and mother having had double mastectomy, among others. Married (89%) and White (74%) participants demonstrated higher awareness of the recommendation on when to introduce cow’s milk.
Conclusions: This study reveals significant disparities in infant feeding knowledge and awareness of breastfeeding laws among U.S. women of childbearing age, especially influenced by income, employment, and marital status. Lower-income and single women were less aware of breastfeeding guidelines and legislation, which may contribute to lower breastfeeding rates. Additionally, misinformation about animal milk alternatives was more common in smaller households and among women without children. The findings emphasize the need for targeted interventions, stronger workplace policies, and accessible education to better support all mothers, especially those in underserved communities.