title: Evaluating regional differences in breast-feeding in French maternity units: a multi-level approach.
abstract: OBJECTIVE
  To study how individual and regional characteristics might explain regional variations in breast-feeding rates in maternity units and to identify outlier regions with very low or high breast-feeding rates.
  
  
  METHODS
  Individual characteristics (mother and infant) were collected during hospital stay. All newborns fed entirely or partly on breast milk were considered breast-fed. Regional characteristics were extracted from census data. Statistical analysis included multi-level models and estimation of empirical Bayes residuals to identify outlier regions.
  
  
  METHODS
  All births in all administrative regions in France in 2003.
  
  
  METHODS
  A national representative sample of 13 186 live births.
  
  
  RESULTS
  Breast-feeding rates in maternity units varied from 43 % to 80 % across regions. Differences in the distribution of individual characteristics accounted for 55 % of these variations. We identified two groups of regions with the lowest and highest breast-feeding rates, after adjusting for individual-level characteristics. In addition to maternal occupation and nationality, the social characteristics of regions, particularly the population's educational level and the percentage of non-French residents, were significantly associated with breast-feeding rates.
  
  
  CONCLUSIONS
  Social characteristics at both the individual and regional levels influence breast-feeding rates in maternity units. Promotion policies should be directed at specific regions, groups within the community and categories of mothers to reduce the gaps and increase the overall breast-feeding rate.
authors.affiliation: INSERM, UMR S953, U953 - Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, UPMC University Paris 06, Paris, France. mercedes.bonet-semenas@inserm.fr
authors.forename: Mercedes
authors.initials: M
authors.lastname: Bonet
authors.forename: Béatrice
authors.initials: B
authors.lastname: Blondel
authors.forename: Babak
authors.initials: B
authors.lastname: Khoshnood
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000453:epidemiology* / Q000706:statistics & numerical data; D003710:Demography; D005602:France / Q000453:epidemiology; D006757:Hospital Units / Q000706:statistics & numerical data; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D009035:Mothers