title: High education and increased parity are associated with breast-feeding initiation and duration among Australian women.
abstract: Breast-feeding is associated with positive maternal and infant health and development outcomes. To assist identifying women less likely to meet infant nutritional guidelines, we investigated the role of socio-economic position and parity on initiation of and sustaining breast-feeding for at least 6 months.
  
  
  
  Prospective cohort study.
  
  
  
  Australia.
  
  
  
  Parous women from the Australian Longitudinal Study on Women's Health (born 1973-78), with self-reported reproductive and breast-feeding history (N 4777).
  
  
  
  While 89 % of women (83 % of infants) had ever breast-fed, only 60 % of infants were breast-fed for at least 6 months. Multiparous women were more likely to breast-feed their first child (~90 % v. ~71 % of primiparous women), and women who breast-fed their first child were more likely to breast-feed subsequent children. Women with a low education (adjusted OR (95 % CI): 2·09 (1·67, 2·62)) or a very low-educated parent (1·47 (1·16, 1·88)) had increased odds of not initiating breast-feeding with their first or subsequent children. While fewer women initiated breast-feeding with their youngest child, this was most pronounced among high-educated women. While ~60 % of women breast-fed their first, second and third child for at least 6 months, low-educated women (first child, adjusted OR (95 % CI): 2·19 (1·79, 2·68)) and women with a very low (1·82 (1·49, 2·22)) or low-educated parent (1·69 (1·33, 2·14)) had increased odds of not breast-feeding for at least 6 months.
  
  
  
  A greater understanding of barriers to initiating and sustaining breast-feeding, some of which are socio-economic-specific, may assist in reducing inequalities in infant breast-feeding.
authors.affiliation: 1Centre for Longitudinal and Life Course Research,School of Public Health,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Natalie
authors.identifier: 0000-0002-9124-3264
authors.initials: N
authors.lastname: Holowko
authors.affiliation: 1Centre for Longitudinal and Life Course Research,School of Public Health,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
authors.affiliation: 2Centre for Health Equity Studies (CHESS),Stockholm University/Karolinska Institute,Stockholm,Sweden.
authors.forename: Ilona
authors.identifier: 0000-0002-7034-1922
authors.initials: I
authors.lastname: Koupil
authors.affiliation: 1Centre for Longitudinal and Life Course Research,School of Public Health,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Leigh
authors.initials: L
authors.lastname: Tooth
authors.affiliation: 1Centre for Longitudinal and Life Course Research,School of Public Health,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Gita
authors.initials: G
authors.lastname: Mishra
mesh_terms: D001315:Australia; D001942:Breast Feeding; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D012959:Socioeconomic Factors
keywords: Breast-feeding duration; Breast-feeding initiation; Infant feeding guidelines; Social inequalities; Socio-economic position