Spatial inequalities in breastfeeding initiation in the United States: A multiscale analysis of county-level determinants

Abstract

Deepening our understanding of geographic variations in breastfeeding initiation (BFI) remains an important element in developing a comprehensive snapshot of maternal and infant health. Identifying spatial variations in socioeconomic, demographic, cultural, and environmental barriers to breastfeeding can advance intervention efforts to educate and encourage breastfeeding within a community. The purpose of this paper is to provide a comprehensive snapshot of county-level trends in BFI in the United States. Using a suite of exploratory spatial data analysis (ESDA) techniques and multiscale geographically weighted regression (MGWR), we highlight several important regional determinants of BFI and improve model performance, increasing the adjusted R^2 from 0.641 in a traditional OLS model, to 0.852 in the MGWR model. We concluded the paper by identifying potential locations for public health interventions, especially in Appalachia and the Gulf Coast regions of the United States, and provide three relatively cost-effective strategies to improve BFI that focus on community support, healthcare infrastructure, and education.