Breastfeeding practices among foreign-born non-Hispanic mothers of children in the United States – a cross-sectional study of nationwide multi-year data

Existing research has documented various predictors of immigrant breastfeeding, but the research and related interventions have mostly focused on Hispanic populations. Little is known about predictors of relative importance for successful breastfeeding among the growing population of foreign-born non-Hispanic (FBNH) mothers in the U.S. This study examines breastfeeding practices among FBNH mothers relative to other U.S. groups and explores socioeconomic factors associated with FBNH mothers’ ability to meet recommended feeding practices. Cross-sectional data on U.S. children 0–5 years from the 2022–2023 National Survey of Children’s Health were used to examine breastfeeding initiation, exclusive breastfeeding (EBF) for 6 months, breastfeeding for ≥ 12 months, and optimal breastfeeding (all 3 practices) among FBNH, foreign-born Hispanic (FBH) and U.S.-born mothers. Chi-square tests compared proportions and multivariable binomial regression models estimated adjusted prevalence ratios for breastfeeding outcomes by nativity & ethnicity, maternal employment status, community and social support, and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Most FBNH mothers (87.7%) initiated breastfeeding, while about one-quarter (28.2%) practiced EBF for 6 months. More than half (52.9%) reported breastfeeding for at least 12 months and about one-quarter (24.1%) reported meeting all three practices. U.S.-born mothers had significantly lower prevalence of BFI (83.1% vs. 87.7%, p = 0.04), while FBH had significantly higher prevalence of EBF at 6 months (31% vs. 28.2%, p = 0.02) and overall optimal breastfeeding (28.8% vs. 24.1% p = 0.01) in the adjusted models, when compared to FBNH mothers. Maternal employment status, community and social support, and WIC participation were not associated with breastfeeding outcomes among FBNH mothers. Despite higher rates of breastfeeding initiation, only one in five FBNH women achieved all recommended breastfeeding practices, and over 70% did not meet exclusive breastfeeding recommendations. Further research should investigate key drivers of breastfeeding practices and identify factors of relative importance to guide culturally appropriate and context-specific programs targeting this population.