Background: Racial disparities of breast feeding have been reported in various studies, but few have evaluated the factors associated with racial discrepancies in breastfeeding.

Method: We evaluated breastfeeding patterns among 26,926 white and 10,550 black parous females, aged 30 years and above, who were enrolled in the Adventist Health Study-2. We evaluated: 1) initiation of breastfeeding and 2) length (months/child) of breastfeeding using log linear binomial and multiple linear regression, respectively adjusting for age, education, parity, body mass index, marital status, country lived during young adult life (age 6-16), oral contraceptive use and dietary patterns.

Results: Black women were less likely to initiate breastfeeding than white women (Prevalence Ratio=0.87, 95% Confidence Interval: 0.86-0.89) and breastfed on average 1.2 months shorter per child than white women. Older women were less likely to have breastfed their children (PR=0.97, 0.91, 0.87 and 0.95 for ages 41-50, 51-60, 61-70 and 80+ respectively compared to 30-40 year olds. Vegetarians were more likely to initiate breastfeeding than non-vegetarians (Prevalence ratio= 1.07-1.12).

Conclusions: The racial difference on breastfeeding exist and remained virtually unchanged even after adjusting for a number of socio-economic factors including age, marital status, education and place lived during childhood and adolescence. The observed racial disparity warrants further study into possible factors that can explain the differences seen. Attitudes towards breastfeeding, in particular, need to be investigated among black and white females in the US.

Key words: disparity, blacks, white women, breastfeeding, Adventists, North America.