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Explaining socioeconomic inequalities in exclusive breast feeding in Norway
  1. Anne Bærug1,
  2. Petter Laake2,
  3. Beate Fossum Løland1,
  4. Thorkild Tylleskär3,
  5. Elisabeth Tufte1,
  6. Atle Fretheim4,5
  1. 1 Norwegian National Advisory Unit on Breastfeeding, Women and Children's Division, Oslo University Hospital, Oslo, Norway
  2. 2 Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
  3. 3 Centre for International Health, University of Bergen, Bergen, Norway
  4. 4 Knowledge Centre for the Health Services, Norwegian Institute of Public Health, Oslo, Norway
  5. 5 Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Anne Bærug, Norwegian National Advisory Unit on Breastfeeding, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, Oslo N-0424, Norway; anne.baerug{at}, anne.baerug{at}


Background and objective In high-income countries, lower socioeconomic position is associated with lower rates of breast feeding, but it is unclear what factors explain this inequality. Our objective was to examine the association between socioeconomic position and exclusive breast feeding, and to explore whether socioeconomic inequality in exclusive breast feeding could be explained by other sociodemographic characteristics, for example, maternal age and parity, smoking habits, birth characteristics, quality of counselling and breastfeeding difficulties.

Methods We used data from a questionnaire sent to mothers when their infants were five completed months as part of a trial of a breastfeeding intervention in Norway. We used maternal education as an indicator of socioeconomic position. Analyses of 1598 mother–infant pairs were conducted using logistic regression to assess explanatory factors of educational inequalities in breast feeding.

Results Socioeconomic inequalities in exclusive breast feeding were present from the beginning and persisted for five completed months, when 22% of the most educated mothers exclusively breast fed compared with 7% of the least educated mothers: OR 3.39 (95% CI 1.74 to 6.61). After adjustment for all potentially explanatory factors, the OR was reduced to 1.49 (95% CI 0.70 to 3.14). This decrease in educational inequality seemed to be mainly driven by sociodemographic factors, smoking habits and breastfeeding difficulties, in particular perceived milk insufficiency.

Conclusions Socioeconomic inequalities in exclusive breast feeding at 5 months were largely explained by sociodemographic factors, but also by modifiable factors, such as smoking habits and breastfeeding difficulties, which can be amenable to public health interventions.

Trial registration number NCT01025362.

  • Infant Feeding
  • socioeconomic inequality
  • breastfeeding

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  • Contributors AB conceptualised and designed the study, conducted the analyses and drafted the initial manuscript. PL contributed to the study design, supervised the data analyses and interpretation. BFL and ET contributed to study design and data collection. TT contributed to the study design. AF contributed to the study design, data analyses and interpretation, and to writing of the first draft of the article. All contributed with interpretation of the study findings and approved the final manuscript.

  • Funding This trial has been financially supported by the Norwegian ExtraFoundation for Health and Rehabilitation through EXTRA funds (2013/FOM5639) and the Norwegian National Advisory Unit on Breastfeeding, Oslo University Hospital.

  • Competing interests None declared.

  • Ethics approval The Regional Committees for Medical Research Ethics approved the study protocol (REK Sør-Øst C Ref:S-09277c 2009/5783).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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