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Childcare use and inequalities in breastfeeding: findings from the UK Millennium Cohort Study
  1. A Pearce1,
  2. L Li1,
  3. J Abbas2,
  4. B Ferguson2,
  5. H Graham3,
  6. C Law1,
  7. the Millennium Cohort Study Child Health Group
  1. 1Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
  2. 2Yorkshire and Humber Public Health Observatory, York, UK
  3. 3Department of Health Sciences, University of York, York, UK
  1. Correspondence to Ms Anna Pearce, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; a.pearce{at}


Background UK breastfeeding rates are low and socially distributed. Childcare provides a potential setting for breastfeeding promotion. However, little is known about the association between childcare and breastfeeding in different socio-economic groups.

Methods Using data from a contemporary UK cohort of infants (n=18 050) the authors calculated RR for breastfeeding for at least 4 months according to informal childcare (care by friends, grandparents, other relatives, etc) and formal childcare (eg, nurseries, crèches), both lasting at least 10 h a week and commencing before the age of 4 months, compared to being cared for ‘only by a parent’ (this includes childcare for less than 10 h a week), overall and by socio-economic group.

Results Compared to being looked after only by a parent, informal (RR 0.51 (95% CI 0.43 to 0.59)) and formal (0.84 (0.72 to 0.99)) childcare was associated with a reduced likelihood of breastfeeding. For informal childcare, both part-time and full-time care was associated with a reduced risk of breastfeeding, whereas for formal care, only full-time formal childcare was associated with a reduced likelihood of breastfeeding. The reduced likelihood of breastfeeding in informal childcare was similar across all socio-economic groups, whereas for formal childcare the reduced likelihood was only seen for mothers from managerial and professional backgrounds (0.76 (0.62 to 0.94)), those who had a degree (0.71 (0.58 to 0.86)) and couple families (0.79 (0.66 to 0.94)). In contrast, lone mothers were more likely to breastfeed if their infant was cared for in formal childcare (1.65 (1.04 to 2.63)).

Conclusions Informal childcare was associated with a reduced likelihood of breastfeeding for all groups of mothers. Formal childcare arrangements were only associated with a reduced likelihood of breastfeeding if used full-time by more advantaged families.

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  • Millennium Cohort Study Child Health Group Carol Dezateux, Catherine Peckham, Lucy Griffiths, Summer Sherburne Hawkins, Jugnoo Rahi, Tim Cole, Helen Bedford, Carly Rich, Phillippa Cumberland, Richard Pulsford, Jane Ahn, Irina Chris Ster, and Richard Jenkins of the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK

  • Funding This work was undertaken as part of the Public Health Research Consortium. The Public Health Research Consortium is funded by the Department of Health Policy Research Programme. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. Information about the wider programme of the PHRC is available from The Centre for Paediatric Epidemiology and Biostatistics was supported in part by the Medical Research Council in its capacity as the MRC Centre of Epidemiology for Child Health. LL is funded by a Medical Research Council Career Development Award in Biostatistics. Research at the University College London Institute of Child Health and Great Ormond Street Hospital for Children receives a proportion of the funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. The Millennium Cohort Study is funded by grants to Professor Heather Joshi, Director of the study from the Economic and Social Research Council and a consortium of government funders. The study sponsors played no part in the design, data analysis and interpretation of this study, the writing of the manuscript, or the decision to submit the paper for publication and the authors' work was independent of their funders.

  • Competing interests None.

  • Ethics approval Received from the South West and London Multi-Centre Research Ethics Committees.

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