Breast-Feeding Initiation Rate Across Western Countries Does Religion Matter? An Ecological Study

ABSTRACT Background: Breast feeding initiation rates remain below 80% in some Western countries. Many individual-level determinants are known; however, less is known regarding cultural and societal determinants, such as religion, that could explain population-level variations. We examined the correlations of the proportions of Catholics and Protestants with the breast feeding initiation rates across and within Western countries. Methods: Using publicly available data, we carried out an ecological study comparing the proportions of Catholics and Protestants with the rates of breast feeding initiation. We correlated data at the country level, and additionally explored within-country data in five Western countries: France (Departments), Ireland (counties), the UK (countries), Canada ( provinces) and the USA (states). Our analyses accounted for human development index, gross domestic product and population density. Results: We observed a negative correlation (r=−0.30) between the proportion of Catholics and the rate of breast feeding initiation in Western countries. This correlation was consistent when using within-country data in France (r=−0.27), Ireland (r=−0.23), the UK (r=−0.79) and Canada (r=−0.62). In the USA, the positive correlation (r=0.26) between a state’s proportion of Catholics and its breast feeding initiation rate was confounded by race, education and socioeconomic status (SES). After controlling for education and SES, the state proportion of non- Hispanic white Catholics was negatively correlated (r=−0.29) with the rate of breast feeding initiation. Conclusions: In this ecological study, we found consistent negative correlations between Catholicism and breast feeding initiation rates. Qualitative and quantitative studies at the individual level are needed to confirm and explain our findings. Our results suggest that women living in a country or region where Catholicism has historically dominated are less likely to initiate breast feeding, and that breast feeding promotion policies should be adapted to better fit populations’ cultural and religious norms. INTRODUCTION The presence of mammary glands and the female’s ability to lactate/breastfeed are key features of all mammals, including humans.1 2 Yet breast feeding among modern humans is strongly influenced by cultural values, beliefs and customs, leading to variations in breast feeding practices.3 Many studies reported benefits of breast feeding (vs formula feeding) for the short- term and long-term health of the offspring and the mother.4 5 The WHO now recom- mends exclusive breast feeding for 6 months