New data on breastfeeding initiation across the U.S. reveal broad geographic patterns as well as local factors that can inform targeted public health interventions. The study by Tony Grubesic from the University of California Riverside and colleagues was published July 15, 2026, in the open-access journal PLOS Global Public Health.
Breastfeeding is widely recognized as having important health benefits for both mothers and infants. National initiatives such as Healthy People 2030 aim to increase rates of breastfeeding initiation and persistence in the U.S. One of the challenges toward this goal is that national statistics can mask geographic, demographic, economic, and cultural variability. At a county level, breastfeeding initiation rates varied from 22% to more than 90% in 2018-2019. Understanding this local variation is crucial to developing effective strategies to enhance breastfeeding education, community support, and, ultimately, breastfeeding initiation.
In this study, researchers analyzed county-level breastfeeding initiation data for infants born in 2018 and 2019, covering approximately 95.8% of U.S. counties. Using a multiscale geographically weighted regression (MGWR) model, they were able to gain a more accurate and nuanced understanding of breastfeeding patterns than traditional linear models, which can overlook local variation.
The study suggests that breastfeeding initiation is influenced by both broad national trends and highly localized factors. Consistent with previous studies, breastfeeding initiation rates were higher in the Northeast and along the West Coast, while lower rates were concentrated in Gulf Coast states and portions of Appalachia.
Several global trends were relatively sticky—education and race always matter regardless of geography. However, other trends were multifaceted. For example, while there was a strong positive association between breastfeeding initiation and Hispanic populations, this was primarily in the eastern U.S., not in the West or Southwest, where Hispanic populations are larger.
Overall, the study emphasizes that addressing disparities in breastfeeding initiation requires tailored, locally informed approaches in addition to national policy efforts. They also recommend 3 actionable, cost-effective strategies with a proven track record for improving breastfeeding initiation: more access to lactation consultants in hospitals; encouraging peer-to-peer breastfeeding support groups (like La Leche League); and expanding WIC eligibility and removing income restrictions for mothers seeking breastfeeding support.
The authors add: "By providing a comprehensive county-level analysis, this manuscript deepens our understanding of the structural and geographic barriers to breastfeeding initiation, which remains one of the most effective preventive health measures for reducing infant mortality and protecting mothers against chronic diseases. Furthermore, the study demonstrates that applying advanced spatial statistical modeling significantly outperforms traditional statistical methods, offering public health officials a precise, data-driven roadmap for deploying cost-effective community interventions where they are needed most."
In your coverage please use this URL to provide access to the freely available article in PLOS Global Public Health: https://plos.io/4ffuj1c
Citation: Grubesic TH, Kang W, Durbin KM, Helderop E (2026) Spatial inequalities in breastfeeding initiation in the United States: A multiscale analysis of county-level determinants. PLOS Glob Public Health 6(7): e0005659. https://doi.org/10.1371/journal.pgph.0005659
Author Countries: New Zealand, United States
Funding: The authors received no specific funding for this work.
