Date of Award

5-2026

Document Type

Thesis

Degree Name

Master of Science (MS)

College/School

College for Community Health

Department/Program

Nutrition and Food Studies

Thesis Sponsor/Dissertation Chair/Project Chair

Lauren Dinour

Committee Member

Yeon Bai

Committee Member

Sze Yan Liu

Abstract

Breastfeeding provides substantial health benefits for both infants and mothers and is widely recognized as the optimal method of infant feeding. Despite these benefits, breastfeeding initiation rates in the United States (US) vary across populations and are influenced by social, economic, and structural factors. Socioeconomic disparities, access to healthcare support, and employment conditions may affect a mother’s ability to initiate breastfeeding during the postpartum period. In particular, mothers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may face additional barriers that influence breastfeeding behaviors. The purpose of this thesis was to examine factors associated with breastfeeding initiation among postpartum mothers in the US, with particular attention paid to socioeconomic and structural factors affecting WIC participants. Two cross-sectional studies were conducted using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8, (2019-2020). The first study examined differences in breastfeeding initiation between mothers who received WIC benefits during pregnancy and mothers who did not receive WIC benefits. The second study evaluated the association between state-level paid maternity leave policies and breastfeeding initiation among WIC participants. Multivariate logistic regression models were used in both analyses, adjusting for maternal, sociodemographic, and birth characteristics. Study 1 indicated that mothers receiving WIC benefits had significantly lower odds of initiating breastfeeding compared to non-WIC participants (adjusted odds ratio [AOR] = 0.67, 95% confidence interval [CI] [0.60- 0.76], p < .001). Results from Study 2 demonstrated that WIC participants residing in states with paid maternity leave policies had higher odds of initiating breastfeeding compared with those in states without paid leave (AOR= 1.89; 95% CI: 1.38-2.57, p < .001). These findings show that breastfeeding disparities exist among socioeconomically at-risk postpartum mothers and highlight the role of structural factors contributing to these inequities. Expanding access to paid maternity leave may reduce these disparities and improve maternal and infant health equity.

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