Comparison of Social Gradients in Breastfeeding Rates in Europe

This study aims to compare inequality gaps in breastfeeding rates across Europe. Breastfeeding rates were collected from: national surveys, studies under the auspices of national authorities or, failing the latter, peer-reviewed surveys. The national rates presented were collected in different years, starting in 2003 in Romania until 2015/16 in the Netherlands and Poland. Average rates were reported for all 28 EU Member States, plus Norway and Iceland. However only 19 EU Member States, Norway and Iceland, had rates that were disaggregated by level of maternal education. Only 16 of these countries had comparable data on “ever breastfeeding” rates because national data collection methods are not harmonized across Europe. The social gradient by level of maternal education and inequality gaps, between those with high and low education levels, were calculated in each of the 16 countries. A wide range of inequality gaps was found, from nearly 50% in Ireland to around 0% in Bulgaria, Poland, Romania and Norway. Inequalities were found between mothers with low, middle or high education levels and were largest in mothers with low compared with high levels. Breastfeeding initiation is lower and cessation occurs faster in mothers with low compared with high education levels. Protection policies and legislation, i.e. paternal leave, and the International Code of Marketing of Breast Milk Substitutes, may have potential to reduce inequalities compared with just implementing breastfeeding promotion alone.