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Breast feeding initiation rate across Western countries: does religion matter? An ecological study
  1. Jonathan Y Bernard1,2,3,
  2. Emmanuel Cohen4,5,
  3. Michael S Kramer6,7,8
  1. 1Inserm, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Developmental Origins of Health and Disease (ORCHAD) Team, Villejuif, France
  2. 2Paris Descartes University, France
  3. 3Paris-Sud University, Faculty of medicine, Kremlin-Bicêtre, France
  4. 4CNRS, UMI 3189 Environnement, Santé, Société, Faculté de Médecine Secteur Nord, Marseille, France
  5. 5CNRS, UMR 7206 Eco-anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, Paris, France
  6. 6McGill University, Departments of Pediatrics, Montréal, Québec, Canada
  7. 7McGill University, Departments of Epidemiology, Biostatistics and Occupational Health, Montréal, Québec, Canada
  8. 8National University of Singapore, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, Singapore
  1. Correspondence to Dr Jonathan Y Bernard; jonathan.bernard{at}inserm.fr

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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2016-000151

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    Footnotes

    • Handling editor Soumitra Bhuyan

    • Contributors JYB designed the study, collected and analysed the data and wrote a first draft of this manuscript. EC and MSK provided input in study design, data analysis and manuscript writing. All authors interpreted the results, revised the manuscript and approved the final version to be submitted. JYB confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.

    • Competing interests None declared.

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

    • Data sharing statement The data collected online and used in this manuscript can be shared by the authors on request.