Breastfeeding Practices in Georgia: Rural-Urban Comparison and Trend Analyses Based on 2004-2013 PRAMS Data.

Purpose: The Centers for Disease Control and Prevention identified rural mothers as a priority population for targeted breastfeeding promotion programs. In Georgia, breastfeeding rates lag behind the national ones. This study examines rural-urban differences and trends over time in breastfeeding initiation and continuation (breastfeeding for at least 8 weeks) among women with a live birth from 2004 to 2013 in Georgia.

Methods: This observational study is based on the Pregnancy Risk Assessment Monitoring System data. The National Center for Health Statistics urban-rural continuum codes were used to operationalize mother's county of residence. Prevalence of breastfeeding was estimated from the logistic regression models, unadjusted and adjusted for sociodemographic and health-related characteristics.

Findings: In both unadjusted and adjusted analyses, significantly fewer rural (60.2%, 95% CI: 57.5-62.9 and 64.5%, 95% CI: 61.3-67.6, respectively) than urban (74.9%, 95% CI: 73.4-76.4 and 72.9%, 95% CI: 71.1-74.6, respectively) mothers initiated breastfeeding (P < .001). Similar rural-urban differences persisted throughout the 10-year study period-approximately 15 percentage points (pps) in unadjusted and over 8 pps in adjusted analyses (Ps < .001). Fewer rural (35.9%, CI: 32.4-39.3) than urban (44.7%, CI: 42.7-46.7) mothers continued breastfeeding, but this difference was significant overall and over time in unadjusted analyses only (P < .001).

Conclusions: Interventions increasing breastfeeding initiation in rural mothers can be expected to lead to cumulative increase in breastfeeding practices among Georgia women. Equally important, however, is to increase the rates of breastfeeding initiation in all women and support for all women to continue breastfeeding for longer duration.