effect of ethnicity. In addition, it may be that the high
rates of breastfeeding in ethnically diverse areas supports
the concept of
‘
community ethnicity
’
,
20
whereby some
groups of White women appear to be more likely to
breastfeed if they reside in an area with a high BME
population. Differences in the composition of BME
populations in London compared with outside London
may also help to explain the inconsistency in the
observed effect of BME on breastfeeding.
PCTs in the most deprived quintile had a 21
–
32%
reduced odds of breastfeeding compared with PCTs in
the least deprived quintile. In London PCTs, results
were less consistent after adjustment, with area depriv-
ation only associated with breastfeeding initiation, and
this association being in the opposite direction to that
observed outside London (increased deprivation asso-
ciated with increased odds of initiation). This perhaps
highlights the complex relationships between ethnicity,
socioeconomic status and breastfeeding behaviour. BME
populations tend to cluster in more deprived neighbour-
hoods. Women from non-White backgrounds are more
likely to breastfeed. In general, mothers from lower
socioeconomic backgrounds are less likely to breastfeed.
There is evidence that this latter trend cannot be gener-
alised to mothers from non-White backgrounds.
17
Several studies have found that the effects of depriv-
ation,
17
socioeconomic status
19
and income
22
are negli-
gible when looking at breastfeeding among certain
minority ethnic groups. Outside London, both depriv-
ation and area level ethnicity remained independent
predictors of breastfeeding even after adjusting for the
other. Within London, the effect of one appeared to be
attenuated by the other, except when looking at exclu-
sive breastfeeding, which was not independently asso-
ciated with either.
Our analysis was designed to explain the variation in
breastfeeding between PCTs. Only a handful of PCTs
reported breastfeeding
fi
gures substantially above or
below the proportions predicted by our models. The
majority of outliers were PCTs with observed proportions
higher than expected based on the national average
having adjusted for sociodemographic factors, though
two PCTs did report breastfeeding initiation as being
lower than predicted and one PCT had a lower than
expected proportion of any breast