Ethnic Inequalities in Breastfeeding among Roma and Non-Roma Women in Hungary

This study aims to examine ethnic differences in breastfeeding intentions and six-month breastfeeding among Roma and non-Roma mothers in Hungary, and to assess whether these differences are explained by demographic, socioeconomic, health-related and contextual factors within a structural inequality framework. Data were derived from the nationally representative Cohort ‘18 Growing Up in Hungary birth cohort survey (n = 7,674). Weighted logistic regression models estimated ethnic differences in (1) intention to breastfeed beyond one year (measured prenatally) and (2) breastfeeding at six months postpartum. Covariates were introduced sequentially by thematic blocks. Fairlie nonlinear decomposition was applied to quantify the contribution of compositional differences to ethnic gaps under pooled and group-specific specifications. Roma mothers were more likely than non-Roma mothers to intend prolonged breastfeeding (51.4% vs. 42.3%), yet less likely to breastfeed at six months (46.6% vs. 53.0%). After full adjustment, Roma mothers had higher odds of intending breastfeeding beyond one year (OR = 1.364; 95% CI: 1.113–1.672) and of breastfeeding at six months (OR = 1.326; 95% CI: 1.075–1.636). The initial six-month disadvantage disappeared. Decomposition showed that only 4.3% of the intention gap was explained by observed covariates. Socioeconomic factors reduced the Roma advantage (−3.5 percentage points), while maternal health factors increased it (+2.4 percentage points). In contrast, the six-month breastfeeding gap was largely driven by compositional differences, with maternal health and healthcare utilisation factors. Roma mothers express comparatively favourable intentions, but maternal health, healthcare utilisation and socioeconomic disadvantage constrain sustained breastfeeding. The findings provide little support for cultural deficit explanations and instead highlight structural maternal health inequalities as key drivers of ethnic disparities.

Key messages

• Roma mothers show stronger breastfeeding intentions, yet lower six-month breastfeeding rates; disparities are not cultural but driven by structural inequalities in socioeconomic and health conditions.

• The gap between intention and practice is shaped by maternal health and healthcare access; reducing structural barriers is essential to improve equitable breastfeeding outcomes.