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Background
Assessment Goal: The purpose of this needs assessment is to assess breastfeeding among women in
Ypsilanti, Michigan.

Breastfeeding is defined as an “infant receiving only breast milk and no other liquids or solids
except for drops or syrups consisting of vitamins, minerals, or medicines” (1). It is clear that there is a
large amount of evidence about the benefits in breastfeeding that aid both the mother and the infant.
Organizations such as the American Academy of Pediatrics (AAP) and World Health Organization
(WHO) both recommend that infants be breastfed for the first 6 months continue being breastfeed while
complementary foods are added through 12 months or 2 years, respectively (1). Recent studies have
shown that breastfeeding is associated with a mother’s physical and emotional health. Some immediate
benefits include reduced infection, reduced postpartum depression, and reduced stress and anxiety, while
some long-term benefits are reduced risk of respiratory, cardiovascular, and gastrointestinal diseases (2).
In regards to the infant, breast milk has many bioactive health factors that aid in immune development,
microbiome bacterial diversity, and a decreased mortality rate when compared to formula fed infants (3).
Based on these benefits, it seems obvious that all women should be breastfeeding their children. However,
this solution is harder to achieve than expected, as many women begin breastfeeding but stop, or women
are not able to breastfeed at all, lowering our national breastfeeding continuation rates. Even with
recommendations in place for breastfeeding for 6 months, according to the CDC in 2013 “81.1% initiated
breastfeeding; 51.8% continued breastfeeding; and 30.7% continued throughout the 1st year” (4). This
reveals that there are many barriers present to mothers that need to be addressed with this trend of
declined breastfeeding. There are also clear racial disparities, with black and Hispanic groups facing more
barriers in their breastfeeding rates. For example, African American mothers are 2.5 times less likely to
breastfeed than White mothers (5). Highlighting these barriers can help to produce some solutions that
will support mothers that are having difficulties with breastfeeding.

There are many social determinants of health that affect mothers who want to breastfeed but
cannot anymore. For example, one’s income can impact whether they have access to resources that can
assist them in breastfeeding. A randomized control trial of low-income Hispanic mothers revealed that
they were concerned about breastfeeding because their diets were poor and “their breast milk would be of
low quality and lack the necessary nutrients” (6). Food insecurity from their low socioeconomic status
caused stress on the mother and created a burden in them being able to breastfeed their child. Full-time
maternal employment for the first year of the infant’s life is associated with a decrease in breastfeeding
rates when compared to mothers who are not employed. When analyzing the relationship between
employment and breastfeeding rates in mothers, it was discovered that US unemployed mothers were
more than twice as likely to breastfeed at 6 months when compared to mothers that work full time (7).
There needs to be increased support for moms who choose to breastfeed and need to work full-time so
there is not such a drastic decline in breastfeeding rates in this population. Societal barriers such as lack of
prenatal education influence breastfeeding rates: it was found that promoting breastfeeding through health
education can help to increase initiating breastfeeding rates among US mothers that are of low-income
through reassurance and improving confidence in mothers (1). When examining homeless mothers from
31 states in the US, infant birth weight was lower, and they were “significantly less likely to have a
prenatal visit during the first trimester, breastfeed their child, and have a well-baby checkup” (8).
Homelessness can engender many barriers to mothers that want to breastfeed their children, such as a lack
of resources and support for breastfeeding, as well as transportation for visits. There is a clear association
between lack of transportation and health education. From 25 separate studies on transportation and health
care access, it was found that “10-51% of patients reported that transportation was a barrier to health care
access” (9). Furthermore, regarding missing clinic appointments, 51% of parents stated that the primary
reason for missing their clinic appointment was due to lack of transportation access (9). Since
transportation and prenatal education is important for new mothers that want to breastfeed, barriers to
transportation would prove to be difficult for these mothers. Lastly, the role of maternal education on
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breastfeeding shows that increased education level increases breastfeeding duration. A study on the
relationship between maternal age and breastfeeding duration in US mothers found that “education
attainment accounts for a significant portion of the association between age and total breastfeeding
duration (77.8%)” (10). Moreover, the duration of exclusive breastfeeding was 3.6 weeks for mothers less
than 20 years, while mothers over 30 were averaging 9.5 weeks (10). Overall, higher education can
possibly lead to increased access to resources, knowledge on breastfeeding and how to find extra support,
leading them to have more increasing breastfeeding duration.

Community stakeholders that should be included in this needs assessment include Trinity Health
IHA Medical Group on Breastfeeding Medicine, Luminary Lactation Support, and St. Joseph Mercy
Hospital in Ypsilanti. All three of these agencies provide support for moms that need help with
breastfeeding. St. Joseph Mercy Hospital provides free services including a breastfeeding club and
preparation class to help educate mothers on breastfeeding techniques. Both Trinity Health IHA Medical
Group and Luminary Lactation support are clinics that provide lactation and medical knowledge to
educate mothers on breastfeeding.

Population Data

Ypsilanti, Michigan is located in Washtenaw County, with a total population of 20,792 based on
census data from 2020. Table 1 describes the age distribution in Ypsilanti, Michigan, including female
population and percentage. Approximately twenty-three percent of the overall population make up 20 to
24 year old individuals, representing the largest proportion of Ypsilanti residents. Of the total population,
48.4% identify as female and 51.6% identify as male.

Table 1: Distribution of Age in Ypsilanti, Michigan

Age Ypsilanti Population Ypsilanti Population (%)
Total population 20,792
Female 10,054 48.4%
Under 5 years 1,123 5.4%
5 to 9 years 800 3.8%
10 to 14 years 739 3.6%
15 to 19 years 3,003 14.4%
20 to 24 years 4,863 23.4%
25 to 34 years 3,801 18.3%
35 to 44 years 1,865 9.0%
45 to 54 years 1,382 6.6%
55 to 59 years 769 3.7%
60 to 64 years 821 3.9%
65 to 74 years 953 4.6%
75 to 84 years 387 1.9%
85 years and over 286 1.4%
Source: US Census Bureau, 2020 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=ypsilanti,%20michigan&tid=ACSDP5Y2020.DP05
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Ypsilanti and Michigan were compared on identification of Race and Ethnicity, shown in Table 2.
In both Ypsilanti and Michigan, the majority of individuals have identified themselves at White (60.5%
and 74.5%, respectively). Ypsilanti has a larger proportion of residents who identify as Black or African
American (26.5%) in comparison to Michigan (13.5%). Hispanic or Latino and Asian populations have
similar percentages between Ypsilanti and Michigan, with Ypsilanti having a slightly higher percentage of
Hispanic/Latino identifying residents (6% to 5.2%, respectively), and a slightly lower percentage of Asian
identifying residents (2.7% to 3.2%, respectively). In the United States, breastfeeding rates are
significantly lower in Black and Hispanic/Latino races compared to other races (5).

Table 2: Race/Ethnicity Percent Population Distribution in Ypsilanti and Michigan

Race/Ethnicity Ypsilanti Michigan
Hispanic or Latino (of any race) 6% 5.2%
White 60.5% 74.5%
Black or African American 26.5% 13.5%
American Indian and Alaska
Native NA 0.4%
Asian 2.7% 3.2%
Native Hawaiian and Other
Pacific Islander NA NA
Some other race alone NA 0.3%
Source: US Census Bureau, 2020 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=ypsilanti,%20michigan&tid=ACSDP5Y2020.DP05
NA - insufficient sample or small sample

Table 3 outlines the percentage distributions between the city of Ypsilanti and the state of
Michigan on Race and educational attainment based on obtaining a High School degree or higher or
Bachelor’s degree or higher. In both Ypsilanti and Michigan, residents who identify as White have the
highest percentage of obtaining a High School degree or higher. Both Black and Asian individuals in
Ypsilanti have very similar percentages in reporting a High School degree or higher, while in Michigan
Asian individuals have a higher reporting of a High School degree. In some other race alone, Ypsilanti has
100% of its residents completing a High School degree, while Michigan has only 69.50%, respectively. In
regards to Bachelor’s degree or higher, Asian individuals in both Ypsilanti and Michigan have the highest
percentage of obtainment. In addition, Black individuals in Ypsilanti have the lowest percentage of
reporting a Bachelor’s degree or higher. Higher breastfeeding rates are associated with higher educational
attainment of the mother, as she has more access to resources and support on breastfeeding (10).
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Table 3: Distribution of Education Attainment in Ypsilanti by Race

Education Level Ypsilanti Michigan
High School Bachelor's degree High School degree Bachelor's degree
Race degree or higher or higher or higher or higher
White 96.5% 53.6% 93.0% 31.1%
Black 87.4% 20.8% 86.9% 17.9%
American Indian and
Alaska Native NA NA 85.8% 13.5%
Asian 87.1% 71.3% 89.2% 64.3%
Native Hawaiian and
Other Pacific Islander NA NA 81.2% 22.1%
Hispanic or Latino
Origin 83.8% 49.1% 74.8% 20.6%
Two or More Races 86.5% 34.5% 88.8% 29.1%
Source: US Census Bureau, 2020 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=ypsilanti,%20michigan%20educational%20attainment&g=0400000US26&tid=ACSST5Y2020.S1501&m
oe=false
NA - insufficient sample or small sample

Table 4 indicates unemployment rates in Ypsilanti and Michigan based on identification of race.
Unemployment rate is higher in Ypsilanti for both those who identified as White (8%) and Asian (13%)
when compared to Michigan. On the other hand, Michigan’s highest rate of unemployment were those
who identified as Black (12.9%). Mothers who are full-time unemployed have lower rates of
breastfeeding, limiting them from the known benefits to breastfeeding (7).

Table 4: Unemployment status percentage by Race/Ethnicity in Ypsilanti and Michigan

Race Ypsilanti Michigan
White 8.0% 4.8%
Black 11.0% 12.9%
American Indian and Alaska
Native NA 8.0%
Asian 13.0% 4.3%
Native Hawaiian and Other
Pacific Islander NA 3.3%
Hispanic or Latino 2.6% 7.2%
Two or More Races 4.4% 9.2%
Source: US Census Bureau, 2020 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=Ypsilanti%20city,%20Michigan%20S2301&g=0400000US26&tid=ACSST5Y2020.S2301&moe=false
NA - insufficient sample or small sample

When analyzing Figure 1 below of the median annual income between Ypsilanti and Michigan by
race, the total median annual income in Ypsilanti and Michigan are $39,332 and $57,144, respectively. In
Ypsilanti, Asian residents have the highest annual median income of $49,844, followed closely by White
residents ($46,276). Similarly, Asian residents in Michigan also have the highest annual income of
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$86,611. Those who identified as two or more races had the lowest median annual income in Ypsilanti
($26,044) and Black individuals reported to have the lowest median annual income in Michigan
($35,322). Data was not available for American Indian and Alaska Native and Native Hawaiian and Other
Pacific Islander residents in Ypsilanti. In regards to breastfeeding rates, low-income women do not have
access to as many resources, which can create barriers to breastfeeding (6).

Figure 1: Median Annual Income in Dollars in Ypsilanti and Michigan by Race (in dollars)

Source: US Census Bureau, 2019 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=Ypsilanti%20city,%20Michigan%20S1903&g=0400000US26&tid=ACSST5Y2019.S1903&moe=false

Table 5 highlights the percentage of the adult population for Ypsilanti and Michigan who are
living below the poverty line by sex and age. Ypsilanti has a higher percentage of females and all adult
groups who are below the poverty level when compared to Michigan. The proportion of adults aged 18-34
who are living below the poverty line in Ypsilanti is almost double the proportion of adults aged 18-34
who are living below the poverty line in Michigan. This age group reflects many women who are
pregnant and who are facing barriers to breastfeeding because they are living below the poverty line. This
population is less likely to breastfeed their child and have access to go to appointments for them and their
baby (8).
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Table 5: Percentage of Population Living Below the Poverty Line in Ypsilanti and Michigan
Below Poverty Level (%)
Sex and Age Ypsilanti Michigan
Male 27.4% 12.6%
Female 32.4% 14.8%
18-34 years 34.8% 17.9%
35-64 years 22.6% 10.9%
60+ years 19.2% 9.0%
65+ years 14.6% 8.5%
Source: US Census Bureau, 2020 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=Ypsilanti%20city,%20Michigan%20poverty&g=0400000US26&tid=ACSST5Y2020.S1701&moe=false

The table below describes housing instability in Ypsilanti and Michigan based on owning or
renting occupied housing units (Table 6). Overall, Ypsilanti had a greater percentage of renter-occupied
housing units while Michigan had a greater percentage of owner-occupied housing units. In regards to
households composed of married-couples, in both Michigan and Ypsilanti there are greater percentages of
these families owning their housing units. When the female is the householder without a husband present,
she will more likely be renting a housing unit in Ypsilanti while owning a property in the state of
Michigan. Mothers who have housing instability or are homelessness have lower breastfeeding initiation
rates, as this is also correlated with decreased education and employment status (12).

Table 6: Housing Instability in Ypsilanti and Michigan

Ypsilanti Michigan
Housing
Instability Owner-occupied Renter-occupied Owner-occupied Renter-occupied
housing units housing units housing units housing units
Total 34.5% 65.5% 71.7% 28.3%
Married-couple
family household 67.5% 32.5% 88.1% 11.9%
Female
householder, no
husband present 32.4% 67.6% 54.3% 45.7%
Source: US Census Bureau, 2020 American Community Survey 5-yr estimate; data available at:
https://data.census.gov/cedsci/table?q=ypsilanti,%20michigan%20housing%20S1101&g=0400000US26&tid=ACSST5Y2020.S1101&moe=false

Health Data

Table 7 describes the top ten leading causes of death in rates per 100,000 people for Washtenaw
County, Michigan, and the United States. For all causes of death, Michigan has the highest mortality rate
of 913.8, followed by the United States with 830.5 and Washtenaw county with 701.8. Heart disease is the
leading cause of death in all three areas with Michigan also having the highest rate (206.0) compared to
Washtenaw County (163.3). However, Washtenaw’s age-adjusted mortality rate for Stroke and
Alzheimer’s Disease is higher than Michigan’s.
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Table 7: Number of Deaths and Age-Adjusted Mortality Rates for the Ten Leading Causes of
Death, Washtenaw County, Michigan and United States Residents, 2020 (Rates are per 100,000)

Source: Michigan Department of Health and Human Services, Mortality Characteristics 2020; data available at:
https://vitalstats.michigan.gov/osr/CHI/deaths/frame.asp

The table below describes the age-adjusted mortality rates in Michigan per 100,000 based on the
ten leading causes of death as well as gender and race. Michigan was chosen instead of Washtenaw
county or Ypsilanti because there was enough data collected for Michigan. When examining all races,
males have the highest mortality rate for all causes of death compared to females. Furthermore, Black
residents have the highest rate in all-cause mortality and all causes of death except Alzheimer’s disease
compared to all races and White alone.
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Table 8: Age-Adjusted Mortality Rates for Ten Leading Causes by Sex and Race in Michigan 2020
(Rate per 100,000)

Source: Michigan Department of Health and Human Services, Mortality Characteristics 2020; data available at:
https://vitalstats.michigan.gov/osr/CHI/deaths/frame.asp

Table 9 explains the crude rate per 100,000 of chronic disease via hospital discharges for
Washtenaw County and Michigan. Washtenaw has higher crude rates for all chronic diseases shown when
compared to the state. Stroke for ages 65 and above has the highest crude rate for both Washtenaw County
and Michigan, and congestive heart failure for all ages has the lowest crude rate. In addition to the crude
rates, it is important to note that age-adjusted mortality rates for all cancers in Washtenaw County is 438.8
and Michigan is 441.9 (13).
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Table 9: Chronic Disease Hospital Discharges, 2018-2020

Washtenaw County Michigan
Chronic Disease Hospital Discharges (Crude Rate)
Acute Myocardial Infarction 123.2 79.4
Congestive Heart Failure (all
ages) 31.8 11.0
Congestive Heart Failure (65+) 144.9 39.8
Stroke (all ages) 214.5 108.7
Stroke (65+) 1,060.20 410.2
Arthritis (45+) 717.6 289.3
Asthma 37.5 17.2
Diabetes 152.2 76.2
Hip Fractures (65+) 234.7 77.9
Osteoporosis (65+) 1,618.70 536.3
Source: Michigan Department of Health and Human Services, Mortality Characteristics 2020; data available at:
https://vitalstats.michigan.gov/osr/chi/profiles/frame.html

Weight status of adults in Washtenaw County and Michigan was examined from 2015 data (Table
10). Body Mass Index, or BMI, of gender and race were compared. BMI was calculated from
self-reporting height and weight, with a BMI of 25-29.9 classified as overweight and a BMI greater than
or equal to 30 classified as obese. In both Washtenaw County and Michigan, Males have a greater
percentage of being classified as overweight than Females. Furthermore, there is a greater percentage of
Black individuals that are classified as obese when compared to White and Asian residents.

Table 10: Weight Status Percentage of Adults in Washtenaw County and Michigan
Washtenaw County Michigan
Overweight Obese Overweight Obese
Male 42.7% 21.4% 40.3% 31.7%
Female 25.4% 22% 29.8% 30.6%
White 35.9% 21.5% 36% 29.7%
Black 27.5% 36.2% 32.7% 40.2%
Asian 33.5% 1.9% 30% NA
Hispanic or Latino 37.5%* 28.3%* 29.40% 41%
Source: CDC BRFSS Prevalence & Trends Data 2015, Washtenaw County Community Health Data 2015; data available at:,
https://www.michigan.gov/mdhhs/inside-mdhhs/statisticsreports, https://www.washtenaw.org/1908/Health-Improvement-Plan-HIP-Survey-Data
* Data for Hispanic or Latino was collected in 2014 for Washtenaw County Community Health Data
NA - insufficient sample or small sample

Figure 2 represents percentages of adults who have ever been told they have high cholesterol with
data collected in 2015 from both Washtenaw County and Michigan*. For gender and all races, Washtenaw
County had lower percentages of high cholesterol compared to the percentages in the state of Michigan.
In addition, in both Washtenaw County and Michigan, Asian residents had the lowest percentage of high
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cholesterol (11.8% and 26.5%, respectively), while White residents had the highest percentage of being
told they had high cholesterol (24.4% and 39.6%, respectively).

Figure 2: Percentage of Adults With High Cholesterol in Washtenaw County and Michigan

Source: CDC BRFSS Prevalence & Trends Data 2015, Washtenaw County Community Health Data 2015; data available at:
https://www.michigan.gov/mdhhs/inside-mdhhs/statisticsreports, https://www.washtenaw.org/1908/Health-Improvement-Plan-HIP-Survey-Data
* Data for Hispanic or Latino was collected in 2014 for Washtenaw County Community Health Data

Nutrition Data

Table 11 exhibits fruit and vegetable consumption in Washtenaw Country from 2010 to 2015,
which is broken down by gender and race. Percentages of fruit and vegetable intake are split into those
who have less than five servings of fruits and vegetables per day, or five or more servings per day, which
is the recommended daily intake. In all males and females, regardless of race, there is a majority of
individuals reporting that they eat less than the recommended daily intake of fruits and vegetables. From
2010 to 2015, there is an increase in individuals reporting that they eat five or more servings of fruits and
vegetables. However, those who identified as Black males actually had a drastic decrease of eating the
recommended daily intake across the years, dropping from 33.3% to 7.7% of individuals reporting eating
five or more servings per day. While both White and Black females had an overall increase in eating the
recommended daily intake of fruits and vegetables, White females have a greater reporting percentage
compared to Black females in 2015.
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Table 11: Fruit and Vegetable Consumption in Washtenaw County

2010 2015
Gender and Race/Ethnicity Less than 5 5 or more times Less than 5 5 or more times
times per day per day times per day per day
White 85% 15% 81.3% 18.7%
Males Black 66.7% 33.3% 92.3% 7.7%
Asian 72.9% 27.1% 67.3% 32.7%
White 83.3% 16.7% 73% 27%
Females Black 82.7% 17.3% 77.7% 22.3%
Asian NA NA 83% 17%
Source: Washtenaw County Community Health Data 2015; data available at:
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2010/FruitRec?category=Adult&groupby=sex&subgroup=Racecat3
NA - insufficient sample or small sample

Table 12 describes food insecurity percentages from 2020 between Washtenaw County and the
state of Michigan while also comparing race and ethnicity. Washtenaw County has a lower food insecurity
rate than Michigan (10.4% and 11.5%, respectively). More individuals who identify as Black and
Hispanic or Latino in both Washtenaw County and Michigan are food insecure when compared to White
individuals. In Washtenaw County, 9% of White residents are food insecure while 23% of Black residents
are food insecure and 18% of Hispanic or Latino residents are food insecure. Overall, Black and Hispanic
or Latino residents in Washtenaw County have lower food insecurity rates in comparison to Michigan
Black and Hispanic or Latino residents, while White residents had the same food insecurity rate in both
Washtenaw County and Michigan.

Table 12: Food Insecurity Percentage for Washtenaw County and Michigan
Washtenaw County Michigan
Population Food Insecurity 10.4% 11.5%
White 9% 9%
Black 23% 26%
Hispanic or Latino 18% 20%
Source: Feeding America Food Insecurity, 2020; data available at:
https://map.feedingamerica.org/?_ga=2.139109747.1901289657.1665777131-573098241.1665777129

The figure below represents percent changes from 2010 to 2015 on access and proximity to
grocery stores in Washtenaw County based on household resources (Figure 3). Across the five year
follow-up, each household indicator had a decrease in the population in access and proximity to grocery
stores. Households with no car and low access to stores had the greatest percentage decrease of 24.76%,
individuals with low income and low access to stores had a percent decrease of 11.87%, and the general
population of Washtenaw with low access to stores had a percent decrease of 9.14%.
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Figure 3: Access and Proximity to Grocery Stores Percentage Change from 2010-2015 in
Washtenaw County

Source: USDA Food Environment Atlas 2010-2015; data available at:

https://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas/

Table 13 looks at the amount of fast food restaurants in Washtenaw County in 2011 and 2016 as
well as the percent change in these years. There has been an increase in fast-food restaurants and
full-service restaurants built from 2011 and 2016. However, there has been a much greater change in
fast-food restaurants being built (14.3%) when compared to the percent change of full-service restaurants
(5.1%) from 2011 to 2016.

Table 13: Fast-food Restaurants and Full-service Restaurants in Washtenaw County

Quantity 2011 2016 % change 2011-2016
Fast-food restaurants 252 288 14.3%
Full-service restaurants 275 289 5.1%
Source: USDA Food Environment Atlas, 2011-2016; data available at:
https://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas/

Figure 4 examines breastfeeding rates in Michigan and the United States in 2019. Exclusive
breastfeeding was defined as only breast milk without the supplementation of solids, water, or other
liquids (11). In the United States, the majority of mothers reported any breastfeeding (83.2%) and
breastfeeding at 6 months (55.9%). Similarly, in Michigan, 83.1% of mothers reported ever breastfeeding,
and 53.7% reported breastfeeding at 6 months. Michigan has lower exclusive breastfeeding rates through
3 months when compared to the United States (42.6% and 45.3%, respectively), while having
approximately the same rates of exclusive breastfeeding through 6 months. Overall, there is a clear
decrease in breastfeeding rates among mothers as time increases. According to the US Dietary Guidelines
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for Americans, it is recommended that infants be exclusively breastfed for the first 6 months, then
continued breastfeeding with supplementation of foods and other liquids until 12 months or older (11).

Figure 4: Percentage of Breastfeeding Rates in Michigan and the US in 2019

Source: CDC Breastfeeding Rates by State and US, 2019; data available at: https://www.cdc.gov/breastfeeding/data/nis_data/results.html

Table 13 dives into breastfeeding rates by race and ethnicity for the United States. There was not
any data provided for race and ethnicity breastfeeding rates by state. Again there is a clear decline in
breastfeeding rates as time passes for any breastfeeding and exclusive breastfeeding for all races. Black
mothers have the lowest breastfeeding rates when compared to all other races. Approximately twenty-four
percent of Black mothers will breastfeed their infant after 12 months, while White, Asian and Hispanic or
Latino mothers will breastfeed their infants at higher rates at 12 months (39.4%, 45.7%, 33.2%,
respectively). In addition, the lowest percentage of mothers who were exclusively breastfeeding their
infant through 6 months were Black mothers (19.1%), while Asian mothers reported as having the highest
percentage of exclusive breastfeeding at this time (28.5%).
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Table 13: Combination and Exclusive Breastfeeding Rates in the United States
Any Breastfeeding Exclusive breastfeeding
Exclusive Exclusive
breastfeeding breastfeeding
Breastfed at 6 Breastfed at 12 through 3 through 6
Race/Ethnicity Ever breastfed months months months months
White 85.3% 59.9% 39.4% 49% 26.9%
Black 74.1% 44% 24.1% 36.3% 19.1%
Asian 90.8% 70.2% 45.7% 42.5% 28.5%
Hispanic or
Latino 83% 51.4% 33.2% 43.8% 23.5%
2 or more races 82.7% 57.1% 38.1% 47.4% 27%
Source: CDC Breastfeeding Rates by Sociodemographic, 2019; data available at:
https://www.cdc.gov/breastfeeding/data/nis_data/data-files/2019/rates-any-exclusive-bf-socio-dem-2019.html
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Priorities

This community assessment can help understand how to address unmet needs in the community
of Ypsilanti in regards to breastfeeding and additional health and nutritional indicators. Women make up
48.4% of Ypsilanti's total population. Ypsilanti is largely composed of those who identify as White,
however has a larger proportion of Black residents compared to the state of Michigan. Regarding
educational attainment, Black residents were less likely to get a bachelor’s degree or higher when
compared to all other races, highlighting racial inequities in education. Ypsilanti had a lower median
annual income than Michigan, and those who identify as Black, Hispanic or Latino, and two or more
races had lower median incomes than the overall median household income in the city. There is a greater
percentage of females that are living before the poverty line in both Ypsilanti and Michigan compared to
males. In addition, there is a greater proportion of single female householders in Ypsilanti that rent
housing units while in Michigan there is a greater proportion who own housing units.

For the ten leading causes of death except stroke and Alzheimer’s disease, Washtenaw County
had lower age-adjusted mortality rates compared to Michigan and the United States. Washtenaw County
had much higher crude rates than Michigan for chronic disease hospital discharges. This could be because
during this time period the county could have had more cases of chronic disease than Michigan overall,
increasing the crude rate. This drastic increase in crude rates for all chronic disease in Washtenaw shows
that there is an unmet health need in the community. In Washtenaw County, there are a greater proportion
of Black residents that are obese compared to all other races. For all races, there is a much lower
proportion of individuals who have been told they had high cholesterol in Washtenaw County compared
to Michigan.

There is an unmet need for proper fruit and vegetable intake in Washtenaw County, where for all
races there is not a majority who have had five or more servings of fruits and vegetables daily. Food
insecurity rates for Washtenaw County are lower compared to Michigan, however, Black individuals have
a much higher food insecurity in both areas compared to all other races. There was a decrease in the
population of individuals in Washtenaw County who have low access to stores from 2010 to 2015,
including those who are low income, which is promising. However, there has been a much greater
increase in fast-food restaurants built, allowing more non-nutritionally foods to be available to the
community. Lastly, Michigan has lower averages for mothers who breastfeed at six months, twelve
months, and those exclusively breastfeeding through three months compared to the national average.
Moreover, Black mothers have lower breastfeeding rates than all other races.

To address breastfeeding rates among women in Ypsilanti, there are clear racial disparities in the
community. While all other races have ever breastfed above 80%, Black mothers are still behind these
averages with breastfeeding rates. Other nutritional and health determinants can put these minority groups
at a disadvantage for breastfeeding. For example, food insecurity in both Black and Hispanic or Latino
groups are double or more than those who are White in both Washtenaw County and Michigan. In
addition, those who identify as Black, Hispanic or Latino, and two or more races have the lowest median
annual income in Ypsilanti and income that falls below the state median household income. Low income
mothers who have increased food insecurity adversely affects breastfeeding rates as there is limited food
and portion sizes available (6). In Washtenaw County, Black residents reported as being the highest
proportion of individuals who were obese. There is also a clear educational disparity, where in Ypsilanti
those who are Black and two or more races have the lowest percentage of obtaining a Bachelor’s degree
or higher. Prioritizing these minority groups in the community can help to reduce nutritional and health
concerns while ultimately increasing breastfeeding rates. Furthermore, increased education to these
groups can help break down the mistrust, misinformation, and barriers to breastfeeding (12).
 16

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