Breastfeeding Practices and Experiences of Indian-Origin Mothers in the United States: An Integrative Review

BACKGROUND: Asian Indians represent one of the fastest-growing immigrant populations in the United States. Asian Indian women in the United States have one of the highest breastfeeding initiation rates (93.4%) among all racial and ethnic groups. To meet the Healthy People 2030 goal, disaggregated breastfeeding data for this subgroup are needed. Current aggregated data for Asian non-Hispanic mothers show that only 29.1% exclusively breastfeed for 6 months despite high breastfeeding initiation rates (disaggregated rates for Indian-origin mothers are not available). The dual paradox of high initiation alongside diminished sustained breastfeeding and a persistent invisibility in surveillance data highlights a critical gap in understanding the sociocultural and structural determinants of sustained breastfeeding in this population. METHODS: An integrative review was conducted using Whittemore and Knafl's integrative review methodology. Systematic searches across PubMed, CINAHL, PsycINFO, EMBASE, Web of Science, and gray literature sources retrieved 416 articles, and six studies were retained using Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The reviewers used Joanna Briggs Institute critical appraisal tools to assess the methodological quality of the studies and the Melnyk and Fineout-Overholt evidence-level framework to assess the evidence levels. RESULTS: Six key themes emerged from the data: the breastfeeding paradox, traditional cultural beliefs and practices, intergenerational and social support, health care system engagement, acculturation, and workplace demands and convenience culture. CONCLUSION: Indian-origin mothers in the United States face a distinct breastfeeding paradox driven by sociocultural and structural factors, and addressing these factors may help bridge this gap.