1979). Before 1960, black mothers were more likely than white mothers to breastfeed. After 1960, the reverse was true because of the more rapid decline among black mothers.

The trends are somewhat more complex for mothers with different educational levels. In the 1950s breastfeeding rates were lower for women with a high school education than for those with more or less education, but by 1970, these rates varied directly with education (Hendershot, 1981; Hirschman and Hendershot, 1979). According to some observers (Meyer, 1968; Salber et al., 1958), the differences in trends for women with different educational levels represent the trickling down of values and behaviors from economically and socially advantaged women to less advantaged women. Those observers conclude that women with less education adopted formula feeding as the culmination of a trend initiated by better educated mothers earlier in the century.

Turnaround in the 1970s

The overall downward trend in breastfeeding incidence reached its nadir at 22% in 1972 (Hendershot, 1981) (Figure 3-1). The subsequent increase was not uniform across the population. Breastfeeding incidence rose among white and black mothers, although the increase was greater among whites (Hendershot, 1981). Although data on Hispanic mothers are incomplete, there are indications that their breastfeeding incidence remained stable or even continued to fall (Smith et al., 1982). The incidence rose in all education groups (Hendershot, 1981; Martinez and Nalezienski, 1981; Martinez et al., 1981). There are few data on the association between breastfeeding and income. Those from the National Survey of Family Growth indicate that breastfeeding rates remained unchanged among low-income mothers but increased among those with middle and higher incomes (Hendershot, 1981).

Duration of breastfeeding increased after 1972 as well. Approximately 10% of breastfeeding mothers continued the practice for at least 3 months in 1972, whereas approximately 20% did so in 1975 and 37% did so in 1984 (Hendershot, 1981; Martinez and Krieger, 1985; Martinez and Nalezienski, 1981; Martinez et al., 1981).

Ironically, this return to breastfeeding in the 1970s parallelled its decline in the early twentieth century. Once again, women of higher socioeconomic status were the first to adopt a "new" feeding method (breastfeeding), and their rationale was couched in scientific language, this time, focused on such issues as immunologic factors and maternal-infant bonding. Reflecting broader cultural values, many women adopted natural childbirth and, with it, what they considered natural infant feeding.

The upward trend in breastfeeding after 1972 appeared to peak in 1982 at about 61% for initiation and 40% for the percentage of mothers breastfeeding 3 months or longer. The exact zenith of the trend is difficult to pinpoint, because



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