SHORT COMMUNICATION Breastfeeding initiation in immigrant and non-immigrant women in Spain I Rı ´o 1 , A Castello ´ -Pastor 2 , M del Val Sandı ´n-Va ´zquez 2 , C Barona 3 , M Jane ´ 4 , R Ma ´s 3 , M Rebagliato 1 and F Bolu ´ mar 1,2 1 Division of Environmental and Reproductive Epidemiology, Spanish Network for Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain; 2 Department of Public Health Sciences, Faculty of Medicine, University of Alcala´, Madrid, Spain; 3 Department of Health, General Directorate of Public Health, Generalitat Valenciana, Spain and 4 Department of Health. Mother and Child Health Programme, General Directorate of Public Health, Catalonia, Spain Research about inequities between native and immigrant women regarding the quality of health care is still scarce. Initiation of breastfeeding in hospital is considered a quality care indicator. In this study, we explore the association between the geographical origin of the women and the establishment of breastfeeding in Spanish hospitals. Prevalence of breastfeeding initiation is higher for women from Latin America, Eastern Europe, Maghreb or sub-Saharan Africa than for Spanish women, and lower for Chinese women. Compared with Spanish women the odds of not breastfeeding in hospital were lower in all these immigrant groups but more than five times higher for Chinese immigrants. Culturally adapted health services are necessary to maintain breastfeeding rates in most immigrant groups. Moreover, it seems urgent to identify the factors influencing patterns of breastfeeding in Chinese immigrants and to develop innovative strategies to encourage breastfeeding initiation in hospital. European Journal of Clinical Nutrition (2011) 65, 1345 – 1347; doi:10.1038/ejcn.2011.121; published online 29 June 2011 Keywords: migration; breastfeeding; immigrant Migration can be decisive to improve the life of women from developing countries, but it can also be a process that increases their vulnerability and put at risk their health and the health of their progeny. Differences between immigrants and non-immigrants in some reproductive and perinatal indicators have been identified as well as in the quality of the obstetric care. Initiation of breastfeeding in hospital is considered a quality care indicator during the perinatal period. Research in Europe has shown that, in general, the frequency of breastfeeding initiation is high in immigrants, although maintenance of this type of nourishment decreases in parallel to the time of residence in the new country (De Amici et al., 2001; Merten et al., 2007; Hawkins et al., 2008). Spain is among the 10 countries receiving the largest number of international migrants. However, research on the quality of health care among immigrants is very scarce. The aim of our study was to compare rates of breastfeeding initiation in hospital between Spanish and immigrant groups living in Spain. We carried out a cross-sectional study using birth data recorded during 2005–2006 in registries of Catalonia and Valencia, two Spanish regions with the highest concentration of births from immigrant women (more than 35% of total births in 2010). A detailed description of both registries has been presented elsewhere (Rı ´o et al., 2010). Briefly, they record information supplied by public and private hospitals about childbirths (universal coverage), being the only regional source to monitoring breastfeeding patterns. In addition to data reported by nurses about the type of nourishment maintained during the stay in hospital (breastfeeding/artificial feeding), they record infor- mation about the mother’s country of origin (as reported by themselves) and about type (simple/multiple) and mode (vaginal/caesarean section) of delivery and type of hospital (public/private) as well as data about the mother’s age and newborn’s characteristics such as sex, gestational age and birth weight. We classified the women as Spanish-born or Received 3 February 2011; revised 25 May 2011; accepted 31 May 2011; published online 29 June 2011 Correspondence: Professor F Bolu ´ mar, Department of Public Health Sciences, Faculty of Medicine, University of Alcala ´, Alcala ´ de Henares, Madrid, Spain. E-mail: francisco.bolumar@uah.es Contributors: FB conceived and designed the study. CB and MJ were responsible for the acquisition of initial data. IR, AC-P and MdVS-V conducted the statistical analysis, the interpretation of data and drafted the article. All of them along with RM and MR collaborated in the interpretation of results and revised critically the manuscript. European Journal of Clinical Nutrition (2011) 65, 1345–1347 & 2011 Macmillan Publishers Limited All rights reserved 0954-3007/11 www.nature.com/ejcn