BACKGROUND:
Breastfeeding initiation is a key public health indicator linked to better maternal and infant outcomes, yet significant disparities persist across geographic and sociodemographic lines. This study explored the relationship between breastfeeding initiation, prenatal care timing, and geographic access to maternity care across 233 counties in Texas.

METHODS:
A cross-sectional ecological study design was employed. Using the 2021 data from the March of Dimes and the Texas Department of State Health Services, the study analyzed county-level breastfeeding initiation rates, the percentage of mothers lacking first-trimester prenatal care, and levels of maternity care access (categorized as full access, low access, or maternity care desert). Descriptive statistics, Pearson correlations, and ANOVA were employed to assess associations.

RESULTS:
The mean breastfeeding initiation rate was 82.1%, with notable variation across counties. A modest negative correlation (r = -0.20) was observed between breastfeeding initiation and delayed prenatal care. A one-way ANOVA revealed a statistically significant difference in breastfeeding initiation rates between maternity care access groups (F(1, 239) = 14.60, p < .001). For every unit of increase in access to maternity care, the breastfeeding initiation rate increased by 1.94%. A strong positive correlation (r = 0.79) was found between reported and calculated breastfeeding rates, validating data consistency.

CONCLUSIONS:
Access to maternity care and early prenatal engagement are associated with improved breastfeeding initiation. Counties classified as maternity care deserts or with high rates of delayed prenatal care may benefit from targeted interventions, including mobile health services, prenatal education, and lactation support. These findings underscore the importance of addressing structural barriers to maternal healthcare to promote equitable breastfeeding outcomes across Texas.