Addressing Racial Inequities in Breastfeeding in the Southern United States
Anne Merewood1, Kimarie Bugg2, Laura Burnham3
1Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts; anne.merewood@bmc.org.
Pediatrics
|January 20, 2019
Summary
Implementing the Ten Steps to Successful Breastfeeding initiative reduced racial disparities in infant breastfeeding rates. This quality improvement effort saw significant increases in breastfeeding initiation and exclusivity, especially among African American infants.
Area of Science:
- Public Health
- Maternal and Child Health
- Health Disparities
Background:
- Breastfeeding rates in the US are lowest among African American infants, highlighting existing racial disparities.
- Few studies have examined the impact of the Ten Steps to Successful Breastfeeding on racial disparities in breastfeeding rates.
- The study addresses the need to understand if initiatives can decrease racial disparities in breastfeeding.
Purpose of the Study:
- To determine if a hospital- and community-based initiative could increase compliance with the Ten Steps to Successful Breastfeeding.
- To assess if the initiative could lead to Baby-Friendly designation.
- To evaluate the initiative's impact on decreasing racial disparities in breastfeeding.
Main Methods:
- Hospitals in four Southern US states participated in the Communities and Hospitals Advancing Maternity Practices initiative (2014-2017).
- An intensive quality improvement and technical assistance intervention focused on improving compliance with the Ten Steps.
- Monthly aggregate data stratified by race on breastfeeding, skin-to-skin care, and rooming-in practices were collected.
Main Results:
- The disparity in breastfeeding initiation between African American and white infants decreased by 9.6 percentage points over 31 months.
- Overall breastfeeding initiation increased from 66% to 75%, and exclusivity from 34% to 39%.
- Initiation and exclusive breastfeeding significantly increased among African American infants (46% to 63% and 19% to 31%, respectively).
Conclusions:
- Increased compliance with the Ten Steps to Successful Breastfeeding was associated with a significant decrease in racial disparities in breastfeeding.
- The initiative demonstrated success in improving breastfeeding rates and reducing disparities.
- Skin-to-skin care and rooming-in practices were associated with improved breastfeeding outcomes, particularly for African American infants.
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