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Racial Disparities in Patient-Reported Baby-Friendly Breastfeeding Support.

Katherine Standish1, Afi Mansa Semenya1,2, Sojourna Ferguson3,4

  • 1Department of Family Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts.

Hospital Pediatrics
|June 17, 2026
PubMed
Summary
This summary is machine-generated.

Racial disparities in receiving the Baby-Friendly Ten Steps of breastfeeding support were observed, but disappeared when medical reasons for nonreceipt were excluded. Addressing hospital differences may improve equitable breastfeeding care.

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Area of Science:

  • Perinatal health
  • Breastfeeding support
  • Health equity

Background:

  • The Baby-Friendly Hospital Initiative promotes evidence-based breastfeeding practices through the Ten Steps.
  • Understanding racial disparities in the implementation of these steps is crucial for equitable infant care.
  • Previous research indicates potential disparities in healthcare experiences based on race.

Purpose of the Study:

  • To examine associations between patient race and self-reported receipt of the Baby-Friendly Ten Steps.
  • To determine if medical reasons for nonreceipt influence observed racial disparities.
  • To investigate variations in Ten Steps receipt between two Baby-Friendly hospitals.

Main Methods:

  • Cross-sectional study with stratified sampling of Black and white participants intending to breastfeed.
  • Online survey administered within two weeks of discharge.
  • Logistic regression used to calculate adjusted odds ratios (aORs) for receipt of Ten Steps, with and without accounting for medical reasons.

Main Results:

  • Black participants reported significantly lower odds of receiving immediate skin-to-skin contact (step 4), exclusive breastfeeding in hospital (step 6), and avoidance of pacifiers (step 9).
  • After excluding participants with reported medical reasons for nonreceipt, these significant racial disparities were no longer observed.
  • Differences in the receipt of Ten Steps were also noted between the two participating hospitals.

Conclusions:

  • Observed racial differences in Ten Steps receipt were mediated by medical reasons for nonreceipt.
  • Hospital-level factors may contribute to disparities in breastfeeding support.
  • Interventions should focus on addressing perinatal morbidity and hospital variations to promote equitable breastfeeding support.