Racial/Ethnic Disparities in Breastfeeding and Potential Mediation by Hospital Practices
Bennett, Amanda C.
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Breastfeeding is the healthiest way to feed an infant and is related in a dose-response manner to many maternal and child health outcomes. Despite this, many women do not breastfeed, do so for only short periods of time, or supplement with formula, and there is persistent variation in breastfeeding across racial/ethnic subgroups in the United States. The Baby-Friendly Hospital Initiative (BFHI) was initiated in 1991 by the World Health Organization to make hospital environments more supportive of breastfeeding. This study used secondary data from the 2004–2008 Illinois Pregnancy Risk Assessment Monitoring System to quantify racial/ethnic disparities in breastfeeding, assess the effectiveness of BFHI practices at improving breastfeeding, and to demonstrate whether differential experience of BFHI practices contributes to observed racial/ethnic disparities in breastfeeding. Several breastfeeding outcomes were defined: never breastfeeding and, among breastfeeding initiators, termination of any and exclusive breastfeeding before two, six, and twelve weeks. After adjusting for covariates, significant black-white and Hispanic-white disparities existed for never breastfeeding and exclusive breastfeeding termination before two, six, and twelve weeks, but not any breastfeeding termination. Several BFHI practices were independently associated with any and exclusive breastfeeding termination. High overall hospital breastfeeding support was strongly associated with reduced odds of any and exclusive breastfeeding termination, but was generally more protective against breastfeeding termination for white and black women than Hispanic women. High overall hospital breastfeeding support was a significant mediator of the black-white disparity (but not the Hispanic-white disparity) in exclusive breastfeeding at every time point and was a stronger mediator than any individual BFHI practice. So, while BFHI practices are effective at improving overall breastfeeding outcomes, equalizing access to such practices may not substantially change the observed racial/ethnic disparities in breastfeeding, demonstrating the needs for more targeted public health interventions. Mediation methods can be further used to understand the causes of racial/ethnic disparities in breastfeeding, inform program development, and to evaluate the effect of breastfeeding interventions.
maternal and child health