Breastfeeding African American and Latino Teenage Parents Playing With Baby

Breastfeed Med. 2015 May i; 10(4): 186–196.

Racial and Indigenous Disparities in Breastfeeding

Katherine M. Jones

¹Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C.

^twoDepartment of Psychology, American University, Washington, D.C.

Michael L. Power

¹Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C.

John T. Queenan

³Section of Obstetrics and Gynecology, Georgetown Academy School of Medicine, Washington, D.C.

Jay Schulkin

^aneDepartment of Inquiry, American Higher of Obstetricians and Gynecologists, Washington, D.C.

Abstruse

This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, accost barriers to breastfeeding among minority women, deport a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they tin help increase rates among minority women. In guild to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers amongst minority women was reviewed, and a systematic review of breastfeeding interventions amidst minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to accept lower breastfeeding rates than white women and are not close to coming together the Good for you People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are however needed to improve breastfeeding initiation and duration rates among minority women in the The states. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the hereafter health of the female parent and kid.

Introduction

It is well established that breastfeeding is beneficial for the mother, baby, and guild; however, the proportion of mothers breastfeeding in the United States is disappointing.^ane Recognizing the importance of breastfeeding, the U.S. Department of Health and Human Services sets forth national breastfeeding objectives for women every decade. The Healthy People 2010 initiative set the following goals for breastfeeding: 75% of all mothers to initiate breastfeeding, with 50% continuing for at least six months postpartum and 25% continuing to 1 year as well as 40% exclusively breastfeeding at 3 months and 17% exclusively at 6 months. The only national objective for Good for you People 2010 that was met was that 75% of new mothers initiated breastfeeding.² Even so, national rates of continued breastfeeding at 6 and 12 months and rates of exclusive breastfeeding at 3 and six months savage well beneath public health recommendations (Table ane).

Table 1.

Healthy People 2010 and 2020 Goals and Centers for Affliction Control and Prevention Data from 2007 on Racial and Ethnic Breastfeeding Initiation and Continuation ^2,3

		Breastfeeding
Race/ethnicity	north	Always	At 6 months	At 12 months
Healthy People 2010 Goals		75%	50%	25%
American Indian or Alaska Native	552	73.8±half-dozen.nine	42.4±8.8	20.7±7.0
Asian or Pacific Islander	1,077	83.0±5.2	56.4±half dozen.3	32.8±6.5
Asian	886	86.4±v.7	58.6±7.1	34.viii±7.v
Native Hawaiian and other	239	72.iv±eleven.1	45.3±12.one	23.9±ten.8
African American	two,606	59.7±2.9	27.9±ii.v	12.ix±1.9
White	13,425	77.7±one.ii	45.1±1.5	23.half dozen±1.iii
Hispanic	2,895	80.six±2.4	46.0±3.1	24.7±ii.8
Healthy People 2020 goals		81.ix%	61%	34%

Based on the more ambitious Healthy People 2020 objectives, the gap has grown fifty-fifty wider between breastfeeding outcomes and Centers for Illness Control and Prevention goals (Tabular array one). Asian women are currently the but racial/ethnic group coming together the Healthy People 2020 goal of breastfeeding initiation of 81.9%, although Hispanic women are very shut, with certain subgroups of Hispanic women coming together this objective.³ African American women have the lowest rates of breastfeeding initiation, as well as continuation at vi months and 12 months, compared with all other racial/ethnic groups in the United States. No racial/ethnic group is currently meeting the Healthy People 2020 objectives for continued breastfeeding at 6 months (61%) and 12 months (34%) and exclusive breastfeeding at 3 months (46%) and six months (26%).^three

Mothers with lower rates of breastfeeding tend to be young, low-income, African American, unmarried, less educated, participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC), overweight or obese earlier pregnancy, and more likely to report their pregnancy was unintended.^four–7 These concluding two points are important to highlight because African American and Hispanic women have the highest rates of being overweight or obese and the largest number of unintended pregnancies.⁸

The Importance of Breastfeeding for Minority Women

Breastfeeding is benign to almost all mothers and infants, simply the benefits may be significantly greater for minority women.⁹ Minority women are disproportionately affected by adverse wellness outcomes, which may improve with breastfeeding.^ten Relative to white women in the United States, African American and Hispanic women have increased rates of obesity, diabetes, and cardiovascular disease.^11,12 Women who breastfeed exclusively are more likely to lose weight postpartum than women who breastfeed nonexclusively and formula-feed.^xiii,14 Some studies also suggest that breastfeeding may subtract the gamble for obesity in the infant during childhood.^fifteen Longer breastfeeding duration has as well been associated with reduced incidence of blazon 2 diabetes in the mother.^xvi Inquiry suggests that breastfeeding may reduce a female parent's gamble of hypertension, hyperlipidemia, and cardiovascular affliction.^17,18 Lastly, minority women have greater rates of unintended pregnancy.¹⁹ Sectional breastfeeding on a strict, routine schedule tin can reduce fertility by inducing amenorrhea, thus delaying ovulation and increasing the interval betwixt offspring.^twenty

Racial and Ethnic Disparities in Breastfeeding

African American women

African Americans continue to have the lowest rates of breastfeeding initiation (60%) and continuation at 6 months (28%) and 12 months (xiii%) compared with all other racial/ethnic groups in the United states of america.³ Although improvements in breastfeeding rates for African American women are axiomatic from the 2000–2007 National Immunization Survey (Figs. 1 and ​ 2), African American mothers are even so two.v times less probable to breastfeed than white women.²¹ A 16 percentage-point gap in the prevalence of continued breastfeeding for 6 months has been consistent since 1990 betwixt African American and white women.² African American women (32%) are also more probable than near minority groups to provide formula supplementation by ii days of life.²² Currently, African American women are not meeting any of the Healthy People 2020 objectives for breastfeeding (Table ane).

Rates of initiation of breastfeeding past race/ethnicity from 2000 to 2007.

Rates of breastfeeding at 6 months by race/ethnicity from 2000 to 2007.

Hispanic women

Although Hispanic women have the highest rates of breastfeeding initiation and continuation among all women in the The states, there remain some ethnic health disparities among Latina mothers and children that are worth noting.³ Hispanic mothers are not soon meeting Healthy People 2020 objectives for postpartum breastfeeding continuation and exclusive breastfeeding.²² Hispanic mothers (33%) are slightly more probable than other racial/ethnic groups to provide formula supplementation every bit early as 2 days of life.²² Compared with white women, Hispanic and African American mothers are more probable to introduce solid foods before 4 months of age, accept higher rates of maternal restrictive feeding practices, and lower rates of exclusive breastfeeding.²³

There is show for pregnant variation in breastfeeding practices among ethnic subgroups of Hispanic women. However, U.S. national information do not typically written report breastfeeding rates for individual subgroups, which can mask big between-group variation.²⁴ For example, breastfeeding rates are significantly higher for Mexican Americans than for Puerto Ricans.²⁵ Chapman et al.²⁶ institute significantly lower rates of breastfeeding continutation amidst Puerto Ricans (median breastfeeding elapsing, <0.5 months) compared with Hispanic women from other Spanish-speaking countries (median breastfeeding elapsing, >6.0 months). Moreover, differences in breastfeeding patterns accept been noted amid Hispanic women living in western versus eastern states. Compared with white women, Hispanic women have lower rates of breastfeeding when living in western states but accept college rates when living in eastern states.^two

Another major cistron impacting Hispanics' decision to breastfeed is their level of acculturation. There has been some disagreement within the literature regarding the association between acculturation and breastfeeding practices amidst Hispanic women. Beck²⁷ reviewed the perinatal literature from 1990 to 2005 on the clan between acculturation and breastfeeding among Hispanic women. Several studies examining this association establish a negative relationship between acculturation and likelihood of breastfeeding.^28–31 Rassin et al.²⁸ found that least acculturated Mexican Americans had the highest rates of breastfeeding initiation (52.9%), whereas those who were almost acculturated exhibited the lowest rates of breastfeeding initiation (36.1%). Several other studies have likewise found prove that Hispanic breastfeeding rates decrease with greater acculturation.^29–31 Anderson et al.³² did not find any association between level of acculturation and breastfeeding rates amidst Puerto Rican women relative to Mexican American women living in the Us. The authors explained that their results could exist due to differences in breastfeeding background and civilisation, in add-on to varying breastfeeding back up systems in the state of origin.

These results provide further evidence that Hispanic subpopulations are notably heterogeneous. Rates for exclusive breastfeeding at half-dozen months are 97% in Chile, 96% in Republic of ecuador, 95% in Colombia, 59% in Republic of bolivia, 38% in United mexican states, and 10% in the Dominican Republic.³³ Breastfeeding attitudes are often carried over to the United States when Latinas emigrate, and rates amidst these women living in the Us may be strongly influenced by the background rate in their country of origin.

American Indian/Alaska Native women

The current literature on breastfeeding patterns amid American Indian/Alaska Native (AI/AN) mothers is scarce, thus warranting further research. Based on the limited information, AI/AN mothers have lower rates of breastfeeding initiation, duration, and exclusivity relative to other racial/ethnic groups except for African Americans.³ Apart from African American women, breastfeeding duration and exclusivity rates decline faster amidst AI/AN women than amid other racial/indigenous groups.³ AI/ANs have the second lowest rates of breastfeeding initiation (73.8%) among all races/ethnicities post-obit African American women (59.vii%), also equally the second lowest rates of breastfeeding duration relative to African American women at 6 months (42.4% and 27.nine%, respectively) and 12 months (20.7% and 12.9%, respectively).³ Rates for breastfeeding initiation and elapsing among AI/AN women still require much improvement in order to come across the Healthy People 2020 goals.

Lindberg et al.³⁴ plant that among AI/AN mothers, rates of breastfeeding initiation were low (59%), and those of formula supplementation were high (97%). Results too indicated that 76% of AI/AN mothers terminated breastfeeding within 4 months of the child's nascency. These rates are significantly higher than typically observed in U.S. samples.³⁵ Furthermore, their results indicated that among AI/AN mothers who initiated breastfeeding, the median duration was only 13 weeks, and the median time for introducing solid foods was 22 weeks. On a positive note, AI/AN mothers who were still breastfeeing at half dozen months were more likely to nevertheless exist breastfeeding at 12 months.³⁶ Although fewer than half of all AI/AN mothers who initiated breastfeeding were still breastfeeding at four months, they were among several other racial/ethnic groups with the highest rate of breastfeeding at 12 months.

Asian women

Overall, Asian mothers have high breastfeeding initiation rates and are currently coming together the Healthy People 2020 goals.^three At 6 and 12 months, Asian mothers have the highest breastfeeding rates relative to all other racial/ethnic groups; all the same, at that place are some disparities among Native Hawaiian and Filipino women.³⁷ Although the breastfeeding initiation rate in Hawaii for the general population (89.half-dozen%) is higher than the national average, Native Hawaiian women (64%) accept much lower breastfeeding initiation rates.³⁷ The pct of mothers who continue breastfeeding for at least 6 months in Hawaii is above the national average; however, only 25% of Native Hawaiian mothers who initiated breastfeeding are withal breastfeeding exclusively at 20 weeks.³⁷ Furthermore, Native Hawaiian mothers introduce formula at a very early age, with 46% introducing formula within the first week after commitment.³⁷

Barriers to Breastfeeding Amidst Minority Women

There are numerous barriers to breastfeeding that affect all women such as reported pain/discomfort, embarrassment, employment, and inconvenience. However, at that place are also barriers that are unique and more frequent among racial/indigenous minority women. Major barriers to breastfeeding reported past low-income minority women include lack of social, piece of work, and cultural credence/support, language and literacy barriers, lack of maternal admission to information that promotes and supports breastfeeding, acculturation, and lifestyle choices, including tobacco and alcohol apply (Table 2 gives a comprehensive list).^{5,21,38–forty} One of the largest studies that has examined the impact of nascence/immigrant status, race/ethnicity, and socioeconomic factors on breastfeeding in the The states found that immigrant women in each racial/ethnic group had significantly college rates of breastfeeding initiation and duration than native women.³¹ Immigrant children with foreign-born parents had the highest likelihood of being breastfed at 6 and 12 months, whereas the chances of not being breastfed at 6 and 12 months were twice equally high among native children with native parents.

Table 2.

Common Barriers to Breastfeeding for Mothers, Which May Exist Specially Relevant for Racial and Ethnic Minority Women

• Preference to canteen feed

• Pain

• Discomfort

• Lack of social and cultural acceptance

• Employment

• Inconvenience

• Lack of time

• Lack of parental cognition regarding breastfeeding practices

• Lack of maternal admission to data that promotes and supports breastfeeding

• Sexual perceptions

• Language and literacy barriers

• Acculturation

• Lifestyle choices, including smoking, alcohol use, and the desire of younger women who want to be contained and complimentary to get out their infant in the care of others

• Lack of support from family, peers, work, and the healthcare community

• Difficulty with the baby latching onto the chest

• Inadequate milk production

Barriers that affect African American and Hispanic women include historical, cultural, social, economic, political, and psychosocial factors. Information technology is important to recognize the historical challenges that African American women have faced, which may take shaped perceptions and attitudes toward breastfeeding in the African American community and later contributed to lower breastfeeding rates amid these women.

Several studies have institute that WIC participation is strongly associated with low rates of breastfeeding initiation and early breastfeeding discontinuation, especially amongst African American and Hispanic women.^36,41 The Centers for Disease Control and Prevention reports that the breastfeeding rate among low-income women participating in WIC is 67.5%, whereas the rate for higher income WIC-eligible participants is 84.six%.² Beal et al.⁴² establish that African American women were less likely than white women to study having received breastfeeding advice from WIC counselors and, instead, were more likely to report having received formula-feeding advice. WIC counselors may have a significant impact on African Americans' and Hispanics' decisions to breastfeed given that African American women (19.two%) and Hispanic women (39.2%) make upwardly the largest minority proportion of the total population of WIC women.⁴³ The U.Southward. Department of Agronomics reports that although the racial/ethnic makeup for WIC'southward certification categories mirrors the overall racial/indigenous distribution of WIC clients, at that place is one noteworthy exception. Breastfeeding women in WIC are unduly Hispanic relative to all WIC women: 49.4% of breastfeeding women are Hispanic, whereas 39.2% of all WIC women are Hispanic. African American women (fifteen.2%) represent a smaller proportion of all breastfeeding women in WIC.⁴³

In addition to the possible disincentive to breastfeed due to access to free infant formula, low breastfeeding rates specifically among African American mothers may also reverberate a negative perception of breastfeeding in the African American community.⁴⁴ Another ofttimes reported barrier by African American women is lack of access to information that promotes and supports breastfeeding.³⁹ In a study past Kulka et al.,³⁹ African American mothers reported that they need more specific information about what to look and how to address possible complications during breastfeeding. Supporting previous findings, these mothers voiced concerns about differential treatment from healthcare providers with regard to breastfeeding encouragement and information. These results are particularly troubling considering it is well documented that women who are encouraged past healthcare professionals are more likely to initiate breastfeeding.⁴⁵

Another frequently cited barrier to breastfeeding initiation and continuation past depression-income minority women is the necessity to return to work.⁴ Working breastfeeding women face conflict in balancing the ability to breastfeed with the demands of work (e.g., inflexible hours, decreased income, and express motherhood get out).⁴⁶ Many depression-income jobs are non covered nether the Family and Medical Leave Human activity, forcing low-income women to render to work sooner than other women and perchance before breastfeeding is well established.⁴⁷ The majority of women in the United states return to work between iii and 6 months after nascence; however, African American women typically return to work 2 weeks earlier and are more likely to take jobs that are not welcoming to breastfeeding.⁴⁸ Information technology is of import to exist sensitive to the challenges working women may face, while providing them with information nigh the benefits of breastfeeding every bit well every bit possible strategies and support systems to encourage continuing to feed their babies on breast milk.

Breastfeeding Interventions: A Systematic Review

Several studies have identified successful interventions to increase breastfeeding rates among racial/ethnic minority women. Chapman and Pérez-Escamilla²² conducted a systematic review of PubMed searches to evaluate the current status of knowledge regarding the effectiveness of breastfeeding interventions targeting minority women. They selected 22 manufactures that evaluated 18 interventions: peer counseling (PC) (n=4), professional support (northward=4), a breastfeeding team (peer+professional support; northward=3), breastfeeding-specific clinic appointments (northward=2), group prenatal education (n=3), and enhanced breastfeeding programs (n=2). Results indicated that PC interventions (solitary or in combination with a wellness professional), breastfeeding-specific clinic appointments, group prenatal educational activity, and hospital/WIC policy changes significantly improved breastfeeding initiation, duration, or exclusivity. Postpartum breastfeeding support offered by nurses was found to be the least effective intervention.

Considering Chapman and Pérez-Escamilla²² recently conducted a systematic review of breastfeeding interventions targeting racial/ethnic minority women, we used their review as a foundation for ours. Nosotros conducted a systematic review of PubMed and MEDLINE searches in December 2013 to determine whether there were other relevant studies that had not been included in their review. Similar Chapman and Pérez-Escamilla,²² we used "breastfeeding" and "randomized trial" along with each of the following descriptors "Latina," "Latino," "Hispanic," "black," "African American," "Asian," "Native American," "Kickoff Nation," "Indian," "minority," and "low-income." Nosotros also included the descriptor "American Indian," which was not included in the previous review. Furthermore, we conducted another search using "breastfeeding," "randomized trial," and "intervention" along with each of the descriptors listed above. Lastly, we conducted a search using "breastfeeding interventions among minority women" and "breastfeeding interventions among depression-income women." Nosotros used the aforementioned inclusion criteria as Chapman and Pérez-Escamilla²²: studies had to exist U.Due south.-based randomized controlled trials evaluating a breastfeeding promotion intervention, enrolling primarily racial/ethnic minority women, reporting breastfeeding outcome data, and conducting analyses with intention to treat. We merely included studies that were published subsequently 1999. After relevant abstracts were identified, the full text article was reviewed to place those coming together inclusion criteria.

Based on the master focus of the intervention and the ways in which Chapman and Pérez-Escamilla²² categorized their results, the studies included in our review were grouped into one of the following 3 categories: PC, professional support, and enhanced breastfeeding programs (plan add-ons). In regard to the studies included in our review, breastfeeding initiation indicates that the infant was ever breastfed or received chest milk. Exclusive breastfeeding reflects that the infant received but breast milk, allowing for vitamin/mineral drops and medications, in accord with the Earth Health Arrangement definition of exclusive breastfeeding.⁴⁹

Our search yielded 7 studies that were not included in the systematic review by Chapman and Pérez-Escamilla.²² The target populations of these interventions were African American women (n=1), Hispanic women (n=two), African American and Hispanic women (due north=3), and AI/AN women (n=1). We did non place a single randomized trial targeting Asians. One report⁵⁰ did not specify the race/ethnicity of the participants but instead stated that participants were low-income women. The identified interventions included PC (n=iv), professional support (northward=ane), and enhanced breastfeeding programs (n=2). The details of each randomized trial are summarized in Table 3. Nosotros used the evidence rating scale from the Centre for Evidence-Based Medicine, Oxford, United kingdom,⁵¹ to evaluate the quality of each study included in our review. Prove rating codes can be found in Table 3.

Table iii.

Summary of Randomized Controlled Trials Evaluating Breastfeeding Interventions Targeting Racial and Ethnic Minority Women

Study	Quality rating	Study population	Intervention	Outcomes (intervention versus control)
Peer counseling
Howell et al.52 (2014)	1b	due north=540; 64% Hispanic, 38% black	Educational session: 1 Hospital session: one Telephone session: 1 ii-week telephone needs assessment: i	Median breastfeeding duration: 12 versus 6.five weeks
Anderson et al.53 (2007)	1b	n=162; 81.nine% Hispanic, 18.one% black	Domicile visits: 3 prenatal, 9 PP Hospital visits: daily perinatal	Initiation: xc% versus 79% Exclusive breastfeeding: at 1 month, 33.8% versus 6.5%; at 2 months, 28.2% versus i.6%
Sandy et al.54 (2009)	1b	n=238; most 100% Hispanic, less than 0.five% blackness	Habitation visits: weekly prenatal and PP Hospital visit: 1 PP	Exclusive breastfeeding first week postpartum: 32% versus 20%
Edwards et al.55 (2013)	1b	n=248; 100% black	Abode visits: prenatal average=ten, PP boilerplate=12 Telephone support: daily Breast pumps provided as needed	Breastfeeding at >vi weeks: 29% versus 17% Wait ≥iv months to innovate complementary food: 21.3% versus 12.5%
Professional back up
Ryser50 (2004)	1b	n=54; race/ethnicity not specified	Office visits: 4 (Best Start educational program)	Initiation: 61% versus xv%
Enhanced breastfeeding programs
Ahluwalia et al.56 (2000)	2c	PRAMS information n=three,724 PNSS data n=158,495	Enhanced breastfeeding education Breast pump loans Hospital-based programs Peer counseling Community coalitions	Initiation increment from 1992 to 1996: PNSS, 31.half dozen% to 39.5%; PRAMS, 33.half-dozen% to 42.i% Program with highest initiation rate in 1992: breast pump loans (55.6%) Program with highest initiation rate in 1996: hospital-based programs (52.2%) Program with largest change in initiation: hospital-based program (75%)
Karanja et al.57 (2010)	2b	n=205; 100% AI/AN	Community-wide intervention Community-wide intervention+family component	Initiation: 74% Breastfeeding: at 6 months, 38%; at 12 months, 17%

PC

Four randomized controlled trials evaluating PC interventions amidst African American and Hispanic women were identified (Tabular array 3).^52–55 These studies included prenatal, perinatal, and postpartum behavioral instruction interventions delivered in hospitals or homes or via phone by social workers, family unit support workers, and doulas. The intervention programs aimed to prepare and educate mothers about the benefits and challenges of breastfeeding. Overall findings indicate that PC interventions are successful in increasing breastfeeding initiation, duration, and exclusivity amongst minority mothers. Results also suggest that mothers who receive PC are significantly more likely to delay the introduction of complementary foods longer than mothers who receive standard care.

Professional person support

One written report evaluated the effectiveness of exposure to the All-time Beginning educational program (versus no exposure to the Best Start program) delivered by an obstetrician-gynecologist (ob-gyn) (Tabular array 3).⁵⁰ Results indicated that mothers (61%) who were exposed to the Best Start program had college rates of breastfeeding initiation than controls (xv%) at the fourth dimension of the first week postpartum telephone call (p=0.01). Mothers in the intervention grouping also exhibited greater breastfeeding intention and positive breastfeeding sentiment. Findings from the review by Chapman and Pérez-Escamilla²² of professional person support yielded mixed results; however, none of the studies in their review included interventions delivered by a dr.. Given the limited and mixed evidence, current findings should be interpreted with caution, and future research is needed to analyze these results.

Enhanced breastfeeding programs

2 studies^56,57 were identified evaluating the effectiveness of enhanced breastfeeding programs. Supporting the findings of Chapman and Pérez-Escamilla,²² results from i study⁵⁶ demonstrated that enhanced hospital practices and WIC-based services tin accept a significant impact on breastfeeding initiation rates. It should be noted that this written report analyzed preexisting data from the 1992–1996 Pregnancy Nutrition Surveillance System and the Pregnancy Risk Assessment Monitoring System and may non be representative of the electric current impact of enhanced breastfeeding programs. Another weakness of this study is the difficulty of evaluating the efficacy of the intervention programs implemented because comparative statistics were non reported. Results from this study indicated that the almost successful interventions were infirmary-based programs, PC, enhanced breastfeeding education, and breast pump loans, with the hospital-based intervention having the largest alter in breastfeeding initiation (75%).

The second study⁵⁷ identified that implemented an enhanced breastfeeding intervention was besides the only written report found targeting AI/AN women. The main purpose of this study was to investigate the feasibility of delivering a community-wide intervention, solitary or in combination with a family unit-based intervention, among iii AI/AN tribes to promote breastfeeding and reduce the intake of sugar-sweetened beverages. Findings illustrated an increment in breastfeeding initiation and duration among all tribes compared with national rates for AI/AN mothers. The rate of breastfeeding initiation among all tribes was 74%, and the rate of breastfeeding at 6 and 12 months was 38% and 17%, respectively.

Limitations

An overall limitation to the empirical research reviewed in this analysis is the wide range in the dates when the interventions were conducted. Breastfeeding initiation has increased in the African American community, whereas continuation rates through vi months among all women have generally increased over the past decade (Figs. 1 and ​ 2). This makes direct comparisons of breastfeeding rates betwixt studies problematic; this is especially true for the 1 written report based on information from the 1990s.⁵⁶ The breastfeeding initiation rates for African American and AI/AN mothers remain significantly below the Healthy People 2020 goal, as does breastfeeding at vi months for all groups.

Ob-Gyns and Their Patients' Breastfeeding Practices

Encouraging breastfeeding, especially exclusive breastfeeding, is an surface area in which ob-gyns can contribute to improving health amidst women and infants. Ob-gyns are generally supportive of breastfeeding, and the American Higher of Obstetricians and Gynecologists strongly supports breastfeeding for feeding infants and recommends exclusive breastfeeding for the first six months of life.⁵⁸ Although almost ob-gyns encourage breastfeeding, in that location are varying levels of support and promotion amid ob-gyn practices.⁵⁹ Findings from a recently published commodity indicate that breastfeeding conversations between physicians and their patients are infrequent (29% of visits) and extremely brief (mean of 39 seconds).^sixty Results likewise revealed that ob-gyn residents were least likely to talk over breastfeeding with their patients compared with certified nurse midwives and nurse practitioners.

In a recent national study, Queenan et al.⁵⁹ examined whether ob-gyns' practices might contribute to breastfeeding rates. Physician reports of breastfeeding rates inside their patient populations were consistent with Centers for Affliction Control and Prevention rates for states with high, medium, and depression rates. Physicians who adept in states with high breastfeeding rates were more satisfied with their patients' breastfeeding behaviors than were ob-gyns who practiced in states with medium or low rates. Physicians with high proportions of African American or low-income patients reported lower rates of breastfeeding initiation or continuation at 3, half dozen, or 12 months and were less satisfied with breastfeeding rates among their patients. Physician effort toward encouraging breastfeeding was not associated with their patients' breastfeeding behaviors.

These results propose that patient demographics, non md practices, predict depression breastfeeding rates. Although Queenan et al.⁵⁹ constitute that ob-gyn practices do not predict low rates, results point that there is still room for comeback amidst ob-gyns. For example, 55% of ob-gyns surveyed agreed that formula feeding is an acceptable pick that volition not harm the infant. Female physicians were significantly more likely than males to indicate that they strongly agree that sectional breastfeeding is the all-time option (68.v%±6.0% versus 44.4%±6.4%; p=0.005).

Ob-Gyn Multicultural Competence to Aid Improve Breastfeeding Rates Amid Minority Women

It is important to consider how varying cultural beliefs may influence a woman'south perceptions and attitudes toward breastfeeding. Research shows that back up and strategies for breastfeeding, especially targeted at low-income women, tin increase breastfeeding initiation and duration.⁴ Given the research documenting frequent barriers to breastfeeding reported past minority women, ob-gyns should direct accost mothers' breastfeeding concerns within a cultural context while exhibiting cultural competence and sensitivity.

Bai et al.⁶¹ found that the strongest predictor of intention to continue exclusive breastfeeding for Hispanic women was perceived behavioral control. Latina mothers reported that ease of pumping breast milk provided them with a sense of command that pushed them to continue exclusive breastfeeding for half-dozen months. Bai et al.⁶¹ recommended that in order "to enable Latina mothers to maintain EBF [exclusive breastfeeding] for 6 months, wellness professionals need to provide a safe environment to larn and practice pumping, which may entail (a) a provision of electronic or manual breast pump kits at low/reduced prices or free of charge to low income families, (b) less restrictive eligibility criteria for rental electric or transmission pumps for WIC participants, (c) preparation of written and visual education materials in Spanish (e.g., pumping/latching demonstration videos, data on proper storage and feeding of expressed milk), and (d) an increased number of Spanish-speaking peer counselors and lactation consultants."

Negative perceptions of breastfeeding in the African American community may accept a straight influence on an African American woman's decision to breastfeed. Bai et al.⁶¹ plant that the strongest predictor of intention to go on exclusive breastfeeding for African American women was subjective norm. Results indicated that support from family unit and friends was very influential in an African American woman's decision to continue exclusive breastfeeding. Ob-gyns should consider including family unit members, fathers, and close friends of African American mothers in educational discussions virtually breastfeeding. Family, peer, and begetter counseling and support groups may also assistance increase rates for sectional breastfeeding duration among African American mothers.

Lu et al.⁶² examined racial/ethnic disparities associated with attendance of childbirth classes and the association betwixt omnipresence and breastfeeding initiation. White women were twice equally probable as African American mothers to take e'er attended a childbirth course. Mothers who attended childbirth classes were 75% more probable to initiate breastfeeding than mothers who did not attend. Given the success of childbirth classes and the depression attendance among minority women, ob-gyns tin can aid encourage these mothers to attend classes and provide them with advisable resources for successful attendance. Ideas generated by a focus grouping of African American women to improve breastfeeding rates included support groups, 1-on-ane support and mentoring afterwards birth, increased support from healthcare providers, and a social marketing entrada that depicts positive images of African American mothers breastfeeding.³⁹

In the Design for Activity on Breastfeeding, the Surgeon General discusses the importance of family and community support for minority women during prenatal and postnatal periods.⁶³ The report advocates for the promotion and support of breastfeeding continuation upon a mother'south return to work, workplaces that facilitate on-site breastfeeding or breast milk expression in private areas, and flexible work hours and breaks. Above all, the study addresses the importance of the healthcare system and order equally a whole to ship the message to mothers that breastfeeding is completely normal, optimal, nutritional, desirable, and doable. The Surgeon General advocates for a national public marketing campaign that can work toward obtaining this goal. The Surgeon Full general's nigh contempo statement, The Surgeon General's Call to Action to Support Breastfeeding, lays out 20 action items and sample implementation strategies for each intervention to increase national breastfeeding rates.⁶³ A few national breastfeeding campaigns are listed in Table 4.

Table 4.

National Campaigns to Promote Breastfeeding Amid Racial and Ethnic Minority Women

Endmost Comments

Major efforts are however needed to improve breastfeeding initiation and duration rates in the Us. Research shows that some racial/ethnic minority women confront greater obstacles establishing and maintaining breastfeeding. Ob-gyns have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy. Ob-gyns should be familiar and knowledgeable most breastfeeding recommendations that are laid out in the Guidelines for Perinatal Intendance by the American University of Pediatrics and The American College of Obstetricians and Gynecologists.⁶⁴ Discussions of breastfeeding should begin early on during prenatal care. Enquiry shows that women's predelivery intentions are strong predictors of both initiating and standing breastfeeding.^four Ob-gyns are encouraged to brainstorm providing patients with breastfeeding education during the kickoff prenatal engagement and to use all subsequent visits equally an opportunity to promote and encourage breastfeeding.^58,65 Ob-gyns should not just counsel expectant mothers on the positive benefits of breastfeeding, merely also discuss possible obstacles that may arise during breastfeeding and strategies to overcome them. In practices with greater racial/ethnic minority populations, early breastfeeding conversations may be even more crucial because these women are more likely to take inconsistent prenatal care.^66,67

The American University of Pediatrics and The American Higher of Obstetricians and Gynecologists advise that supplemental formula should not exist given to breastfeeding infants unless otherwise advised by a healthcare professional.⁶⁴ If the infant becomes partially satiated by formula supplementation, the infant will accept less milk from the chest, and thus the mother'due south milk production will decrease. Equally a result, formula supplementation may significantly reduce the success of breastfeeding.

Ob-gyns' efforts to encourage and support breastfeeding tin positively touch on breastfeeding practices among women. It is important to first understand and accost cultural and social predictors impacting low breastfeeding rates amongst minority women. These factors influence a woman'south breastfeeding attitudes, her determination to breastfeed, and, ultimately, health outcomes for the mother and child. Past directly addressing these obstacles and promoting positive breastfeeding practices, ob-gyns tin can accept a meaningful impact on the future wellness of the mother and child.

Acknowledgments

Financial support for this study was provided in role by grant UA6MC1901 0 from the Maternal and Child Health Bureau (Championship V, Social Security Human activity, Wellness Resources and Services Administration, and U.Southward. Department of Health and Human Services).

Disclosure Argument

No competing financial interests be.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410446/

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