This article introduces the concept of vulnerability in health care and explores the extant literature to determine its tenets. The debate over what constitutes ethical research is centered in part on the concept of vulnerability. The Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), the first human research ethics guideline to identify vulnerable groups, specified that those identified as vulnerable need extra protections during research participation. Identified limitations of the Belmont Report, especially with regard to racial minorities, led to the Heckler Report (Heckler, M. M., & U. S. Department of Health and Human Services, 1985), which laid the foundation for actionable steps to eliminate health disparities among racial and ethnic minority groups. The American Nurses Association's Code of Ethics for Nurses with Interpretive Statements (American Nurses Association, 2015), requires nurses to promote, advocate, and strive to protect the health, safety, and rights of all individuals and groups. A conceptual understanding of vulnerability allows nurses and researchers to advocate for and better serve individuals and groups deemed vulnerable. Nurse advocacy is paramount in reducing health disparities and improving health outcomes among vulnerable groups.
Breastfeeding, a health behavior that provides well-known benefits for mothers, infants, and children, is an essential strategy to improve public health. Breastfeeding can reduce the incidence of infant illness and death and provides both short- and longterm physiological benefits to mothers. National and international government agencies and grassroots organizations supporting breastfeeding include the World Health Organization, the United Nations International Children's Emergency Fund, the World Alliance for Breastfeeding Action, the Centers for Disease Control and Prevention, and the La Leche League. In the United States, breastfeeding of infants was the norm until the late 1890s when the Progressive Era's emphasis on science and modernity led to the transition of childbirth from residential in-home births to community-based hospital births and the aggressive rise of the baby formula industry. By 1966, only 18% of mothers were exclusively breastfeeding their infants at hospital discharge. This drastic decrease in breastfeeding reduced the percentage of mothers and grandmothers who could share their breastfeeding knowledge and experience. Nurses who provide care for women and infants are essential stakeholders in bridging the breastfeeding knowledge gap by offering education on the short- and long-term health benefits of breastfeeding to both mother and baby and timely encouragement to mothers during the most significant time for establishing lactation.
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