Breastfeeding Among Minority Women: Moving From Risk Factors to Interventions

Abstract

The gap between current breastfeeding practices and the Healthy People 2020 breastfeeding goals is widest for black women compared with all other ethnic groups. Also of concern, Hispanic and black women have the highest rates of formula supplementation of breast-fed infants before 2 d of life. These disparities must be addressed through the scale-up of effective interventions. The objective of this critical review is to identify and evaluate U.S.-based randomized trials evaluating breastfeeding interventions targeting minorities and highlight promising public health approaches for minimizing breastfeeding disparities. Through PubMed searches, we identified 22 relevant publications evaluating 18 interventions targeting minorities (peer counseling [n = 4], professional support [n = 4], a breastfeeding team [peer + professional support, n = 3], breastfeeding-specific clinic appointments [n = 2], group prenatal education [n = 3], and enhanced breastfeeding programs [n = 2]). Peer counseling interventions (alone or in combination with a health professional), breastfeeding-specific clinic appointments, group prenatal education, and hospital/Special Supplemental Nutrition Program for Women, Infants, and Children enhancements were all found to greatly improve breastfeeding initiation, duration, or exclusivity. Postpartum professional support delivered by nurses was found to be the least effective intervention type. Beyond improving breastfeeding outcomes, 6 interventions resulted in reductions in infant morbidity or health care use. Future research should include further evaluations of successful interventions, with an emphasis on determining the optimal timeframe for the provision of support, the effect of educating women's family members, and the impact on infant health care use and cost-effectiveness.

Reflections of Black Women Who Choose to Breastfeed: Influences, Challenges and Supports

“…Some participants reported being discharged home without a plan to address their questions or problems, thus limiting their ability to successfully breastfeed. Some hospitals and pediatricians have established breastfeeding clinics staffed by lactation consultants and some offer home visits from a lay worker or a nurse, but consistent, affordable, individualized help from well-prepared providers continues to be lacking [34,35]. Our study findings support the need for comprehensive post-discharge support tailored to the needs of Black women.…”

Racial and Ethnic Disparities in Breastfeeding

“…2 African American women (32%) are also more likely than most minority groups to provide formula supplementation by 2 days of life. 22 Currently, African American women are not meeting any of the Healthy People 2020 objectives for breastfeeding (Table 1).…”

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

“…2 WIC-receiving mothers in Puerto Rico maintain a median duration of 5 months for any breastfeeding 18 ; however, a considerable disparity in breastfeeding duration has been observed among low-income Puerto Rican women in the United States, reported with a median duration of only 2 weeks in a sample. 31 Peer support is more effective than structured education or professional support in maintaining breastfeeding. 32 -35 However, a review by Chapman and PerezEscamilla 31 demonstrated that the observed improvements in continuation at 1 and 3 months were generally not statistically significant, despite significantly improved initiation rates among minority women.…”