Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions

Abstract

The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.

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.…”

“…Exploration of this bias is needed; we have very limited information about the occurrence and impact of racial discrimination on breastfeeding. Reluctance of researchers to include any focus on this in their studies [34] also must be overcome. Such experiences led some participants to either delay in asking for help or not asking at all.…”

The individual focus of nursing research in breastfeeding: Perpetuating a neoliberal perspective

“…In the era of slavery, Black women were forced to breastfeed the children of slave owners, at the expense of their own infants. The history of this forced role has contributed to a negative perception of breastfeeding among some in the Black community and is a compounding factor amidst other cultural barriers Black women face, such as the lack of family and peer support (Allers, ; Carter & Anthony, ; Johnson, Kirk, Rosenblum, et al, ; Reeves & Woods‐Giscombé, ).…”

“…Current nursing research examining breastfeeding has had considerable focus on these disparities, but concentrates heavily on individual factors associated with breastfeeding, such as maternal attitude or partner support (Alnasser et al, ; Bhairo & Elliott, ; Rempel, Rempel, & Moore, ). This focus on individual‐level interventions, while an important aspect of improving breastfeeding rates, fails to acknowledge systemic and structural barriers to breastfeeding, such as lack of paid family leave, failure to regulate formula advertising, and the systemic racism that influences cultural norms and access to unbiased care (Johnson, Kirk, Rosenblum, & Muzik, ; Jones, Power, Queenan, & Schulkin, ; Reno, Barnhart, & Gabbe, ). Focusing research on the individual insinuates that breastfeeding is a choice; however, as I will argue, the individually focused nature of nursing research in breastfeeding adheres to a neoliberalist perspective of individual responsibility.…”

Violência Doméstica Na Gravidez E Aleitamento Materno Exclusivo: Estudo De Coorte

“…Apresentam-se como fator de risco para o início da amamentação a baixa escolaridade, paridade, trabalho informal, desemprego, uso de tabaco e rotinas hospitalares que não oferecem suporte a puérperas (FOSTER,2015;JOHNSON, 2015;VENÂNCIO,2005). Já a extensão do período da amamentação foi observada entre mulheres que foram preparadas durante as consultas de pré-natal, não fumantes, multíparas e tiveram apoio para retornar ao trabalho (RENFREW, 2012;FOSTER,2015).…”