Racial Disparities in Breastfeeding Support

1. Racial Disparities in Breastfeeding Support Lauren Zerbib, MD Candidate1, Brian Luckett, PhD2, Rebekah Gee, MD, MPH, MSHPR2 1Tulane University School of Medicine, New Orleans LA 2Departments of Health Policy and Systems Management, Louisiana State University School of Public Health, New Orleans, LA , Materials & Methods Background Table 2. Odds ratios and 95% confidence intervals for African-American race in predicting the experience of each of ten types of hospital-based support for breastfeeding. Breastfed children have reduced rates of GI infection, respiratory disease, hospitalization, obesity and type 2 diabetes. Mothers who breastfeed also experience reduced risks of developing type 2 diabetes, breast cancer and ovarian cancer. African-Americans have higher rates of diabetes, obesity, death from breast cancer that are potentially modifiable by breastfeeding. The state of Louisiana has the lowest rates of breastfeeding in the nation and a large disparity in breastfeeding initiation rates by race: 59.8% of non-hispanic white women initiate breastfeeding, compared to only 31.8% of non-hispanic African-American women Healthy people 2020 breastfeeding objectives: MICH-21: Increase the proportion of infants who are breastfed MICH-21.1 Ever (Target 81.9%, Louisiana 48.9%) MICH-21.2 At 6 months (Target 60.6%, Louisiana 18.2%) MICH-21.3 At 1 year (Target 34.1%, Louisiana 7%) • Louisiana Pregnancy Risk Assessment Monitoring System 2007-2008 data (LaPRAMS, n=2534) were used to estimate the effect of African-American race on the experience of hospital breastfeeding support (Table 2). • African-American respondents accounted for 39.5% of weighted respondents., and “other race” consisted of white, 57.3%, Asian, 1.5%, Native-American, 0.6%, and other non-white women, 1.2%. • LaPRAMS questionnaire reflects the UNICEF/WHO designation of “Baby-friendly” hospitals. Louisiana has a similar program that designates hospitals “GIFT Certified” (Guided Infant Feeding Techniques) if they follow ten specific steps (Box 1). • Breastfeeding initiation was determined by affirmative response to: “Did you ever breastfeed or pump breast milk to feed your new baby after delivery?” If the woman reported “yes,” she was then asked ten Baby-friendly or GIFT hospital questions (Table 2). • Weighted logistic regression was used for effect of race on hospital experience of breastfeeding support. Chi-square tests were used for differences in sample characteristics between African-American respondents versus other races. All analyses used SAS-callable SUDAAN 10.0. All models adjusted for maternal age, marital status, education, household income, low birth weight, smoking during pregnancy, rural residence, receipt of WIC during pregnancy and previous births. Objective Comments To determine the variation in breastfeeding support for Caucasian and African-American women in Louisiana prior to and after delivery Box 1. The GIFT’s “Ten Steps to a Healthy, Breastfed Baby” Have a written breastfeeding policy that is routinely communicated to all staff. Train hospital employees who care for mothers, newborns, and infants to implement this policy. Promote breastfeeding as the normal and preferred feeding method of choice to all mothers prior to birth, following birth, and after hospital discharge. Encourage mothers and newborns to breastfeed within the first two hours after birth, with the first hour being ideal. Show mothers how to breastfeed and how to maintain lactation, even if separated from their infants. Give breastfed infants no food or drink other than breast milk unless medically indicated. Encourage rooming-in both day and night. Encourage mothers to breastfeed their newborns without restrictions. Give no pacifiers or artificial nipples to breastfeeding infants. The hospital should address support for breastfeeding mothers following hospital discharge. • Racial disparities in breastfeeding support in the hospital may contribute to the lower rates of breastfeeding among African-American women. • Our study found that while African-American women were more likely to discuss breastfeeding with a health professional prior to delivery, they were less likely to initiate breastfeeding.Among all women regardless of breastfeeding initiation, African-Americans were less likely to receive in-hospital instruction and support. • Only 23% of delivery hospitals in Louisiana have comprehensive breastfeeding policies. Moreover, only 43% of African-Americans in Louisiana deliver in GIFT certified hospitals compared to 51% of white women (see Box 1). • Increasing the number of GIFT certified hospitals may help close the breastfeeding gaps in Louisiana by ensuring all women receive the option to obtain equal breastfeeding support services. • The period immediately post-partum presents an opportunity for hospital physicians and staff to promote breastfeeding practices before the demands of home and work influence a mother’s decision to breastfeed. • Ongoing research and policy to evaluate the effectiveness of breastfeeding programs in Louisiana’s hospitals should specifically address barriers encountered by African-American women. Results Table 1: Characteristics of LAPRAMS respondents • African-American expectant women were more likely to receive counseling on breastfeeding prior to delivery than women of other races (OR=1.39, 95% CI:1.02-1.91). • African-American women were 60% less likely than women of other races to initiate breastfeeding or pump milk after adjusting for confounders (OR=0.40, 95% CI: 0.31-0.52). • Breastfeeding counseling prior to delivery did not predict initiation (OR=1.28, 95% CI: 0.99-1.65). • Table 2 presents OR and 95% CI for the effect of African-American race in predicting whether a new mother received each of ten types of in-hospital breastfeeding support after delivery. • African American respondents were significantly less likely to report that hospital staff helped to teach them how to breastfeed, instructed them how to breastfeed, instructed them to breastfeed on demand or provided a helpline number. • All African-American respondents were significantly less likely than all respondents of other races to report that their baby stayed in the same hospital room with them. References available on request. Acknowledgements: We are grateful for the assistance of Dr. Lyn Kieltyka, Senior Maternal and Child Health Epidemiologist and Ms. Lillian Funke, both from the Louisiana Department of Health and Hospitals. Support for this project was provided to Dr. Rebekah Gee through a career development grant from the Institute of Medicine, the Norman F. Gan Fellowship.