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Hospitals Play Role in Lower Breastfeeding Rates Among Some Groups

EVANSTON, IL – Hospital practices appear to play a role in the significant racial and ethnic disparities in breastfeeding outcomes, according to a recent study published online by the journal Pediatrics.

"We found that higher rates of poverty and lower levels of education helped explain breastfeeding gaps between black and white women, especially in determining whether mothers started breastfeeding in the first place," said co-author Sharon Landesman Ramey, PhD, a professor and distinguished research scholar at the Virginia Tech Carilion Research Institute in Roanoke, VA. "But those factors weren't the only ones responsible for mediating these relationships."

Researchers reported they were surprised by a broad difference in mothers' initial decision to breastfeed, finding that black mothers were nine times more likely to be given formula for their babies than white mothers in the hospital.

"Our results suggest that hospitals and policy makers should limit in-hospital formula introduction and consider family history and demographics to reduce racial and ethnic breastfeeding disparities," emphasized co-investigator Madeleine Shalowitz, MD, MBA, a director at the NorthShore University Health System Research Institute in Evanston.

"Hospitals and policy makers should consider non-demographic factors to help reduce racial and ethnic breastfeeding disparities," Ramey added. "Change is possible, and it's necessary."

The American Academy of Pediatrics recommends children should be exclusively breastfed for the first six months of life, with continued breastfeeding and complementary foods until the child's first birthday, at a minimum. Despite the recommendation, about half of children in the United States are weaned from breastfeeding by the time they are six months old, according to background information in the report.

To help determine why, researchers analyzed data from the Community and Child Health Network study, assessing breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration postpartum among 1,636 mothers in Los Angeles, Baltimore, Washington, DC, and Lake County, IL. The mother's immediate intent regarding breastfeeding was recorded with follow-up at one month and again at six months after birth.

Results indicate that Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks). Least likely to initiate were black mothers (61%), who also showed lower rates for intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks).