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Breastfeeding Intervention Cuts Racial Gap at Southern Hospitals
Ten Steps to Successful Breastfeeding framework associated with a dramatic increase in breastfeeding rates among African Americans.
black mother and baby practice skin-to-skin care in hospital
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February 11, 2019

CONTEXT |  Breastfeeding has been associated with better health outcomes for both infants and mothers. In the U.S., there are significant disparities in breastfeeding rates across races and ethnicities, with African American infants having the lowest rates. These disparities are especially pronounced in the South. The CDC reported recently that rates of breastfeeding initiation in Mississippi were 25 percentage points higher among whites than among African Americans. In Louisiana, the gap was 32 percentage points.

STUDY OBJECTIVE  |  A group of investigators from several academic medical centers partnered with providers, payers, funders, and advocacy organizations to implement or strengthen the Ten Steps to Successful Breastfeeding framework at local hospitals in four Southern states. The study sought to understand whether better compliance with the Ten Steps framework (the cornerstone of the Baby-Friendly Hospital Initiative led by the World Health Organization and UNICEF) would reduce racial disparities in breastfeeding.

DATA SOURCES  |  Monthly data by race, gathered from 2014 to 2017, on breastfeeding, skin-to-skin care, and rooming-in practices at 33 hospitals across Mississippi, Louisiana, Tennessee, and Texas.

FINDINGS  |  Following the roll-out of the study intervention, breastfeeding and exclusive breastfeeding increased across all races and hospitals. The increase was especially dramatic among African American infants. Rates of breastfeeding initiation in that group increased from 46% to 63%, which narrowed the racial disparity in breastfeeding initiation by nearly 10 percentage points in less than three years.

PULL QUOTE  |  "During the process, many outdated and non-evidence-based practices, such as breast binding, universal 'trials of swallowing' with bottles of sterile water, physician orders stating that infants must be fed every two to three hours, nasogastric tubal insertion for healthy newborns, long periods of maternal/infant separation, and supplementation of all newborns with glucose water to 'prevent hypoglycemia' came to light."

SO WHAT?  |  Expanding compliance with the Ten Steps framework has the potential to reduce racial disparities in breastfeeding further and improve health outcomes for African American infants and moms.


Authors. Merewood A, Bugg K, Burnham L, et al.

Source. Addressing Racial Inequities in Breastfeeding in the Southern United States. Pediatrics. 2019; 143(2):e201818