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Williams MS, McKinney SJ, Cheskin LJ. Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities. Curr Obes Rep 2024; 13:617-625. [PMID: 38878122 PMCID: PMC11306445 DOI: 10.1007/s13679-024-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE OF REVIEW: To analyze how social and structural determinants of health and social injustice impact the risk of obesity, its treatment and treatment outcomes, and to explore the implications for prevention and future treatment interventions. RECENT FINDINGS: Racial and ethnic minorities, such as non-Hispanic Black adults and Hispanic adults, and adults with a low socioeconomic status have a greater risk of obesity than non-Hispanic white adults and adults with a high socioeconomic status. The underlying causes of obesity disparities include obesogenic neighborhood environments, inequities in access to obesity treatment, and lack of access to affordable nutrient-dense foods. Experts have called for interventions that address the social and structural determinants of obesity disparities. Population-based interventions that focus on improving neighborhood conditions, discouraging the consumption of unhealthy foods and beverages, expanding access to obesity treatment, and ensuring equitable access to fruits and vegetables have been proven to be effective. There is a growing body of evidence that shows the relationship between social and structural determinants of health and injustice on disparities in obesity among racial and ethnic minorities and individuals with a low SES. Population-based, equity-focused interventions that address the underlying causes of obesity disparities are needed to reduce obesity disparities and improve the health outcomes of minoritized and marginalized groups.
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Affiliation(s)
- Michelle S Williams
- George Mason University, College of Public Health, Department of Global and Community Health, Fairfax, VA, 22030, United States
| | - Sheila J McKinney
- Jackson State University, School of Public Health, Department of Epidemiology and Biostatistics, Jackson, MS, 39217, United States
| | - Lawrence J Cheskin
- George Mason University, College of Public Health, Department of Nutrition and Food Studies, Fairfax, VA, 22030, United States.
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA.
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Aderibigbe T, Kelleher SL, Henderson WA, Prescott S, Young EE, Lucas RF. COMT Variants are Associated With Breast and Nipple Pain. THE JOURNAL OF PAIN 2024; 25:104568. [PMID: 38763257 DOI: 10.1016/j.jpain.2024.104568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024]
Abstract
Estimates suggest that only 24.9% of infants born in 2019 were exclusively breastfed before 6 months of age, despite the known health benefits of exclusive breastfeeding. Breast and nipple pain is one of the primary determinants of exclusive breastfeeding. Environmental contributions to breastfeeding success have been reported extensively in the literature, but the contribution(s) of maternal genetics has yet to be discovered. The purpose of the study was to identify an association between pain and lactation-related gene variants with exclusive breastfeeding determinants. We selected 4 genes having single nucleotide polymorphisms (SNPs) with potential functional significance in breastfeeding and pain: prolactin receptor (PRLR), oxytocin receptor (OXTR), catechol-O-methyltransferase (COMT), and milk fat globule epidermal growth factor and factor V/VIII domain containing (MFGE8). We performed a cross-sectional secondary analysis of a longitudinal randomized controlled trial study, Promoting Self-Management of Breast and Nipple Pain with Biomarkers and Technology for Breastfeeding Women (NCT05262920). Breast and nipple pain, perceived insufficient milk, and breastfeeding self-efficacy were examined using total scale scores for the Brief Pain Inventory, Visual Analog Scale, H&H Lactation Scale, and the Breastfeeding Self-efficacy Scale-short form, respectively. Of the candidate genes examined, SNPs within COMT were significantly associated with breastfeeding-related outcomes. Specifically, COMT rs4633 and rs4680 minor allele carriers (T, A) reported higher breast and nipple pain intensity than women homozygous for the major allele (C, G). COMT is the most widely researched "pain gene" and has been linked to cold, postoperative, and postpartum pain. This study is the first to identify a contribution of COMT variants to breast and nipple pain and, as a result, to breastfeeding exclusivity. PERSPECTIVE: Two SNPs in the pain gene COMT are associated with breast and nipple pain. Clinically, a minor allele in COMT rs4633 and rs4680 may increase a woman's rating of moderate breast and nipple pain. TRIAL REGISTRATION: PROMPT was registered in ClinicalTrials.gov (protocol #NCT05262920).
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Affiliation(s)
| | - Shannon L Kelleher
- Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts
| | - Wendy A Henderson
- School of Nursing, University of Connecticut, Storrs, Connecticut; School of Medicine, University of Connecticut, Farmington, Connecticut
| | | | - Erin E Young
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas School of Medicine, KU Medical Center, Kansas City, Kansas
| | - Ruth F Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut; School of Medicine, University of Connecticut, Farmington, Connecticut.
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Reis JD, Sánchez-Rosado M, Mathai D, Kiefaber I, Brown LS, Lair CS, Nelson DB, Burchfield P, Brion LP. Multivariate Analysis of Factors Associated with Feeding Mother's Own Milk at Discharge in Preterm Infants: A Retrospective Cohort Study. Am J Perinatol 2024. [PMID: 38991527 DOI: 10.1055/s-0044-1787895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study aimed to develop a predictive model of feeding mother's own milk (MOM) at discharge using social determinants of health (SDOH), maternal and neonatal factors after deliveries at <33 weeks of gestational age (GA), or birth weight <1,500 g. STUDY DESIGN Secondary analysis of a retrospective cohort in an inner-city hospital before (Epoch-1, 2018-2019) and after (Epoch-2, 2020-2021) implementing a donor human milk (DHM) program. RESULTS Among 986 neonates, 495 were born in Epoch-1 (320 Hispanic White, 142 Non-Hispanic Black, and 33 Other) and 491 in Epoch-2 (327, 137, and 27, respectively). Feeding any MOM was less frequent in infants of non-Hispanic Black mothers than in those of Hispanic mothers (p < 0.05) but did not change with epoch (p = 0.46). Among infants who received any MOM, continued feeding MOM to the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers, 94/237 (40%) versus 339/595 (57%; p < 0.05), respectively. In multivariate analysis including SDOH and maternal variables, the odds of feeding MOM at discharge were lower with SDOH including neighborhoods with higher poverty levels, multiparity, substance use disorder, non-Hispanic Black versus Hispanic and young maternal age and increased with GA but did not change after implementing DHM. The predictive model including SDOH, maternal and early neonatal variables had good discrimination (area under the curve 0.85) and calibration and was internally validated. It showed the odds of feeding MOM at discharge were lower in infants of non-Hispanic Black mothers and with feeding DHM, higher need for respiratory support and later initiation of feeding MOM. CONCLUSION Feeding MOM at discharge was associated with SDOH, and maternal and neonatal factors but did not change after implementing DHM. Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of feeding MOM but not by later initiation of feeding MOM. KEY POINTS · In this cohort study of preterm infants, factors of feeding MOM at discharge included (1) SDOH; (2) postnatal age at initiation of feeding MOM; and (3) maternal and neonatal factors.. · Feeding MOM at the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers.. · Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of MOM feeding but not by later postnatal age at initiation of feeding MOM..
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Affiliation(s)
- Jordan D Reis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Baylor Scott & White Health, Dallas, Texas
| | - Mariela Sánchez-Rosado
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Daizy Mathai
- Parkland Hospital and Health System, Dallas, Texas
| | - Isabelle Kiefaber
- Health Systems Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
| | - Patti Burchfield
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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Ehmer A, Greisch C, Sonnen E, Scott S, Carter D, Ashby B. Maternal depression, psychosocial stress and race/ethnicity: examining barriers to breastfeeding for young mothers. J Reprod Infant Psychol 2024:1-13. [PMID: 38828541 DOI: 10.1080/02646838.2024.2361367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Breastfeeding has a positive impact on child and maternal health outcomes. Black and Latina women and adolescent mothers have lower rates of breastfeeding initiation and continuance in the U.S. Maternal depression and psychosocial stressors may contribute to reduced rates of breastfeeding. The current study aims to better understand behaviours and associated factors related to breastfeeding in a diverse group of adolescent mothers attending a teen-tot clinic for postpartum and infant well care. METHODS Participants were 191 mother-infant dyads. Mother's age ranged from 13 to 25, and 54% of mothers identified as Latina, 22% Black, 11% more than one race and 5% white. Demographic information and breastfeeding behaviour were abstracted from the medical record. Rates of postpartum mood/anxiety symptoms and psychosocial stressors were obtained from screening measures completed at medical visits. RESULTS Analyses revealed that 87% of adolescent mothers in the sample initiated breastfeeding at birth and the racial/ethnic breakdown of those mothers closely mirrored the overall population (58% Hispanic or Latina, 17% Black, 10% more than one race, 5% white). At 2 months postpartum, only 41% of the population was still breastfeeding. Mothers with significant mood/anxiety symptoms at the newborn visit were more likely to be breastfeeding at the 1- and 2-month visits. Mothers with psychosocial stressors at the newborn visit were less likely to be breastfeeding at the 1- and 2-month visits. CONCLUSION Efforts to promote health equity through breastfeeding for at-risk mothers must occur within the first few weeks postpartum and must consider associated factors including postpartum mood/anxiety symptoms and psychosocial stressors.
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Affiliation(s)
- Amelia Ehmer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, USA
- Departments of Psychiatry and Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Catherine Greisch
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, USA
- Departments of Psychiatry and Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Emily Sonnen
- Departments of Psychiatry and Pediatrics, Children's Hospital Colorado, Aurora, USA
- Department of Clinical Psychology, University of Nebraska-Lincoln, Lincoln, USA
| | - Stephen Scott
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, USA
- Departments of Psychiatry and Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Debbie Carter
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, USA
- Departments of Psychiatry and Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Bethany Ashby
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, USA
- Departments of Psychiatry and Pediatrics, Children's Hospital Colorado, Aurora, USA
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LaPlant HW, Francis-Edoziuno C, Guan Z, Aderibigbe T, Chang X, Alhabodal AS, Delaney K, Scott D, Marshall-Crim M, Freytes I, Henderson WA, Walsh S, Lucas RF. Retention and the Intersection of Structural Inequities in a Breastfeeding Intervention Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.15.24304355. [PMID: 38559187 PMCID: PMC10980120 DOI: 10.1101/2024.03.15.24304355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Women below the poverty threshold have lower representation and retention in breastfeeding studies. Methods A secondary analysis of a longitudinal randomized controlled self-management for breast and nipple pain during breastfeeding study. Participants completed online surveys at discharge, weeks 1, 2, 3, 6, 9, 12, 18, and 24, with face-to-face interviews at 6 and 24 weeks. Text messages were sent to participants when modules and surveys were due. Retention was assessed in R with descriptive statistics, Mann-Whitney, Pearson's chi-square, and Cox Proportional Hazard Regression. Results Two hundred and forty-four women (89 ≤$50,000 and 155 >$50,000) were recruited. Retention rates at 1 (93%), 2 (87%), 6 (82%), 9 (77%) and 24 (72%) weeks. For women of low income compared to those of high income there was a hazard ratio (HR) of 2.5 (p=0.0001) for retention. For non-Hispanic Black and Hispanic women compared to the combined non-Hispanic White and Other group, HRs for retention were 3.3 and 2.6 respectively (p=0.0001). Adjustment for age in the final hazard regression model of income, age, race and ethnicity decreased the HR for women of low income to 1.6 and HRs for non-Hispanic Black and Hispanic women to 2.1 and 1.9, respectively (p=.0001). However, none of the individual factors in the model achieved statistical significance. Discussion Retention in breastfeeding studies impacts breastfeeding duration, a key lifelong preventative health behavior. Despite accessible study design, retention of women desiring to breastfeed was adversely affected by the intersection of income, race and ethnicity, and age.
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Affiliation(s)
| | | | - Zhe Guan
- Department of Statistics, University of Connecticut
| | | | | | | | | | - Dana Scott
- Obstetrics and Gynecology Unit, Breast Health and Cancer Genetics, University of Connecticut Health Center
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Rhodes EC, Zahid M, Abuwala N, Damio G, LaPlant HW, Crummett C, Surprenant R, Pérez-Escamilla R. Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation. BMC Pregnancy Childbirth 2024; 24:120. [PMID: 38336607 PMCID: PMC10854050 DOI: 10.1186/s12884-023-06213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women's experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States. METHODS This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework. RESULTS Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women's individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women's infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women's efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women. CONCLUSIONS Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women's feedback on their experiences of these services.
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Affiliation(s)
- Elizabeth C Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Mahrukh Zahid
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Nafeesa Abuwala
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Grace Damio
- Hispanic Health Council, 175 Main Street, Hartford, CT, 06106, USA
| | | | - Carrianne Crummett
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
| | - Rebecca Surprenant
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
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Subramani S, Vinay R, März JW, Hefti M, Biller-Andorno N. Ethical Issues in Breastfeeding and Lactation Interventions: A Scoping Review. J Hum Lact 2024; 40:150-163. [PMID: 38087449 PMCID: PMC10799543 DOI: 10.1177/08903344231215073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/31/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Infant feeding interventions that promote and support breastfeeding are considered important contributions to global public health. As these interventions often target private settings (e.g., individuals' homes) and involve vulnerable populations (e.g., pregnant women, infants, and underprivileged families), a keen awareness of ethical issues is crucial. RESEARCH AIM The purpose of this scoping review was to capture the key elements of the current ethical discourse regarding breastfeeding and lactation interventions. METHOD A scoping review was conducted using Arksey and O'Malley's (2005) methodology to identify the ethical issues of breastfeeding and lactation interventions as they are reflected in the scholarly literature published between January 1990 and October 2022. Abstracts (N = 3715) from PubMed, ScienceDirect, JSTOR and the Cochrane Database of Systematic Reviews were screened. The final sample consisted of 26 publications. RESULTS The recurring ethical issues identified in these studies were: the normative assumptions of motherhood; maternal autonomy and informed choice; information disclosure, balancing risks and benefits, and counseling practices; stigma and social context; ethics of health communication in breastfeeding campaigns; and the ethical acceptability of financial incentives in breastfeeding interventions. CONCLUSION This review illustrated that, while a wide range of ethical arguments were examined, the emphasis has been primarily on accounting for mothers' experiences and lactating persons' choices, as well as achieving public health objectives relating to infant nutrition in breastfeeding interventions. To effectively and ethically implement breastfeeding and lactation interventions, we must consider the social, economic, and cultural contexts in which they occur. One key learning identified was that women's experiences were missing in these interventions and, in response, we suggest moving beyond the dichotomous approach of individual health versus population health.
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Affiliation(s)
- Supriya Subramani
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, University of Medicine, Camperdown, NSW, Australia
| | - Rasita Vinay
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Julian W. März
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Michaela Hefti
- Family Larsson-Rosenquist Foundation, Frauenfeld, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Pollock L, Levison J. 2023 updated guidelines on infant feeding and HIV in the United States: what are they and why have recommendations changed. TOPICS IN ANTIVIRAL MEDICINE 2023; 31:576-586. [PMID: 38198669 PMCID: PMC10776031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The US Department of Health and Human Services guidelines on infant feeding among people with HIV have changed in response to (1) evidence of low risk of transmission via breast milk among individuals with consistent viral suppression, (2) considerations of equity and cultural norms, and (3) community desires. The 2023 guidelines recommend patient-centered shared decision-making. Individuals with HIV who are receiving antiretroviral therapy (ART) and have consistent viral suppression should be counseled on the options of for-mula feeding, feeding with banked donor milk, or breast (or chest) feeding, and nonjudgmentally supported in their decision. Individuals who choose to breastfeed should be counseled on and supported in adherence to ART, viral suppression, and engagement in postpartum care for themselves and their babies. Exclusive breastfeeding is recommended, with the understanding that brief periods of replacement feeding may be necessary. Data are lacking on ideal infant prophylaxis regimens.
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Butler MS, Smart BP, Watson EJ, Narla SS, Keenan-Devlin L. U.S. Breastfeeding Outcomes at the Intersection: Differences in Duration Among Racial and Ethnic Groups With Varying Educational Attainment in a Nationally Representative Sample. J Hum Lact 2023; 39:722-732. [PMID: 37522342 DOI: 10.1177/08903344231186786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND As breastfeeding rates in the United States increase, barriers persist for Black, Latine, and low-socioeconomic status household dyads when compared to White and high-socioeconomic status household dyads. Previous breastfeeding disparities research has almost exclusively considered the influence of race, ethnicity, and socioeconomic status separately, although these attributes are not randomly distributed across the population. RESEARCH AIM To identify breastfeeding duration patterns by race/ethnicity and educational attainment in a nationally representative U.S. National Immunization Survey sample. METHOD We conducted a cross-sectional, secondary analysis of the U.S. Centers for Disease Control and Prevention's 2020 National Immunization Survey-Child public-use data. To examine breastfeeding and exclusive breastfeeding durations at the intersection of race/ethnicity and educational attainment, we created a 12-item, cross-classified variable using three educational attainment groups and four race/ethnicity groups. We used linear regressions to test these associations. RESULTS In all, 83% of the sample breastfed. Mean durations of breastfeeding were 7.5 (SE = 1.95) months and exclusive breastfeeding duration was 4.9 (SE = 0.87) months. In adjusted models, multi-race/other high-educational attainment participants had the longest breastfeeding duration by almost 3 weeks (β: 19.53, 95% CI [5.27, 33.79]), and Black low-educational attainment participants exclusively breastfed for 1 month less than White high-educational attainment participants (β:-30.23, 95% CI [-40.87, -19.58]). CONCLUSIONS Examining race/ethnicity and educational attainment together provides an intersectional understanding of breastfeeding outcomes and can inform targeted, culturally appropriate interventions.
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Affiliation(s)
- Margaret S Butler
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elijah J Watson
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Shreya S Narla
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Van T, Varadi D, Adams AC, Feldman-Winter L. Promotion, Protection, and Support of Breastfeeding as a Human Right: A Narrative Review. Breastfeed Med 2023; 18:561-570. [PMID: 37428560 DOI: 10.1089/bfm.2023.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background: Despite the benefits of breastfeeding, there are significant disparities in rates among various racial, social, and economic groups. Society poses various barriers to breastfeeding, threatening the child's access to a basic human right. Exploring and understanding these issues can ensure that effective interventions are implemented. Objective: To present situations in which the mother's and child's basic human right to breastfeeding is threatened and to highlight opportunities to uphold their rights within social and health care systems. Methods: A literature search of relevant articles was performed via PubMed regarding (1) rights to optimal protections for breastfeeding, (2) situations in which the rights of breastfeeding parents are threatened, and (3) challenges in providing inclusive and equitable breastfeeding care along with strategies to uphold the human right to breastfeed. Results: Maternity leave of at least 12 weeks was associated with higher breastfeeding rates, whereas mandated breaks in the workplace resulted in either positive or inconclusive effects. Peer counseling, institutional initiatives, and mass media campaigns were among the most effective interventions; however, effects on breastfeeding varied among different racial groups. Conclusions: There are clear benefits of breastfeeding for mothers and infants, which highlight the importance of prioritizing breastfeeding as a basic human right. Regardless, there are numerous societal barriers to providing equitable breastfeeding care. Although there are interventions that have proven to be helpful in breastfeeding promotion, protection, and support, further standardized research will be beneficial in identifying effective and inclusive interventions.
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Affiliation(s)
- Trina Van
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Daphna Varadi
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Amanda C Adams
- Medical Library, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Children's Regional Hospital at Cooper University Healthcare-Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Racial Disparities in Consumption of Mother's Own Milk by Infants in the Neonatal Intensive Care Unit. J Perinat Neonatal Nurs 2023; 37:184-186. [PMID: 37494685 DOI: 10.1097/jpn.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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Pagano-Therrien J, Griswold MK, Amoah RK. "Go With the Flow": A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States. J Assoc Nurses AIDS Care 2023; 34:376-388. [PMID: 37199426 DOI: 10.1097/jnc.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
ABSTRACT Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother-infant dyad.
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Affiliation(s)
- Jesica Pagano-Therrien
- Jesica Pagano-Therrien, PhD, RN, CPNP-PC is an Associate Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA. Michele K. Griswold, PhD, MPH, RN, IBCLC is an Assistant Professor, Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, USA. Rita Amoah, PhD, RN, is an Assistant Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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Nommsen-Rivers L, Black MM, Christian P, Groh-Wargo S, Heinig MJ, Israel-Ballard K, Obbagy J, Palmquist AEL, Stuebe A, Barr SM, Proaño GV, Moloney L, Steiber A, Raiten DJ. An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5. Am J Clin Nutr 2023; 117 Suppl 1:S87-S105. [PMID: 37173062 DOI: 10.1016/j.ajcnut.2023.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.
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Affiliation(s)
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - M Jane Heinig
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Julie Obbagy
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Washington, DC, USA
| | - Aunchalee E L Palmquist
- Department of Maternal & Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Quinn EA, Sobonya S, Palmquist AE. Maternal perceptions of human milk expression output: An experimental design using photographs of milk. Soc Sci Med 2023; 324:115871. [PMID: 37023658 DOI: 10.1016/j.socscimed.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/20/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research. Research aim/question: To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. METHODS We surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). RESULTS Participants randomized to a higher volume reported more positive feelings and used the terms "good", "great", and "accomplished" to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of "bad" or "depressed." A subset of participants reported feeling "annoyed" about small volumes of milk. CONCLUSIONS Participants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration.
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Palmquist AEL, Tomori C, Tumlinson K, Fox C, Chung S, Quinn EA. Pandemic policies and breastfeeding: A cross-sectional study during the onset of COVID-19 in the United States. FRONTIERS IN SOCIOLOGY 2022; 7:958108. [PMID: 36405376 PMCID: PMC9669788 DOI: 10.3389/fsoc.2022.958108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
The United States is one of the few countries, and the only high-income country, that does not federally mandate protection of postpartum employment through paid postpartum maternity and family leave policies. At the onset of the COVID-19 pandemic in the U.S., stay-at-home orders were implemented nationally, creating a natural experiment in which to document the effects of de facto paid leave on infant feeding practices in the first postpartum year. The purpose of this cross-sectional, mixed-methods study was to describe infant and young child feeding intentions, practices, decision-making, and experiences during the first wave of the COVID-19 pandemic in the U.S. Quantitative and qualitative data were collected March 27-May 31, 2020 via online survey among a convenience sample of respondents, ages 18 years and older, who were currently feeding a child 2 years of age or younger, yielding 1,437 eligible responses. Nearly all (97%) respondents indicated an intention to feed their infant exclusively with human milk in the first 6 months. A majority of respondents who were breastfeeding (66%) reported no change in breastfeeding frequency after the implementation of COVID-19 stay-at-home orders. However, thirty-one percent indicated that they breastfed more frequently due to stay-at-home orders and delayed plans to wean their infant or young child. Key themes drawn from the qualitative data were: emerging knowledge and perceptions of the relationship between COVID-19 and breastfeeding, perceptions of immune factors in human milk, and the social construction of COVID-19 and infant and young child feeding perceptions and knowledge. There were immediate positive effects of stay-at-home policies on human milk feeding practices, even during a time of considerable uncertainty about the safety of breastfeeding and the transmissibility of SARS-CoV-2 via human milk, constrained access to health care services and COVID-19 testing, and no effective COVID-19 vaccines. Federally mandated paid postpartum and family leave are essential to achieving more equitable lactation outcomes.
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Affiliation(s)
- Aunchalee E. L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cecília Tomori
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carolyn Fox
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, United States
| | - Stephanie Chung
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - E. A. Quinn
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, United States
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16
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Nidey N, Hoyt-Austin A, Chen MJ, Bentley B, Tabb KM, Anyigbo C, Wilder C, Terplan M, McAllister JM, Wexelblatt SL, Murnan A, Kair LR. Racial Inequities in Breastfeeding Counseling Among Pregnant People Who Use Cannabis. Obstet Gynecol 2022; 140:878-881. [PMID: 36201781 PMCID: PMC9588485 DOI: 10.1097/aog.0000000000004834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
We examined how breastfeeding advice in the context of cannabis use differed by race and ethnicity. Data from the 2017-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) survey were used to assess differences in breastfeeding guidance related to cannabis use among 1,213 individuals who self-reported cannabis use 3 months before or during pregnancy. A multivariable logistic regression model was specified to examine the extent to which the odds of receiving prenatal advice against breastfeeding if using cannabis differed by self-reported race and ethnicity. We found that non-Hispanic Black people were four times more likely than non-Hispanic White people to be advised against breastfeeding if using cannabis (adjusted odds ratio 4.1, 95% CI 2.1-8.2). Pregnant non-Hispanic Black people were disproportionately advised not to breastfeed if using cannabis.
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Affiliation(s)
- Nichole Nidey
- Division of Biostatistics and Epidemiology and the Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital, the Department of Pediatrics and the Center for Addiction Research, University of Cincinnati College of Medicine, the Division of General and Community Pediatrics and the Perinatal Institute, Cincinnati Children's Hospital Medical Center, and the College of Nursing, University of Cincinnati, Cincinnati, Ohio; the Department of Pediatrics and the Department of Obstetrics and Gynecology, University of California, Davis, Davis, California; the School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois; and the Friends Research Institute, Baltimore, Maryland
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Tomori C, Palmquist AEL. Racial capitalism and the US formula shortage: A policy analysis of the formula industry as a neocolonial system. FRONTIERS IN SOCIOLOGY 2022; 7:961200. [PMID: 36386859 PMCID: PMC9644151 DOI: 10.3389/fsoc.2022.961200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The U.S. is currently experiencing a formula shortage and an infant feeding crisis that began with a formula recall and the hospitalization of 4 infants, 2 of whom died. Since 1981, governments around the world have been calling for an end to blatant human rights violations made by the commercial milk formula (CMF) industry. These practices not only involve targeting nutritionally vulnerable populations of mothers and newborns to turn a profit, but also actively undermining the implementation of policies, legislation, and regulatory oversight that might compromise their accumulation of wealth. In this paper we analyze the 2022 formula-shortage-as-infant-feeding-crisis through the lens of the history of colonialism and critical theory in the anthropology of reproduction. First, we provide an overview of the colonial roots of the formula industry from a global perspective. We then focus on how the mechanisms of racial exploitation remain entrenched in the U.S. approach to infant feeding policies, regulation and investment, setting the stage for the current infant feeding crisis. Through our analysis of the 2022 infant feeding crisis we demonstrate how the multinational CMF industry perpetuates racial capitalism and racialized health inequities and disparities through its operations as a neocolonial enterprise. Finally, we offer policy interventions and potential solutions that are grounded in structural interventions for more equitable, anticolonial, antiracist infant feeding systems.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing and the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Aunchalee E. L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Palmquist AE, Asiodu IV, Tucker C, Tully KP, Asbill DT, Malloy A, Stuebe AM. Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records. Health Equity 2022; 6:798-808. [PMID: 36338802 PMCID: PMC9629910 DOI: 10.1089/heq.2022.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate differences in the use of pasteurized donor human milk (PDHM) by maternal race-ethnicity during postpartum hospitalization using electronic medical records (EMRs). MATERIALS AND METHODS A retrospective cohort study of all live-born infants at our academic research institution from July 1, 2014, to June 30, 2016, was conducted. EMR data were used to determine whether each infant received mother's own milk (MOM), PDHM, or formula. These data were stratified based on whether the infant received treatment in the Neonatal Critical Care Center. Generalized estimating equation models were used to calculate the odds of receiving PDHM by maternal race-ethnicity, adjusting for gestational age, birth weight, insurance, preferred language, nulliparity, and mode of delivery. RESULTS Infant feeding data were available for 7097 infants, of whom 49% were fed only MOM during their postpartum hospitalization. Among the 15.9% of infants admitted to neonatal critical care, infants of non-Hispanic Black (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.31-0.72), Hispanic (OR 0.65, 95% CI 0.36-1019), and Other (OR 0.63, 95% CI 0.32-1.26) mothers had lower rates of PDHM feedings than infants of non-Hispanic White mothers in the adjusted models. Among well infants, the use of PDHM was lower among non-Hispanic Black and Hispanic mothers (OR 0.25, 95% CI 0.18-0.36, and OR 0.38, 95% CI 0.26-0.56) compared with non-Hispanic White mothers. CONCLUSIONS Inequities in exclusive human milk feeding and use of PDHM by maternal race-ethnicity were identified. Antiracist interventions are needed to promote equitable access to skilled lactation support and counseling for PDHM use.
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Affiliation(s)
- Aunchalee E.L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Address correspondence to: Aunchalee E.L. Palmquist, PhD, MA, IBCLC, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB-7445, Chapel Hill, NC 27599-7400, USA.
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | - Christine Tucker
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin P. Tully
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Angela Malloy
- Momma's Village of Fayetteville, Fayetteville, North Carolina, USA
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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20
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Seiger ER, Wasser HM, Hutchinson SA, Foster G, Sideek R, Martin SL. Barriers to Providing Lactation Services and Support to Families in Appalachia: A Mixed-Methods Study With Lactation Professionals and Supporters. Am J Public Health 2022; 112:S797-S806. [PMID: 36288532 PMCID: PMC9612188 DOI: 10.2105/ajph.2022.307025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To understand the barriers and facilitators that lactation professionals and supporters (LPSs) in the Appalachian region of the United States experience when providing services and support to families. Methods. We used a mixed-methods explanatory sequential design with a survey of LPSs in Appalachia (March‒July 2019), followed by semistructured interviews with LPSs (January‒April 2020). We summarized survey responses descriptively and analyzed interview transcripts thematically. Results. The survey was completed by 89 LPSs in Appalachia. We conducted semistructured interviews with 20 LPSs. Survey participants most commonly identified challenges with other health care providers, hospital practices, and non‒medically indicated supplementation as barriers. Interview participants described challenges with clients' families not supporting breastfeeding, difficulty reaching clients, limited numbers of LPSs, and lack of racial/ethnic diversity among LPSs. LPSs identified the need for training in lactation and substance use, mental health, and birth trauma, and supporting lesbian, gay, bisexual, transgender, queer or questioning, plus (LGBTQ+) families. LPSs described social media and telehealth as both facilitators and barriers. Social support from other LPSs was a facilitator. Conclusions. LPSs in Appalachia face various challenges. Addressing these challenges has the potential to improve the lactation support and services families in Appalachia receive. (Am J Public Health. 2022;112(S8):S797-S806. https://doi.org/10.2105/AJPH.2022.307025).
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Affiliation(s)
- Emily R Seiger
- Emily R. Seiger, Stephanie L. Martin, Heather M. Wasser, Grace Foster, and Ruwaydah Sideek are with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Stephanie A. Hutchinson is with the Appalachian Breastfeeding Network, Gallipolis, Ohio
| | - Heather M Wasser
- Emily R. Seiger, Stephanie L. Martin, Heather M. Wasser, Grace Foster, and Ruwaydah Sideek are with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Stephanie A. Hutchinson is with the Appalachian Breastfeeding Network, Gallipolis, Ohio
| | - Stephanie A Hutchinson
- Emily R. Seiger, Stephanie L. Martin, Heather M. Wasser, Grace Foster, and Ruwaydah Sideek are with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Stephanie A. Hutchinson is with the Appalachian Breastfeeding Network, Gallipolis, Ohio
| | - Grace Foster
- Emily R. Seiger, Stephanie L. Martin, Heather M. Wasser, Grace Foster, and Ruwaydah Sideek are with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Stephanie A. Hutchinson is with the Appalachian Breastfeeding Network, Gallipolis, Ohio
| | - Ruwaydah Sideek
- Emily R. Seiger, Stephanie L. Martin, Heather M. Wasser, Grace Foster, and Ruwaydah Sideek are with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Stephanie A. Hutchinson is with the Appalachian Breastfeeding Network, Gallipolis, Ohio
| | - Stephanie L Martin
- Emily R. Seiger, Stephanie L. Martin, Heather M. Wasser, Grace Foster, and Ruwaydah Sideek are with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Stephanie A. Hutchinson is with the Appalachian Breastfeeding Network, Gallipolis, Ohio
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21
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Haas DM, Yang Z, Parker CB, Chung J, Parry S, Grobman WA, Mercer BM, Simhan HN, Silver RM, Wapner RJ, Saade GR, Greenland P, Merz NB, Reddy UM, Pemberton VL. Factors associated with duration of breastfeeding in women giving birth for the first time. BMC Pregnancy Childbirth 2022; 22:722. [PMID: 36138368 PMCID: PMC9494803 DOI: 10.1186/s12884-022-05038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine maternal, psychosocial, and pregnancy factors associated with breastfeeding for at least 6 months in those giving birth for the first time. Methods We performed a planned secondary analysis of an observational cohort study of 5249 women giving birth for the first time. Women were contacted at least 6 months after delivery and provided information regarding breastfeeding initiation, duration, and exclusivity. Maternal demographics, psychosocial measures, and delivery methods were compared by breastfeeding groups. Results 4712 (89.8%) of the women breastfed at some point, with 2739 (58.2%) breastfeeding for at least 6 months. Of those who breastfed, 1161 (24.7% of the entire cohort), breastfed exclusively for at least 6 months. In the multivariable model among those who ever breastfed, not smoking in the month prior to delivery (adjusted odds ratio [aOR] 2.04, 95%CI 1.19–3.45), having a Master’s degree of higher (aOR 1.89, 95%CI 1.51–2.36), having a planned pregnancy (aOR 1.48, 95%CI 1.27–1.73), older age (aOR 1.02, 95% CI, 1.01–1.04), lower BMI (aOR 0.96 95% CI 0.95–0.97), and having less anxiety measured during pregnancy (aOR 0.990, 95%CI 0.983–0.998) were associated with breastfeeding for at least 6 months. Compared to non-Hispanic White women, Hispanic women, while being more likely to breastfeed initially (aOR 1.40, 95%CI 1.02–1.92), were less likely to breastfeed for 6 months (aOR 0.72, 95%CI 0.59–0.88). While non-Hispanic Black women were less likely than non-Hispanic White women to initiate breastfeeding (aOR 0.68, 95%CI 0.51–0.90), the odds of non-Hispanic Black women of continuing to breastfeed for at least 6 months was similar to non-Hispanic White women (aOR 0.92, 95%CI 0.71–1.19). Conclusions In this cohort of women giving birth for the first time, duration of breastfeeding was associated with several characteristics which highlight groups at greater risk of not breastfeeding as long as currently recommended. Trial registration NCT01322529 (nuMoM2b) and NCT02231398 (nuMoM2b-Heart Health) Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05038-7.
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Affiliation(s)
- David M Haas
- Department of OB/GYN, Indiana University School of Medicine, 550 N. University Blvd, UH 2440, Indianapolis, IN, 46202, USA.
| | - Ziyi Yang
- Department of OB/GYN, Indiana University School of Medicine, 550 N. University Blvd, UH 2440, Indianapolis, IN, 46202, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, USA
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Grubesic TH, Durbin KM. Breastfeeding, Community Vulnerability, Resilience, and Disasters: A Snapshot of the United States Gulf Coast. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11847. [PMID: 36231150 PMCID: PMC9564847 DOI: 10.3390/ijerph191911847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Climate change-induced disasters are increasing in intensity and frequency in the United States. Infant feeding in the aftermath of an extreme event is particularly challenging, especially given large variations in community vulnerability and resilience. The aim of this study was to identify the physical, social, and spatial vulnerabilities of communities along the Gulf Coast and highlight locations where high (or low) breastfeeding initiation rates have the potential to offset (or exacerbate) infant feeding challenges in the wake of a disaster. We structured this study as a retrospective, spatial data analysis of breastfeeding initiation, the risk for extreme events, social vulnerability, and community resilience to uncover locations that may need post-disaster intervention. The results suggested that significant gaps in the geographic distribution of community risk, vulnerability, resilience, and breastfeeding initiation existed. While many metropolitan areas benefitted from high breastfeeding initiation rates, they were also the most "at risk" for disasters. Conversely, many rural communities faced less risk for extreme events but exhibited more social vulnerability and less resilience should a disaster strike. Prioritizing emergency response resources to support infant feeding after a disaster is critically important, but urban and rural communities have divergent profiles that will require variable strategies to ensure recovery. Our results highlight this variability and provide prescriptive guidance regarding where to potentially allocate emergency resources.
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Affiliation(s)
- Tony H. Grubesic
- Center for Geospatial Sciences, School of Public Policy, University of California at Riverside, Riverside, CA 92521, USA
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Hunagund S, Golan Y, Asiodu IV, Prahl M, Gaw SL. Effects of Vaccination Against Influenza, Pertussis, and COVID-19 on Human Milk Antibodies: Current Evidence and Implications for Health Equity. Front Immunol 2022; 13:910383. [PMID: 35903100 PMCID: PMC9314549 DOI: 10.3389/fimmu.2022.910383] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022] Open
Abstract
Human milk contains three antibody classes that confer mucosal immunity to the breastfed infant: secretory IgA (SIgA), secretory IgM (SIgM), and IgG. Influenza and pertussis vaccines administered during pregnancy induce pathogen specific SIgA and IgG responses in human milk that have been shown to protect the breastfed infant from these respiratory illnesses. In addition, mRNA vaccines against the SARS-CoV-2 virus administered during pregnancy and lactation induce anti-SARS-CoV-2 IgG and IgA responses in human milk. This review summarizes the immunologic benefits of influenza, pertussis, and COVID-19 vaccines conferred by human milk. Additionally, future research direction in human milk immunity and public health needs to improve lactational support are discussed.
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Affiliation(s)
- Soumya Hunagund
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Yarden Golan
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, United States
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Mary Prahl
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Division of Pediatric Infectious Diseases and Global Health, University of California, San Francisco, San Francisco, CA, United States
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
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Tully KP, Smith JL, Pearsall MS, Sullivan C, Seashore C, Stuebe AM. Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey. J Hum Lact 2022; 38:287-297. [PMID: 34841934 PMCID: PMC9805698 DOI: 10.1177/08903344211057876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization. RESEARCH AIMS To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed. METHODS This was a prospective cross-sectional survey study. Through secure online survey, participants submitted (N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics. RESULTS Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood. CONCLUSION Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.
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Affiliation(s)
- Kristin P Tully
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacquana L Smith
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Carl Seashore
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison M Stuebe
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Directionality of the associations between bedsharing, maternal depressive symptoms, and infant sleep during the first 15 months of life. Sleep Health 2022; 8:39-46. [PMID: 34922857 PMCID: PMC8821130 DOI: 10.1016/j.sleh.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify predictors of infant sleep arrangement and examine the directionality of the relationships between maternal depressive symptoms, infant sleep problems, and bedsharing. DESIGN Secondary analysis of longitudinal data from the Mothers and Others: Family-Based Obesity Prevention for Infants and Toddlers randomized trial. SETTING Central North Carolina, USA. PARTICIPANTS Four-hundred and twenty-eight predominantly low-income, non-Hispanic Black mother-infant pairs. MEASUREMENTS Data were collected at 28 weeks pregnancy and 1, 3, 6, 9, 12, and 15 months postpartum. Maternal depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale and infant sleep variables were measured using the Brief Infant Sleep Questionnaire. RESULTS The prevalence of reported bedsharing increased from 16.7% at 1 month to 35.6% at 15 months postpartum. Bedsharing was associated with shortened breastfeeding duration and maternal perception of an infant sleep problem. Concurrently, maternal perception of an infant sleep problem, but not presence of maternal depressive symptoms, was associated with an increased likelihood of bedsharing. Longitudinally, neither maternal perception of an infant sleep problem nor presence of maternal depressive symptoms predicted bedsharing. Bedsharing predicted an increased likelihood of maternal perception of an infant sleep problem and presence of maternal depressive symptoms. CONCLUSION Prevalence of bedsharing increased over time and was predictive of maternal depressive symptoms. Providers should discuss the conflicting infant sleep recommendations with their patients and provide safe-sleep guidelines for mothers who intend to bedshare.
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Petit M, Smart DA, Sattler V, Wood NK. Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:977-986. [PMID: 34763821 DOI: 10.1016/j.jneb.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.
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Affiliation(s)
- Melissa Petit
- College of Nursing, Washington State University, Spokane, WA
| | - Denise A Smart
- College of Nursing, Washington State University, Spokane, WA.
| | | | - Natsuko K Wood
- College of Nursing, Washington State University, Spokane, WA
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Foster VA, Harrison JM, Williams CR, Asiodu IV, Ayala S, Getrouw-Moore J, Davis NK, Davis W, Mahdi IK, Nedhari A, Niles PM, Peprah S, Perritt JB, McLemore MR, Mask Jackson F. Reimagining Perinatal Mental Health: An Expansive Vision For Structural Change. Health Aff (Millwood) 2021; 40:1592-1596. [PMID: 34606355 DOI: 10.1377/hlthaff.2021.00805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diagnoses of depression, anxiety, or other mental illness capture just one aspect of the psychosocial elements of the perinatal period. Perinatal loss; trauma; unstable, unsafe, or inhumane work environments; structural racism and gendered oppression in health care and society; and the lack of a social safety net threaten the overall well-being of birthing people, their families, and communities. Developing relevant policies for perinatal mental health thus requires attending to the intersecting effects of racism, poverty, lack of child care, inadequate postpartum support, and other structural violence on health. To fully understand and address this issue, we use a human rights framework to articulate how and why policy makers must take progressive action toward this goal. This commentary, written by an interdisciplinary and intergenerational team, employs personal and professional expertise to disrupt underlying assumptions about psychosocial aspects of the perinatal experience and reimagines a new way forward to facilitate well-being in the perinatal period.
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Affiliation(s)
- Vu-An Foster
- Vu-An Foster is the executive director of Life After 2 Losses, in Montclair, New Jersey
| | - Jessica M Harrison
- Jessica M. Harrison is a doctoral candidate in the Department of Social and Behavioral Sciences, University of California San Francisco (UCSF), in San Francisco, California
| | - Caitlin R Williams
- Caitlin R. Williams is a doctoral candidate in the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina
| | - Ifeyinwa V Asiodu
- Ifeyinwa V. Asiodu is an assistant professor in the Department of Family Health Care Nursing, UCSF
| | - Sequoia Ayala
- Sequoia Ayala is the director of operations for Move to End Violence, in Atlanta, Georgia
| | - Jasmine Getrouw-Moore
- Jasmine Getrouw-Moore is a PhD candidate at the University of North Carolina at Greensboro, in Greensboro, North Carolina. She was the executive director of the Office for Diversity, Equity & Inclusion, Guilford County Schools, in Greensboro, North Carolina, at the time this work was performed
| | - Nastassia K Davis
- Nastassia K. Davis is the executive director of the Perinatal Health Equity Foundation, in Montclair, New Jersey
| | - Wendy Davis
- Wendy Davis is the executive director of Postpartum Support International, in Portland, Oregon
| | - Inas K Mahdi
- Inas K. Mahdi is a doctoral student in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Aza Nedhari
- Aza Nedhari is the executive director of Mamatoto Village, in Baltimore, Maryland
| | - P Mimi Niles
- P. Mimi Niles is an assistant professor and faculty fellow at the Rory Meyers College of Nursing, New York University, in New York, New York
| | - Sayida Peprah
- Sayida Peprah is the executive director of Diversity Uplifts, Inc., in Rancho Cucamonga, California
| | - Jamila B Perritt
- Jamila B. Perritt is the president and CEO of Physicians for Reproductive Health, in Washington, D.C
| | - Monica R McLemore
- Monica R. McLemore is an associate professor in the Department of Family Health Care Nursing, UCSF
| | - Fleda Mask Jackson
- Fleda Mask Jackson is the president and CEO of MAJAICA, LLC, in Atlanta, Georgia
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A Vision for the Future of Nursing Leadership in the Lactation Field. J Perinat Neonatal Nurs 2021; 35:302-304. [PMID: 34726646 DOI: 10.1097/jpn.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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