Parental Decision-Making Around Introducing Complementary Foods: An Integrative Review

A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions.

Social Media Usage as a Form of Breastfeeding Support Among Black Mothers: A Scoping Review of the Literature

INTRODUCTION

Social support has been identified in the literature as a key facilitator of breastfeeding success among Black mothers. Over the past decade, there has been a surge of social media groups that can now be used as a means of support for various health and social issues. Social media breastfeeding groups have been used as sources of additional support. A scoping review of the literature was conducted to explore social media usage as a form of social support among Black women in the postpartum period and how it may affect breastfeeding behaviors.

METHODS

Using the 5-stage scoping review methodology, scholarly databases were searched for relevant articles. English-language articles on studies conducted both in and outside of the United States were included. Original studies that focused on social media as a form of breastfeeding support and included Black mothers as part of the study population were included.

RESULTS

After screening 551 articles, 6 studies fulfilled the study criteria. Participants reported being provided with various forms of social support through social media within the included articles. Primary themes included (1) a sense of community and (2) self-efficacy and empowerment. Breastfeeding support through social media appears to positively influence breastfeeding intention and duration rates among Black mothers.

DISCUSSION

Social media is an accessible avenue for breastfeeding information and support. Moreover, it provides a safe space for Black women to interact with others of shared cultural experiences. Therefore, incorporating social media into breastfeeding interventions can positively affect breastfeeding rates among Black women. More research is needed to assess the direct effect of social media breastfeeding support groups on the breastfeeding behaviors and experiences of Black women.

Racial Differences in Breastfeeding on the Mississippi Gulf Coast: Making Sense of a Promotion-Prevalence Paradox with Cross-Sectional Data

Breastfeeding is less prevalent among African American women than their white peers. Moreover, breastfeeding rates in the South lag behind those in other regions of the U.S. Consequently, various efforts have been undertaken to promote breastfeeding among groups for which this practice is less common. This study examines African American and white racial disparities concerning (1) exposure to breastfeeding promotional information and (2) reported prevalence of breastfeeding in primary social networks. The survey combines a randomly selected sample of adults representative of the population and a non-random oversample of African Americans in a predominantly rural tri-county area on the Mississippi Gulf Coast. An initial wave of 2019 Mississippi REACH Social Climate Survey data collected under the auspices of the CDC-funded REACH program (Mississippi's Healthy Families, Mothers, and Babies Initiative; 2018-2023) is used to examine racial disparities in these two key outcomes for Mississippians in Hancock, Harrison, and Jackson counties. The results show that African American respondents are more likely to be exposed to breastfeeding promotional messages than their white counterparts. However, the reported prevalence of breastfeeding in African American respondents' primary social networks is significantly lower than that indicated by their white peers. These paradoxical results underscore the limitations of promotional efforts alone to foster breastfeeding. While breastfeeding promotion is important, the reduction of racial disparities in this practice likely requires a multi-pronged effort that involves structural breastfeeding supports (e.g., lactation spaces, peer networking groups, and pro-breastfeeding employment policies and workplaces). This study provides a promising model of innovative methodological approaches to the study of breastfeeding while underscoring the complex nature of racial disparities in lactation prevalence.

Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records

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.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months

OBJECTIVE

To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States.

DESIGN

A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019.

PARTICIPANTS

We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion.

MEASUREMENTS

The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences.

RESULTS

Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]).

CONCLUSION

Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Black Lives Matter Principles as an Africentric Approach to Improving Black American Health

Although public health has made substantial advances in closing the health disparity gap, Black Americans still experience inequalities and inequities. Several theoretical frameworks have been used to develop public health interventions for Black American health; yet the existing paradigms do not fully account for the ontology, epistemology, or axiology of Black American populations. The Black Lives Matter (BLM) movement provides a basis for understanding the constructs that may contribute to Black American health. By drawing from the 13 BLM principles, this paper presents an alternative approach for developing, implementing, and evaluating public health interventions for Black populations in the USA. Furthermore, the approach may inform future public health research and policies to reduce health disparities within and across Black populations in the USA.

Subject Matter Experts Identify Health Equity Concerns in Breastfeeding for African American Women

Although the rate of breastfeeding initiation in the United States has continued to rise since 1972, African American mothers continue to experience a significant disparity in initiation. The aim of this study was to explore the perceptions of the facilitators and barriers of breastfeeding initiation among African American mothers from the perspective of subject matter experts (SMEs). This study was part of a larger study that also involved focus group methodology with African American women. The purpose of this article is to describe the opinions, knowledge, and perceptions of SMEs who work with African American mothers. A semistructured interview guide was used to interview 7 SMEs at which point no new themes emerged from the data. SMEs highlighted the significance of modifiable factors in breastfeeding initiation decisions and validated many perceptions of African American mothers. SMEs identified many critical issues foundational to community perspective and shaping future success in raising breastfeeding initiation rates. To increase breastfeeding initiation rates among African American mothers, strategies beyond the individual level are necessary. SMEs recognize the importance of addressing fundamental issues related to historical perspectives, normalization, education, and disparities in breastfeeding as critical.

Moving Beyond Breastfeeding Initiation: A Qualitative Study Unpacking Factors That Influence Infant Feeding at Hospital Discharge Among Urban, Socioeconomically Disadvantaged Women

BACKGROUND

Factors that influence breastfeeding initiation and duration have been well established; however, there is limited understanding of in-hospital exclusive breastfeeding (EBF), which is critical for establishing breastfeeding. Grady Memorial Hospital, which serves a high proportion of participants receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and racial/ethnic minorities, had an in-hospital EBF rate in 2018 by the Joint Commission's definition of 29% and sought contextualized evidence on how to best support breastfeeding mothers.

OBJECTIVE

The objectives were to (1) identify facilitators and barriers to in-hospital EBF and (2) explore breastfeeding support available from key stakeholders across the social-ecological model.

DESIGN

In-depth, semistructured interviews were conducted and analyzed using thematic analysis.

PARTICIPANTS

The sample included a total of 38 purposively sampled participants from Grady Memorial Hospital (10 EBF mothers, 10 non-EBF, and 18 key stakeholders such as clinicians, community organizations' staff, and administrators).

RESULTS

Key themes included that maternal perception of inadequate milk supply was a barrier to in-hospital EBF at the intrapersonal level. At the interpersonal level, a personable and individualized approach to breastfeeding counseling may be most effective in supporting EBF. At the institutional level, key determinants of EBF were gaps in prenatal breastfeeding education, limited time to provide comprehensive prenatal education to high-risk patients, and practical help with latching and positioning. Community-level WIC services were perceived as a facilitator due to the additional benefits provided for EBF mothers; however, the distribution of WIC vouchers for formula to mothers while they are in the hospital undermines the promotion of EBF. Cultural norms and a diverse patient population were reported as barriers to providing support at the macrosystem level.

CONCLUSION

Multipronged approaches that span the social-ecological model may be required to support early EBF in hospital settings.

[Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration]

PURPOSE

This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources.

METHODS

A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young's work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration.

RESULTS

The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital. The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group.

CONCLUSION

Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

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

In this paper, I argue for the need to shift the focus of nursing research regarding breastfeeding from that of individual responsibility to include a more system-focused, population health approach. In the 2011, "Call to Action to Support Breastfeeding," the U.S. Surgeon General called attention to the pervasive disparities in breastfeeding outcomes in the United States. A plethora of nursing research exists aimed at addressing these disparities; however, this research leans toward a neoliberal perspective, mainly focusing on individual factors and failing to address the systemic inequities contributing to these disparities. A shift in nursing science that focuses research at a population level would more effectively support addressing disparities in breastfeeding outcomes and embrace a commitment to social justice. In focusing at a population level, specific inequities that must be addressed include the negative history of breastfeeding in the Black population, systemic racism, and gender inequality. Critical research methodologies are proposed as useful approaches to address these inequities. By engaging in this level of research and using a critical lens, nurse scientists broaden their scope of care to include the entire population, motivate needed social and policy change, facilitate the choice to breastfeed, and ultimately eliminate breastfeeding disparities.

It Takes an E-Village: Supporting African American Mothers in Sustaining Breastfeeding Through Facebook Communities

BACKGROUND

Lack of breastfeeding support is a common barrier reported by African American mothers, whose breastfeeding rates remain significantly below the national average. Despite mothers' reported use of social network sites to access support on topics relating to child rearing, few studies have examined their use to exchange breastfeeding support.

RESEARCH AIMS

To describe (1) the experiences of African American mothers who participate in breastfeeding support groups on Facebook and (2) the breastfeeding beliefs, practices, and outcomes for this population of mothers.

METHODS

This was a prospective, cross-sectional qualitative study with an online focus group design. The study was guided by Black Feminist Thought and an integrated model of behavior prediction. Four online focus groups (N = 22) were conducted using video conferencing during September 2017 with African American mothers who were participating in breastfeeding support groups on Facebook.

RESULTS

Thematic analysis was used to develop four themes and two subthemes, including creating a community for Black mothers, online interactions and levels of engagement, advantages of participating in online support groups, critiques of online support groups, empowerment of self and others, and shifts in breastfeeding perceptions and decisions. Among participants in this study, positive imagery of African American breastfeeding mothers and ongoing support from women with shared experiences improved confidence with public breastfeeding and prolonged goals for breastfeeding duration.

CONCLUSION

Receiving peer support within Facebook communities may positively influence breastfeeding norms and confidence in breastfeeding, help mothers to overcome breastfeeding challenges, and ultimately extend intended breastfeeding duration.

Facebook support for breastfeeding mothers: A comparison to offline support and associations with breastfeeding outcomes

OBJECTIVES

For breastfeeding mothers, online support groups through Facebook may be a more convenient and preferred source for accessing breastfeeding information and support, but few studies exist that examine the use of Facebook groups specifically for breastfeeding support. This study explores the sources of support among users of Facebook breastfeeding support groups and a possible mechanism by which support received on Facebook may translate to behavioral outcomes among breastfeeding mothers.

METHODS

From July-September 2017 a survey was distributed online to African American mothers (N = 277) who participate in breastfeeding support groups on Facebook. The survey assessed network support from Facebook and other sources of breastfeeding support, perceived breastfeeding norms, breastfeeding self-efficacy and breastfeeding attitudes. Correlations and linear regression analysis were used to examine the relationship between covariates and outcome variables.

RESULTS

The average intended breastfeeding duration among participants in this study was 19 months. Participants reported the highest amount of breastfeeding support received from their Facebook support group, in comparison to other sources of support, and Facebook support was significantly correlated with intended breastfeeding duration (p < 0.05). Self-efficacy and breastfeeding attitudes remained significant predictors of intended breastfeeding duration within the final regression model.

CONCLUSIONS

Breastfeeding support received within Facebook groups may compensate for inadequate support received within mothers' networks. More research is needed to understand the mechanism through which Facebook support may contribute to prolonged breastfeeding durations.

"Fitting-in Australia" as nurturers: Meta-synthesis on infant feeding experiences among immigrant women

PROBLEM

Migration or resettlement to western nations frequently alters breastfeeding and complementary feeding practices.

BACKGROUND

Infant feeding practices in traditional societies (originally from non-white countries) are ingrained within customary beliefs and practices.

AIM

To understand maternal infant feeding experiences pre- and post-resettlement for the benefit of policy and healthcare practice.

METHODS

This meta-synthesis of qualitative studies on infant feeding experiences of migrant and refugee women in Australia adopted the Noblit and Hare aproach. CINAHL, ScienceDirect, MEDLINE, Social Sciences, SCOPUS and PubMed databases from 1980 to 2018 were searched. Fourteen papers of the 218 retrieved met the inclusion criteria. The Critical Appraisal Skills Programme (CASP) tool was used to assess the quality of papers and data were synthesised through reciprocal translation.

RESULTS

One overarching theme emerged: "Fitting-in" to nurture a healthy child in a new homeland. This theme composed of two major themes: beliefs about breast milk and breastfeeding; and beliefs about complementary feeding. In Australia, manufactured foods such as infant formula were often associated with modernism. Western hospital policies were seen as a deterrent to lactation, while familial disconnections and unfamiliarity with healthcare and societal norms undermined maternal infant feeding confidence. New to the scope of migratory infant feeding literature, this synthesis uncovers how migrants and refugees negotiated the western hierarchical structures differently due to issues of power differences.

CONCLUSION

The 'Fitting-in' notion is best described through the socio-ecological model and maternal capital possessions. This paper calls for a proper 'balancing' between traditional beliefs and the safeguarding of infant health.

Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered care

Postpartum contraceptive decision making is complex, and recommendations may be influenced by breastfeeding intentions. While biologically plausible, concerns about the adverse impact of hormonal contraception on breast milk production have not been supported by the clinical evidence to date. However, the data have limitations, which can lead providers with different priorities around contraception and breastfeeding to interpret the data in a way that advances their personal priorities. Discrepancies in interpretations can lead to divergent recommendations for individual women and may cause conflict. Furthermore, providers must recognize that decision making about contraception and breastfeeding takes place in complex cultural, historical and socioeconomic contexts. Implicit bias may influence a provider's counseling. Unrecognized biases toward one patient or another, or one practice or another, may influence a provider's counseling. It is crucial for providers to strive to recognize their own biases. Providers need to respectfully recognize each patient's values and preferences regarding hormonal contraception and breastfeeding. Developing a patient-centered decision tool or implementing patient-centered interview techniques specifically around breastfeeding and contraception could help to minimize provider-driven variability in care.

A Pilot Study of a Culturally Grounded Breastfeeding Intervention for Pregnant, Low-Income African American Women

BACKGROUND

Increasing breastfeeding rates among low-income African American women may work toward the achievement of health equity. The dynamic breastfeeding assessment process (D-BAP) is a community-grounded, equity-focused intervention designed to increase prenatal breastfeeding self-efficacy. Research aim: The aims of the pilot study were (a) to determine the effect of the D-BAP on breastfeeding self-efficacy among pregnant, low-income African American women, (b) to examine the findings among women with no previous breastfeeding experience, and (c) to compare the findings between women with prior breastfeeding experience and those without it.

METHODS

A pre/post, paired-samples design was utilized. Convenience sampling was used to recruit pregnant, low-income African American women ( N = 25). Participants completed the Breastfeeding Self-Efficacy Scale-Short Form prior to and following the D-BAP.

RESULTS

The Wilcoxon signed rank test indicated that participation in the D-BAP had a statistically significant influence on breastfeeding self-efficacy ( z = -2.01, p = .04). Among a subsample of participants with no previous breastfeeding experience ( n = 12), completion of the D-BAP resulted in a statistically significant increase in breastfeeding self-efficacy ( z = -2.36, p = .02). There was no statistically significant difference between those with prior breastfeeding experience and those without it.

CONCLUSION

Breastfeeding among low-income African American women is a health equity issue for which culturally responsive, effective breastfeeding interventions are needed. This research demonstrates an association between completion of the D-BAP and an increase in prenatal breastfeeding self-efficacy.

Committing to Breastfeeding in Social Work

This article addresses the importance of breastfeeding for the social work profession. Because breastfeeding is a critical component of maternal and child health, persistent racial and socioeconomic breastfeeding inequality is a social justice issue in need of social work commitment. Even while breastfeeding rates have been increasing in the United States there are some groups of mothers who initiate breastfeeding less frequently or have trouble with sustaining breastfeeding for recommended lengths. These mothers and their babies thus miss out on the ample benefits of this nurturing interaction. Using social work's unique disciplinary perspective and commitment to social justice, the authors place essential understanding of breastfeeding health benefits within the core values of the National Association of Social Work ethical code. The practice context for early breastfeeding intervention with mothers and families is discussed with acknowledgment of the maternal-child health focus at the root of the profession. Recognition of the potential of contemporary social work to advance breastfeeding equity through practice, scholarship, and action positions breastfeeding support activities as integral to meeting the grand challenges of the social work profession.

Factors That Influence Breastfeeding Initiation Among African American Women

OBJECTIVE

To examine cultural and socioenvironmental factors that affect breastfeeding initiation among African American women.

DESIGN

Qualitative descriptive design and conventional content analysis.

SETTING

A large, inner-city, primary care center affiliated with a 500-bed children's hospital within a large, Northeastern U.S. city.

PARTICIPANTS

Participants were 34 U.S.-born African American mothers of healthy term infants 0 to 3 months of age.

METHODS

Six focus groups were conducted using a 16-question, scripted interview guide.

RESULTS

A number of complex factors that influenced breastfeeding initiation included certain cultural beliefs about sexuality, the influence of family and peer networks, information sources, intentions, and a variety of other barriers and facilitators.

CONCLUSION

Our findings suggest that the decision to initiate breastfeeding is not solely determined by the woman within the African American community. Because this decision is contingent on multiple factors external to the woman, it is important to recognize the role that partners, grandmothers, communities, information sources, and health care providers/organizations play in women's decisions. Implementation of multilevel strategies is critical to increase breastfeeding initiation among African American mothers.

Influence of Islamic Traditions on Breastfeeding Beliefs and Practices Among African American Muslims in West Philadelphia: A Mixed-Methods Study

BACKGROUND

Little is known regarding the influence of religion on breastfeeding in African American communities. In particular, whether Islamic traditions influence breastfeeding beliefs and practices among African American Muslims has not been studied. Research aim: This study sought to gain understanding of breastfeeding attitudes, rates, and education among African American Muslims in West Philadelphia and to examine if engaging Islamic teachings in breastfeeding education can positively influence breastfeeding attitudes.

METHODS

Open-ended, in-person, digitally recorded qualitative interviews were conducted with 10 community leaders and analyzed by conventional content analysis. A study tool distributed to a convenience sample of 44 community members and 11 leaders was used to gather information about education received from community leaders, breastfeeding attitudes and practices, and the potential for Islamic teachings to positively affect breastfeeding attitudes and practices. To obtain further data on this last topic, preliminary data analysis guided the creation of an education pamphlet, about which feedback was gathered through another study tool.

RESULTS

Education surrounding Islamic perspectives on breastfeeding was not prevalent. African American Muslims in West Philadelphia view breastfeeding favorably and have higher rates of breastfeeding than African Americans as a whole. Community education about breastfeeding that engaged Islamic teachings improved respondents' breastfeeding attitudes.

CONCLUSION

Increasing education among providers and African American Muslims about Islamic perspectives on breastfeeding may improve breastfeeding exclusivity and duration. Healthcare providers who care for Muslim women should be aware of Islam's tradition of positive attitudes toward breastfeeding and partner with Muslim leaders to improve breastfeeding rates and duration among such women.

Effectiveness of CenteringPregnancy on Breastfeeding Initiation Among African Americans: A Systematic Review and Meta-analysis

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiation among only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed.

A Qualitative Study of Social, Cultural, and Historical Influences on African American Women's Infant-Feeding Practices

The purpose of this study was to describe cultural factors influencing African American mothers' perceptions about infant feeding. Analysis of six focus group discussions of diverse African American mothers yielded sociohistorical factors that are rarely explored in the breastfeeding literature. These factors are events, experiences, and other phenomena that have been culturally, socially, and generationally passed down and integrated into families, potentially influencing breastfeeding beliefs and behaviors. The results from this study illuminate fascinating aspects of African American history and the complex context that frames some African American women's choice about breastfeeding versus artificial supplementation feeding. This study also demonstrates the need for developing family centered and culturally relevant strategies to increase the African American breastfeeding rate.

Racial and ethnic disparities in U.S. breastfeeding and implications for maternal and child health outcomes

Marked racial and ethnic disparities exist in infant feeding in the United States. Based on a review of recent literature, this article examines current discrepancies between the 2020 Healthy People breastfeeding goals and current breastfeeding rates among women from different ethnic groups in the United States. We discuss maternal and child health outcomes associated with breastfeeding, and we review potential causes of racial and ethnic disparities in breastfeeding outcomes in the United States, especially among non-Hispanic Black, American Indian/Alaska Native, and Hispanic/Latina populations. We conclude with an overview of best practices in interventions aimed to increase U.S. breastfeeding rates, such as adoption of the baby friendly hospital initiative (BHFI) and programs that utilize peer counseling strategies to increase breastfeeding promotion and support.

Integrative Literature Review of Factors Related to Breastfeeding in African American Women: Evidence for a Potential Paradigm Shift

BACKGROUND

Human milk has widespread health benefits for infants, mothers, and society. However, not all populations of women, particularly African American women, engage in human milk feeding at high rates. Research aim: The purpose of this integrative literature review is twofold: (a) to examine factors that influence low rates of human milk feeding among African American women and (b) to introduce a need for a methodological paradigm shift to develop culturally relevant and effective interventions.

METHODS

The authors searched four electronic social science databases for peer-reviewed journal articles pertaining to human milk among African American women published from 1990 to 2015. Both coauthors independently assessed these articles using thematic analysis and validation. The database search yielded 47 peer-reviewed articles.

RESULTS

Three main themes emerged explaining the human milk feeding disparity: (a) the social characteristics of women likely not to feed human milk (e.g., low socioeconomic status, single); (b) women's perceptions of human milk feeding; and (c) the quality of human milk feeding information provided by health care providers (i.e., limited human milk information).

CONCLUSION

Current literature does include sociohistorical factors that have shaped current norms. Adding sociohistorical frameworks, paying particular attention to the embodied experience of historical trauma, could lead to the development of new evidence-based, culturally sensitive interventions to enhance human milk feeding in the African American community.

Long-Term Breastfeeding in African American Mothers

BACKGROUND

According to the Centers for Disease Control and Prevention, 39.1% of African American infants are breastfed at 6 months. However, few studies have explored the breastfeeding experiences of African American women who successfully breastfeed to 6 months or longer durations. Research aim: The goal of this qualitative study was to explore the long-term breastfeeding experiences of low-income African American women using the positive deviance approach.

METHODS

African American women with breastfeeding experience were recruited through Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) breastfeeding peer counselors. Eligibility criteria included being age 18 or older, currently participating in WIC, and having breastfed one child for at least 6 months in the past 2 years. Semistructured, in-depth interviews were conducted with 11 participants. Interviews were audio-recorded and professionally transcribed. Transcripts were then analyzed for emerging themes using thematic analysis in NVivo software.

RESULTS

Participants had on average three children each, with an average length of breastfeeding of 10.5 months per child. Four main themes developed: (a) deciding to breastfeed, (b) initiating breastfeeding, (c) breastfeeding long-term, and (d) expanding breastfeeding support. Participants offered culturally tailored suggestions to improve breastfeeding support for other African American women: prenatal discussions of breastfeeding with health care providers, African American lactation support personnel and breastfeeding support groups, and African American breastfeeding promotion in print and digital media.

CONCLUSION

Women who participated in this study breastfed for longer durations than the national average for African Americans. Findings can inform practice and research efforts to improve breastfeeding rates in this population using lessons learned from successful women.

Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor

BACKGROUND

While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity.

MATERIALS AND METHODS

A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences.

RESULTS

For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers.

CONCLUSIONS

Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.

African-American Women's Perceptions and Experiences About Breastfeeding

There are health benefits to breastfeeding for both mothers and their children. The preventive health effects of breastfeeding continue into adulthood, lowering rate of various chronic illnesses. African-American women, especially of lower socioeconomic status, are less likely to breastfeed in comparison to their racial and ethnic counterparts. The purpose of this study is to explore how African-American women experience breastfeeding in the early stages of postpartum care. Two focus groups (N = 20, 10 in each group) were conducted with African-American mothers. Results revealed that participants felt that there were health benefits to breastfeeding, and organizations such as Women, Infants, and Children (WIC) provided support. However, participants stated that lack of information, negative perceptions, and unforeseen circumstances were barriers to breastfeeding. This study proposes support and interventions for this group to increase breastfeeding among this population.

Barriers and Contributors to Breastfeeding in WIC Mothers: A Social Ecological Perspective

BACKGROUND

In response to the Surgeon General's Call to Action to Support Breastfeeding, the goal of this research was to assess the barriers and positive contributors to breastfeeding initiation and duration in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants using the social ecological model (SEM).

MATERIALS AND METHODS

A cross-sectional design was used to survey WIC mothers (n = 283) in southern New Hampshire. Analysis of breastfeeding initiation and duration revealed statistically significant results primarily at the individual level of the SEM. Findings also showed influences at the interpersonal, community, and organizational levels. There were significant differences in beliefs toward breastfeeding between women who ever breastfed and women who never breastfed. Women who ever breastfed were more likely to agree that breastfeeding assists with losing baby weight (89% versus 77%; p = 0.03), babies fed breastmilk are less likely to get sick (86% versus 74%; p = 0.04), and breastfeeding helps mothers bond with their babies more quickly than formula feeding (88% versus 72%; p < 0.01). Breastfeeding duration was significantly related to employment status; among women who breastfed for 6 months or longer, 15% were employed full-time, 30% worked part-time, and 55% indicated "other" such as unemployed or stay-at-home mother (p = 0.01). Logistic regression revealed that maternal age was the most significant predictor of breastfeeding duration (odds ratio = 1.11; 95% confidence interval, 1.03, 1.19; p < 0.004).

CONCLUSIONS

Results indicate opportunities to inform and support women in the prenatal and postpartum period, improve the social and built environment, and develop and advocate for policies in an effort to support breastfeeding.

Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions

Maternal obesity is associated with significantly lower rates of breastfeeding initiation, duration and exclusivity. Increasing rates of obesity among reproductive-age women has prompted the need to carefully examine factors contributing to lower breastfeeding rates in this population. Recent research has demonstrated a significant impact of breastfeeding to reduce the risk of obesity in both mothers and their children. This article presents a review of research literature from three databases covering the years 1995 to 2014 using the search terms of breastfeeding and maternal obesity. We reviewed the existing research on contributing factors to lower breastfeeding rates among obese women, and our findings can guide the development of promising avenues to increase breastfeeding among a vulnerable population. The key findings concerned factors impacting initiation and early breastfeeding, factors impacting later breastfeeding and exclusivity, interventions to increase breastfeeding in obese women, and clinical considerations. The factors impacting early breastfeeding include mechanical factors and delayed onset of lactogenesis II and we have critically analyzed the potential contributors to these factors. The factors impacting later breastfeeding and exclusivity include hormonal imbalances, psychosocial factors, and mammary hypoplasia. Several recent interventions have sought to increase breastfeeding duration in obese women with varying levels of success and we have presented the strengths and weaknesses of these clinical trials. Clinical considerations include specific techniques that have been found to improve breastfeeding incidence and duration in obese women. Many obese women do not obtain the health benefits of exclusive breastfeeding and their children are more likely to also be overweight or obese if they are not breastfed. Further research is needed into the physiological basis for decreased breastfeeding among obese women along with effective interventions supported by rigorous clinical research to advance the care of obese reproductive age women and their children.

WIC peer counselors' perceptions of breastfeeding in African American women with lower incomes

BACKGROUND

African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors' perceptions of breastfeeding in African American women.

OBJECTIVE

As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs).

METHODS

Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner's socioecological model was used to group categories into themes.

RESULTS

Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs' low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a "sense of security," (2) cultural pressures to be a "strong black woman" can impede breastfeeding support, and (3) breastfeeding "generational gaps" have resulted from American "slavery" and when formula was "a sign of wealth."

CONCLUSION

As PCs described, low-income African American women's breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.