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Rabb K, Alikhani A, von Ash T, Risica PM. Examining Black Women's Breastfeeding Experiences in the United States: A Scoping Review of Qualitative Studies. Matern Child Health J 2023; 27:1726-1741. [PMID: 37347375 DOI: 10.1007/s10995-023-03692-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND A growing gap in exclusive breastfeeding across racial/ethnic groups in the United States includes a very low proportion of African American/Black women, with only 17.4% breastfeeding exclusively in 2015. While many quantitative studies examine these disparities, few qualitative studies have examined the overall experience of breastfeeding for Black women. OBJECTIVE The aim of this study is to evaluate the existing qualitative literature on experiences of African American/Black women who breastfeed to gain insight on barriers and facilitators unique to this population. METHODS This scoping review included studies that had a focus on any qualitative study design. Evidence was identified by searching electronic databases (PubMed, CINAHL, and PsychINFO). RESULTS Thirteen papers met the inclusion criteria for this review. Each study was summarized and then analyzed for content to produce a synthesis. Seven themes that influence Black women's experience with breastfeeding were identified: influence of interpersonal relationship on intention to and sustained breastfeeding experiences, influence of institutional systems on initiating and sustaining infant feeding decision, influence of personal beliefs on breastfeeding decisions and experience, material barriers and facilitators to breastfeeding experience, traditional stigma of breastfeeding, historical stigma of breastfeeding influences feeding choice in Black women, and negative impacts of body image. CONCLUSION The breastfeeding experience for Black women is unique and poses additional areas for intervention based on cultural and historical stigma. Incorporating the identified factors into intervention design is key to creating more effective policies for improving breastfeeding rates in the Black women and closing the gap across racial/ethnic demographics in the United States. Still, more qualitative research with culturally relevant theories needs to be done to investigate the full scope and complexities of breastfeeding as a Black woman to develop messaging to encourage the behavior.
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Affiliation(s)
- Kaitlyn Rabb
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA.
| | - Anna Alikhani
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
| | - Tayla von Ash
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Providence, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Providence, USA
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
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2
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Dugat V, Dake JA, Czaja E, Saltzman B, Knippen KL. Do Stressful Events and Racial Discrimination Explain Racial Gaps in Exclusive Breastfeeding Duration? A Qualitative Interview Study with Black, Hispanic, and White Mothers Living in Ohio. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01748-6. [PMID: 37668957 DOI: 10.1007/s40615-023-01748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES This study aimed to understand why breastfeeding and exclusive breastfeeding rates substantially decrease shortly after birth among mothers in the USA. Specifically, we aimed to illuminate the impact of stressful life events and racial discrimination on mothers' breastfeeding behaviors and duration. METHODS We conducted a qualitative analysis of semi-structured telephone interviews with women (N = 66; 47 White, 16 Black, and 3 Hispanic) who gave birth between 2019 and 2021 in Ohio. Interviews were conducted between March 2022 and May 2022. Interviews were digitally recorded, transcribed verbatim, analyzed, coded, and organized into themes. RESULTS After thematic analysis of the data, five key themes were identified: (1) stress, (2) breastfeeding barriers, (3) policy and system change to support breastfeeding mothers, (4) racial discrimination, and (5) breastfeeding motivators. Our study found that the breastfeeding experience was both a positive bonding experience and a challenging practice, characterized by physical, mental, and sociocultural struggles. CONCLUSION FOR PRACTICE Addressing stress during pregnancy, equitable access to culturally sensitive lactation support, improved parental leave, and enhanced workplace breastfeeding regulations are essential to increasing breastfeeding duration among racially marginalized women.
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Affiliation(s)
- Vickie Dugat
- College of Health and Human Services, University of Toledo, 2801 West Bancroft Street, 2801 West Bancroft Street MS 119, Toledo, OH, 43606, USA.
| | - Joseph A Dake
- School of Population Health, College of Health and Human Services, University of Toledo, 2801 West Bancroft Street MS 119, Toledo, OH, 43606, USA
| | - Erica Czaja
- School of Population Health, College of Health and Human Services, University of Toledo, 2801 West Bancroft Street MS 119, Toledo, OH, 43606, USA
| | - Barbara Saltzman
- School of Population Health, College of Health and Human Services, University of Toledo, 3000 Arlington Ave MS 4212, Toledo, OH, 43606, USA
| | - Kerri Lynn Knippen
- Department of Public and Allied Health, College of Health and Human Services, Bowling Green State University, Bowling Green, USA
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3
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Harahsheh MM, Mukattash TL, Al-shatnawi S, Abu-Farha R, D’Arcy D, Jarab A, Abuhammad S. Breastfeeding friendly pharmacy from pharmacists perspective. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
<b>Objective:</b> The primary goals of our research were to explore pharmacists’ perception of breastfeeding friendly pharmacy (BFPh) requirements and factors associated with their awareness about these requirements.<br />
<b>Methods:</b> A cross-sectional study design was conducted using a self-administered survey. A convenience sample (n=381) of community pharmacists, was recruited through social media resources. Data were entered and analyzed using SPSS software version 35. The frequency or percentages were used for categorical variables while means and standard deviations were used for continuous variables. Also, linear regression analysis was used to evaluate factors affecting pharmacists’ awareness about BFPh requirements.<br />
<b>Results:</b> The majority of recruited pharmacists were female (n=329, 86.4%), aged between 23 to 30 years of age (78.7%, n=300). The most common steps to describe a pharmacy as a BFPh from the perspective of surveyed pharmacists were training all pharmacy staff to develop the necessary skills (n=239, 62.7%)) followed by informing all pregnant women about the benefits of breastfeeding (n=225, 59.1%)) and having a written policy on feeding infants and young children according to the recommendations of the WHO and in compliance with the international code (n=209, 54.9%)). Furthermore, pharmacists aging 40 years or less showed a significantly higher awareness about BFPh requirements compared to those aging above 40 years (beta=-0.013, p= 0.045). In addition, 37% (n=142) of pharmacists perceived that answering general questions or concerns on general medication intake while breastfeeding babies is their major role in breastfeeding support.<br />
<b>Conclusion:</b> Breastfeeding support is a promising area for promoting professional pharmacy services. Training all pharmacy staff and informing all pregnant about the benefit of breastfeeding are the most common two steps to describe a pharmacy as BFPh. Additionally, the awareness of BFPh requirement was associated with pharmacists age. Future focus should be placed on implementing BFPh project in Jordanian pharmacies, where the steps of this project are modified in line with the capabilities of pharmacies in Jordan within governmental pharmaceutical control.
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Affiliation(s)
- Mea’ad M Harahsheh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
| | - Samah Al-shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, JORDAN
| | - Deirdre D’Arcy
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, IRELAND
| | - Anan Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
- College of Pharmacy, Al-Ain University, Abu Dhabi, UAE
| | - Sawsan Abuhammad
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, JORDAN
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4
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Tran V, Reese Masterson A, Frieson T, Douglass F, Pérez‐Escamilla R, O'Connor Duffany K. Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach. MATERNAL & CHILD NUTRITION 2023; 19:e13428. [PMID: 36098279 PMCID: PMC9749593 DOI: 10.1111/mcn.13428] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Breastfeeding has health benefits for both infants and mothers, yet Black mothers and infants are less likely to receive these benefits. Despite research showing no difference in breastfeeding intentions by race or ethnicity, inequities in breastfeeding rates persist, suggesting that Black mothers face unique barriers to meeting their breastfeeding intentions. The aim of this study is to identify barriers and facilitators that Black women perceive as important determinants of exclusively breastfeeding their children for at least 3 months after birth. Utilizing a Barrier Analysis approach, we conducted six focus group discussions, hearing from Black mothers who exclusively breastfed for 3 months and those who did not. Transcripts were coded starting with a priori parent codes based on theory-derived determinants mapped onto the Socioecological Model; themes were analysed for differences between groups. Facilitators found to be important specifically for women who exclusively breastfed for 3 months include self-efficacy, lactation support, appropriate lactation supplies, support of mothers and partners, prior knowledge of breastfeeding, strong intention before birth and perceptions of breastfeeding as money-saving. Barriers that arose more often among those who did not exclusively breastfeed for 3 months include inaccessible lactation support and supplies, difficulties with pumping, latching issues and perceptions of breastfeeding as time-consuming. Lack of access to and knowledge of breastfeeding laws and policies, as well as negative cultural norms or stigma, were important barriers across groups. This study supports the use of the Socioecological Model to design multicomponent interventions to increase exclusive breastfeeding outcomes for Black women.
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Affiliation(s)
- Victoria Tran
- Yale School of Public HealthNew HavenConnecticutUSA
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | - Amelia Reese Masterson
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | - Tomeka Frieson
- Yale School of Public HealthNew HavenConnecticutUSA
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | - Frankie Douglass
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | | | - Kathleen O'Connor Duffany
- Yale School of Public HealthNew HavenConnecticutUSA
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
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5
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Text Message–Based Breastfeeding Support Compared With Usual Care. Obstet Gynecol 2022; 140:853-860. [DOI: 10.1097/aog.0000000000004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/06/2022]
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Reproductive Justice, Public Black Feminism in Practice: A Reflection on Community-Based Participatory Research in Cincinnati. SOCIETIES 2022. [DOI: 10.3390/soc12010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Research on reproductive justice has mainly, but not exclusively, appeared in academic literature in the context of grassroots social justice movements and as a theoretical framework for understanding the limitations of “reproductive choice” in the absence of social justice. But how can scholars design research to explore and understand reproductive (in)justice in the real lives of women of color? How can research partnerships between university scholars and community stewards be formed and sustained? What tensions and challenges are inherent in these efforts? And how can we find more equitable ways of sharing research findings and creating change with and not on behalf of our community? This paper reflects on the use of Community-Based Participatory Research (CBPR) in a reproductive justice research project focused on Black women residing in Cincinnati.
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Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, Miles N, Leatherwood S, Reese L, Baker T. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med 2021; 16:156-164. [PMID: 33591227 PMCID: PMC8020535 DOI: 10.1089/bfm.2020.0323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Although breastfeeding is optimal infant nutrition, disparities in breastfeeding persist in the African American population. AMEN (Avondale Moms Empowered to Nurse) launched a Peer-to-Peer support group to increase breastfeeding initiation and duration in an under-resourced African American urban community with low breastfeeding rates. Materials and Methods: A Community-Based Participatory Research (CBPR)-guided project was developed in partnership with a neighborhood church. Using modified Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) peer counseling materials, Avondale neighborhood breastfeeding moms were trained and designated Breastfeeding Champions. Community organizations and partnering agencies helped recruit local mothers. Support groups included childcare, transportation, refreshments, and incentives, plus stipends for Champions. A mixed-methods approach captured participation, feeding intention and practices, and program evaluation using electronic data capture. After adding another neighborhood with low breastfeeding rates, AMEN was modified to "All Moms Empowered to Nurse." Additional Champion moms were trained as Reaching Our Sisters Everywhere (ROSE) Community Transformers. During the COVID-19 pandemic, the group has met weekly by virtual platform. Results: Since May 2017, 67 AMEN support meetings have included 158 participants, with average attendance of 10 (range 5-19) per meeting. In addition to 8 Champions, 110 moms have attended, including 24% expecting mothers. Additional attendees include 13 family support persons, 23 guest speakers, and 12 from community outreach programs. Qualitative feedback from participants has been uniformly positive. Breastfeeding initiation rates have increased 12% in the initial neighborhood. Conclusions: Harnessing strength within the local community, Champion Breastfeeding Moms have successfully launched AMEN breastfeeding support groups in under-resourced African American urban neighborhoods, helping more mothers reach their breastfeeding goals.
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Affiliation(s)
- Julie L Ware
- Division of General and Community Pediatrics, Center for Breastfeeding Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dominique Love
- Division of General and Community Pediatrics, Center for Breastfeeding Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,AMEN Champions, Cincinnati, Ohio, USA
| | | | | | | | - Jamaica Gilliam
- AMEN Champions, Cincinnati, Ohio, USA.,Hamilton County Department of Public Health, Cincinnati, Ohio, USA
| | | | | | | | - Theresa Baker
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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8
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Kay MC, Cholera R, Flower KB, Yin HS, Rothman RL, Sanders LM, Delamater AM, Perrin EM. Are Low-Income, Diverse Mothers Able to Meet Breastfeeding Intentions After 2 Months of Breastfeeding? Breastfeed Med 2020; 15:435-442. [PMID: 32357088 PMCID: PMC7374637 DOI: 10.1089/bfm.2020.0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Little is known about intended breastfeeding duration of women who initiate breastfeeding. We describe the association between intended and actual breastfeeding duration among low-income, diverse mothers who report maintaining breastfeeding for the first 2 months postpartum. Materials and Methods: We included mothers (64% Hispanic, 17% non-Hispanic black) participating in Greenlight, a cluster randomized childhood obesity prevention trial, who were providing breast milk at the 2-month preventive service visit and reported intended breastfeeding duration at this visit. Breastfeeding status was assessed at subsequent visits, up to 24 months. Poisson regression with a robust variance estimator was used to estimate risk ratios and 95% confidence intervals for meeting breastfeeding intentions. Covariates included race/ethnicity, income, receiving benefits from the Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC), education, age, employment, depression, maternal obesity, U.S. born, whether infant was first born, and study site. Results: Median intended breastfeeding duration was 11.5 months (interquartile range [IQR]: 6-12) and median actual breastfeeding duration was 8.6 months (IQR: 4-14) (n = 349). Approximately half (49%) met intended breastfeeding duration. Breastfeeding duration differed based on milk type provided at the 2-month visit in that mothers providing mostly or only breast milk had increased likelihood of meeting breastfeeding intentions. Regardless of milk type provided at 2 months, the longer a mother intended to breastfeed, the less likely she was to meet her breastfeeding intentions. Conclusions: In this diverse sample of women less than half met breastfeeding intentions despite maintaining breastfeeding for 2 months. Understanding factors that prevent mothers from attaining intended breastfeeding duration is critical to improving breastfeeding outcomes, especially in low income and ethnic minority populations.
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Affiliation(s)
| | | | - Kori B Flower
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - H Shonna Yin
- New York University School of Medicine, New York, New York, USA
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9
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Parker MG, Greenberg LT, Edwards EM, Ehret D, Belfort MB, Horbar JD. National Trends in the Provision of Human Milk at Hospital Discharge Among Very Low-Birth-Weight Infants. JAMA Pediatr 2019; 173:961-968. [PMID: 31479097 PMCID: PMC6724150 DOI: 10.1001/jamapediatrics.2019.2645] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Human milk confers important health benefits to very low-birth-weight (VLBW) infants (≤1500 g). The extent to which the use of human milk has changed over time and the factors associated with human milk use nationally in this population are poorly understood. OBJECTIVES To describe US trends in the provision of human milk at hospital discharge for VLBW infants during the past decade according to census region and maternal race/ethnicity, quantify associations of census region and maternal race/ethnicity with the provision of human milk at hospital discharge, and examine regional and state variations in any provision of human milk at hospital discharge among racial/ethnic groups. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted of 346 248 infants, born at 23 to 29 weeks' gestation or with a birth weight of 401 to 1500 g, who were cared for at 802 US hospitals in the Vermont Oxford Network from January 1, 2008, to December 31, 2017. The US census region was categorized as West, Midwest, Northeast, and South (reference). Maternal race/ethnicity was categorized as non-Hispanic white (reference), non-Hispanic black, Hispanic, Asian and Pacific Islanders, and Native American. MAIN OUTCOMES AND MEASURES Any provision of human milk at hospital discharge, defined as the use of human milk as the only enteral feeding or the use of human milk in combination with fortifier or formula. RESULTS Of the 346 248 infants in the study (172 538 boys and 173 710 girls), 46.2% were non-Hispanic white, 30.1% were non-Hispanic black, 18.3% were Hispanic of any race, 4.7% were Asian and Pacific Islanders, and 0.8% were Native American. Any provision of human milk at hospital discharge increased steadily among all infants, from 44% in 2008 to 52% in 2017. There were increases across all US census regions and racial/ethnic groups. Any provision of human milk at hospital discharge was higher in the West (among singleton births: adjusted prevalence ratio, 1.32; 95% CI, 1.25-1.39; among multiple births: adjusted prevalence ratio, 1.28; 95% CI, 1.21-1.35) and Northeast (among singleton births: adjusted prevalence ratio, 1.11; 95% CI, 1.04-1.19; among multiple births: adjusted prevalence ratio, 1.11; 95% CI, 1.04-1.19), compared with the South, and was higher among Asian mothers (among singleton births: adjusted prevalence ratio, 1.21; 95% CI, 1.18-1.25; among multiple births: adjusted prevalence ratio, 1.12; 95% CI, 1.09-1.15) and lower among Hispanic (among singleton births: adjusted prevalence ratio, 0.98; 95% CI, 0.96-1.01; among multiple births: adjusted prevalence ratio, 0.88; 95% CI, 0.86-0.91), Native American (among singleton births: adjusted prevalence ratio, 0.64; 95% CI, 0.59-0.70; among multiple births: adjusted prevalence ratio, 0.59; 95% CI, 0.50-0.69), and non-Hispanic black mothers (among singleton births: adjusted prevalence ratio, 0.67; 95% CI, 0.65-0.70; among multiple births: adjusted prevalence ratio, 0.57; 95% CI, 0.54-0.60), compared with non-Hispanic white mothers. These results were robust to adjustment for birth year and infant characteristics. Wide regional and state variations were found in any provision of human milk at hospital discharge. CONCLUSIONS AND RELEVANCE Overall prevalence of any provision of human milk at hospital discharge among VLBW infants has steadily increased during the past decade. Disparities by US region and race/ethnicity in the provision of human milk exist and have not diminished over time.
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Affiliation(s)
- Margaret G. Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont,Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington,Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington
| | - Danielle Ehret
- Vermont Oxford Network, Burlington, Vermont,Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington
| | - Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey D. Horbar
- Vermont Oxford Network, Burlington, Vermont,Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington
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Pal A, Soontarapornchai K, Noble L, Hand I. Attitudes towards Donor Breast Milk in an Inner City Population. Int J Pediatr 2019; 2019:3847283. [PMID: 30713562 PMCID: PMC6332948 DOI: 10.1155/2019/3847283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/14/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022] Open
Abstract
Objective. The purpose of our study was to identify attitudes towards donor breast milk in our population and identify barriers to its acceptance. Methods. The study sample was comprised of a convenience sample of 174 postpartum women. A questionnaire consisting of demographic information and 12 questions relating to attitudes and understanding of donor breast milk was administered. Results. Among the mothers surveyed, 34% were aware of the use of donor breast milk and donor milk banks. 62% of mothers preferred the use of formula compared to donor breast milk if they were unable to provide their own breast milk. Educational level did play a role with 64% of mothers with education beyond high school believing that donor breast milk was beneficial for newborns as opposed to 46% with a high school education or less (p=0.02). US born mothers were more likely to have heard about donor breast milk (47% versus 29%, p=0.025) than foreign born mothers although they were less likely to believe it was a better option for feeding than formula (22.7% versus 43%, p=.016). Mothers with infants in the NICU were more likely than mothers of well babies to accept milk from a milk bank rather than a relative or friend (81% versus 39%, p≤0.001). Conclusion. Although the beneficial effects of donor breast milk are well established in the scientific community, there remains a lack of awareness and a major discrepancy in the understanding and acceptance of it within our community. Education on the benefits of mother's own milk as well as donor breast milk and milk banks is an important public health initiative needed to increase acceptance of human milk as the optimal form of nutrition in infants.
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Affiliation(s)
- Abhinav Pal
- Division of Neonatology, Department of Pediatrics, Kings County Hospital Center, SUNY Downstate School of Medicine, Brooklyn, New York 11203, USA
| | - Kultida Soontarapornchai
- Division of Neonatology, Department of Pediatrics, Kings County Hospital Center, SUNY Downstate School of Medicine, Brooklyn, New York 11203, USA
| | - Lawrence Noble
- Division of Neonatology, Department of Pediatrics, Kings County Hospital Center, SUNY Downstate School of Medicine, Brooklyn, New York 11203, USA
| | - Ivan Hand
- Division of Neonatology, Department of Pediatrics, Kings County Hospital Center, SUNY Downstate School of Medicine, Brooklyn, New York 11203, USA
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Broomfield-Massey K, Noor S. Consider the Context: Commentary on "'You Know if You Quit, That's Failure, Right?': Barriers to Professional Lactation Certification" by Erin V. Thomas. J Hum Lact 2018; 34:471-477. [PMID: 29924936 DOI: 10.1177/0890334418777197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Yourkavitch J, Kane JB, Miles G. Neighborhood Disadvantage and Neighborhood Affluence: Associations with Breastfeeding Practices in Urban Areas. Matern Child Health J 2018; 22:546-555. [PMID: 29294250 PMCID: PMC5857214 DOI: 10.1007/s10995-017-2423-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective To estimate the associations between neighborhood disadvantage and neighborhood affluence with breastfeeding practices at the time of hospital discharge, by race-ethnicity. Methods We geocoded and linked birth certificate data for 111,596 live births in New Jersey in 2006 to census tracts. We constructed indices of neighborhood disadvantage and neighborhood affluence and examined their associations with exclusive (EBF) and any breastfeeding in multilevel models, controlling for individual-level confounders. Results The associations of neighborhood disadvantage and affluence with breastfeeding practices differed by race-ethnicity. The odds of EBF decreased as neighborhood disadvantage increased for all but White women [Asian: Adjusted odds ratio (AOR) 0.82 (95% confidence interval (CI) 0.69-0.97); Black: AOR 0.77 (95% CI 0.70-0.86); Hispanic: AOR 0.78 (95% CI 0.70-0.86); White: AOR 0.99 (95% CI 0.91-1.08)]. The odds of EBF increased as neighborhood affluence increased for Hispanic [AOR 1.19 (95% CI 1.08-1.31)] and White [AOR 1.12 (95% CI 1.06-1.18)] women only. The odds of any breastfeeding decreased with increasing neighborhood disadvantage only for Hispanic women [AOR 0.85 (95% CI 0.79-0.92)], and increased for White women [AOR 1.16 (95% CI 1.07-1.26)]. The odds of any breastfeeding increased as neighborhood affluence increased for all except Hispanic women [Asian: AOR 1.31 (95% CI 1.13-1.51); Black: AOR 1.19 (95% CI 1.07-1.32); Hispanic: AOR 1.08 (95% CI 0.99-1.18); White: AOR 1.30 (95% CI 1.24-1.38)]. Conclusions Race-ethnic differences in associations between neighborhood disadvantage and affluence and breastfeeding practices at the time of hospital discharge indicate the need for specialized support to improve access to services.
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Affiliation(s)
- Jennifer Yourkavitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA.
| | - Jennifer B Kane
- Department of Sociology, University of California, Irvine, CA, 92697-5100, USA
| | - Gandarvaka Miles
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
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13
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Leruth C, Goodman J, Bragg B, Gray D. A Multilevel Approach to Breastfeeding Promotion: Using Healthy Start to Deliver Individual Support and Drive Collective Impact. Matern Child Health J 2017; 21:4-10. [PMID: 29168161 PMCID: PMC5736771 DOI: 10.1007/s10995-017-2371-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose Breastfeeding has been linked to a host of positive health effects for women and children. However, disparities in breastfeeding initiation and duration prevent many low-income and African-American women from realizing these benefits. Existing breastfeeding promotion efforts often do not reach women who need support the most. In response, the Westside Healthy Start program (WHS), located in Chicago, Illinois, developed an ongoing multilevel approach to breastfeeding promotion. Description Key elements of our WHS breastfeeding model include individual education and counseling from pregnancy to 6 months postpartum and partnership with a local safety-net hospital to implement the Baby-Friendly Hospital Initiative and provide lactation support to delivering patients. Assessment In the year our model was implemented, 44.6% (49/110) of prenatal WHS participants reported that they planned to breastfeed, and 67.0% (183/273) of delivered participants initiated. Among participants reaching 6 months postpartum, 10.5% (9/86) were breastfeeding. WHS also had 2667 encounters with women delivering at our partner hospital during breastfeeding rounds, with 65.1% of contacts initiating. Community data was not available to assess the efficacy of our model at the local level. However, WHS participants fared better than all delivering patients at our partner hospital, where 65.0% initiated in 2015. Conclusion Healthy Start programs are a promising vehicle to improve breastfeeding initiation at the individual and community level. Additional evaluation is necessary to understand barriers to duration and services needed for this population.
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Affiliation(s)
- Chelsey Leruth
- Access Community Health Network, 600 W Fulton St, Suite 200, Chicago, IL, 60661, USA.
| | - Jacqueline Goodman
- Access Community Health Network, 600 W Fulton St, Suite 200, Chicago, IL, 60661, USA
| | - Brian Bragg
- Access Community Health Network, 600 W Fulton St, Suite 200, Chicago, IL, 60661, USA
| | - Dara Gray
- Access Community Health Network, 600 W Fulton St, Suite 200, Chicago, IL, 60661, USA
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Kim JH, Fiese BH, Donovan SM. Breastfeeding is Natural but Not the Cultural Norm: A Mixed-Methods Study of First-Time Breastfeeding, African American Mothers Participating in WIC. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:S151-S161.e1. [PMID: 28689552 DOI: 10.1016/j.jneb.2017.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Identify facilitators, barriers, and needs to increase breastfeeding (BF) support. DESIGN Semistructured interviews based on the Theory of Planned Behavior, Iowa Infant Feeding Attitude Scale, and Breastfeeding Self-Efficacy Scale-Short Form to measure attitudes and self-efficacy, respectively. SETTING One WIC clinic in central Illinois. PARTICIPANTS First-time BF African American mothers enrolled in WIC (n = 15). PHENOMENON OF INTEREST BF facilitators and barriers in the African American community. ANALYSIS Descriptive coding and inductive thematic analysis. RESULTS Six themes emerged: normative infant feeding behavior within the sociocultural context; cultural beliefs about maternal nutrition and BF; time and costs associated with BF; managing and integrating BF while maintaining a social life; necessity of social support from significant others and female role models; and suboptimal support from institutions (hospitals, schools, workplace, and community). A novel finding was that participants believed that BF was expensive, because they believed that mothers must eat healthy to breastfeed. In addition, BF was considered natural but not the cultural norm. Mean Iowa Infant Feeding Attitude Scale score (n = 15) was 70 (SD = 7), indicating a positive attitude toward BF. Breastfeeding Self-Efficacy Scale-Short Form mean score of 62 indicated a relatively high level of self-efficacy. CONCLUSIONS AND IMPLICATIONS Interventions should focus on providing social support (emotional, tangible, informational, and encouragement) to African American mothers and their social networks to promote a BF-friendly environment.
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Affiliation(s)
- Julia H Kim
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, IL.
| | - Barbara H Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, IL
| | - Sharon M Donovan
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, IL; Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL
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15
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Joseph HM, Emery RL, Bogen DL, Levine MD. The Influence of Smoking on Breast feeding Among Women Who Quit Smoking During Pregnancy. Nicotine Tob Res 2017; 19:652-655. [PMID: 28403459 PMCID: PMC5896553 DOI: 10.1093/ntr/ntw254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/28/2016] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Understanding factors related to breast-feeding intention, initiation, duration, and weaning among women who quit smoking as a result of pregnancy may inform interventions to increase breast-feeding rates among women who smoke. METHODS Women (N = 300) who quit smoking as a result of pregnancy and enrolled in a postpartum relapse prevention trial were interviewed about breast-feeding intention prior to delivery. Breast-feeding initiation, duration, reasons for weaning, and relapse to smoking were assessed at 12-weeks postpartum. RESULTS The majority of pregnant former smokers intended to breastfeed (68%), and actual rates of breast feeding were higher (74%). Among women who initiated breast feeding, weaning before 2 months was common (41%). For most women (69%), smoking had no effect on breast-feeding decisions. Among the 31% of women who reported that smoking influenced their feeding decisions, 83% indicated that they did not smoke or decreased smoking frequency in order to breastfeed while 17% did not breastfeed or quit breast feeding in order to smoke. Women who decided to forgo breast feeding to smoke were significantly more likely to have a high school education or less (p < .001) and to be African American (p < .0001) than those who had other reasons not to breastfeed. CONCLUSIONS Most women who quit smoking during pregnancy initiate breast feeding, and the majority report smoking did not influence feeding decisions. Importantly, among women for whom smoking did influence feeding decisions, most reported changing smoking behavior to enable breast feeding. Interventions to increase breast-feeding initiation and duration may decrease postpartum relapse and improve maternal and infant health. IMPLICATIONS This study extends the literature on women's perception of the influence of smoking on breast feeding by assessing breast-feeding intent, initiation, duration, and reasons for weaning longitudinally among women who quit smoking as a result of pregnancy. The results support a need for additional research to determine the effectiveness of breast feeding supports as a component of interventions to reduce postpartum smoking relapse.
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Affiliation(s)
- Heather M Joseph
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rebecca L Emery
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Debra L Bogen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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16
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DeVane-Johnson S, Woods-Giscombé C, Thoyre S, Fogel C, Williams R. Integrative Literature Review of Factors Related to Breastfeeding in African American Women: Evidence for a Potential Paradigm Shift. J Hum Lact 2017; 33:435-447. [PMID: 28380305 DOI: 10.1177/0890334417693209] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | | | - Suzanne Thoyre
- 1 School of Nursing, University of North Carolina at Chapel Hill, Durham, NC, USA
| | - Cathie Fogel
- 1 School of Nursing, University of North Carolina at Chapel Hill, Durham, NC, USA
| | - Ronald Williams
- 2 African American and Diaspora Studies, University of North Carolina at Chapel Hill, Durham, NC, USA
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17
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Asiodu IV, Waters CM, Dailey DE, Lyndon A. Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers. Matern Child Health J 2017; 21:863-872. [PMID: 27565664 PMCID: PMC5329142 DOI: 10.1007/s10995-016-2167-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.
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Affiliation(s)
- Ifeyinwa V Asiodu
- Department of Women, Children, and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, NURS 839, Chicago, IL, 60612, USA.
| | - Catherine M Waters
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Dawn E Dailey
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Audrey Lyndon
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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18
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Abstract
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.
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Affiliation(s)
- Tyra Toston Gross
- 1 Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, USA
| | - Marsha Davis
- 2 Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Alex K Anderson
- 3 Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Jori Hall
- 4 Department of Lifelong Education, Administration, and Policy, University of Georgia, Athens, GA, USA
| | - Karen Hilyard
- 5 Social Marketing and Communication, FHI 360, Atlanta, GA, USA
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19
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Pounds L, Fisher CM, Barnes-Josiah D, Coleman JD, Lefebvre RC. The Role of Early Maternal Support in Balancing Full-Time Work and Infant Exclusive Breastfeeding: A Qualitative Study. Breastfeed Med 2017; 12:33-38. [PMID: 27898210 DOI: 10.1089/bfm.2016.0151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Support of others is a key factor for mothers who choose to breastfeed their infants, including those who balance work outside the home and breastfeeding. However, little research has been done to understand how maternal support during the postpartum period impacts mothers' ability to later balance work and breastfeeding, in particular full-time work and exclusive breastfeeding. The results of this qualitative study indicate that the timing of support plays a key role in mothers' ability to successfully overcome barriers during the early postpartum period, thus building maternal self-efficacy in addressing problems encountered when they return to work. METHODS To understand the experience of low-income women who successfully balance full-time work and exclusive breastfeeding for the recommended 6 months, interviews were conducted with women who met study criteria for income level, work status, and exclusive breastfeeding. Breastfeeding peer counselors were also interviewed as key informants. Interviews were recorded, transcribed, and coded for themes. The results of both sets of interviews were triangulated with a focused literature review to assure the soundness of the qualitative analysis. RESULTS Timing of support included acute support, such as help establishing a successful latch needed during the first 2 weeks after delivery, to deal with breastfeeding problems that mothers perceived as being mentally and emotionally overwhelming and longer-term support needed to overcome problems perceived as being less intense. CONCLUSIONS The research invites further exploration into the relationship between breastfeeding support provided by mothers' support system, including healthcare professionals, during the postpartum period and rates of breastfeeding duration and exclusivity.
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Affiliation(s)
- Lea Pounds
- 1 Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center College of Public Health , Omaha, Nebraska
| | | | | | | | - R Craig Lefebvre
- 5 University of South Florida College of Public Health , Tampa, Florida
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20
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Witt AM, Bolman M, Kredit S. Mothers Value and Utilize Early Outpatient Education on Breast Massage and Hand Expression in Their Self-Management of Engorgement. Breastfeed Med 2016; 11:433-439. [PMID: 27575663 DOI: 10.1089/bfm.2016.0100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Breast engorgement is a major cause of pain and weaning in the early postpartum period. While protocols reinforce the need for anticipatory engorgement advice and continued outpatient health professional breastfeeding support, there remains limited information on the efficacy of focused postdischarge engorgement education. This study sought to explore if outpatient postpartum engorgement education changed mothers' home management and if mothers found instruction on specific massage and hand expression techniques helpful. MATERIALS AND METHODS This was a prospective descriptive cohort study. Subjects received engorgement-specific postpartum support from a healthcare professional at the posthospital discharge (PD) newborn visit. Email surveys at 1, 2, and 12 weeks postpartum collected data on engorgement home management, clinical course, and postpartum education. RESULTS After the office visit, mothers changed their engorgement home management. Significantly more mothers utilized massage toward the axillae (25% versus 1%, p ≤ 0.001), reverse pressure softening (18% versus 3%, p = 0.001), and feeding more frequently (32% versus 16%, p = 0.04). Sixty-one percent would not have used massage and hand expression before education in the office. At 12 weeks, 96% of women reported massage and hand expression instruction as helpful. Mothers reported engorgement peaked at a median of 5 days postpartum, corresponding well to the office visit at a median of 4 days postpartum. CONCLUSIONS Maternal engorgement symptoms are commonly present at the PD newborn visit. Education on engorgement, massage, and hand expression at this visit significantly changes home management strategies. Mothers find massage and hand expression instruction helpful.
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Affiliation(s)
- Ann M Witt
- 1 Breastfeeding Medicine of Northeast Ohio , Cleveland, Ohio.,2 Senders Pediatrics, Cleveland, Ohio.,3 Case Western Reserve University , Cleveland, Ohio
| | - Maya Bolman
- 1 Breastfeeding Medicine of Northeast Ohio , Cleveland, Ohio.,2 Senders Pediatrics, Cleveland, Ohio
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Jolly L, Pagels P, Woodfin G, Silver M, Kindratt T, Gimpel N. Knowledge and attitudes toward breastfeeding in an African American male population. J Obstet Gynecol Neonatal Nurs 2015; 42:664-71. [PMID: 25803214 DOI: 10.1111/1552-6909.12258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure knowledge and attitudes toward breastfeeding among African American men. DESIGN Cross-sectional survey. SETTING Three barbershops in Dallas, Texas. PARTICIPANTS African American adult men (N = 81). METHODS Surveys were completed by African American men to evaluate their knowledge, attitudes, and involvement in breastfeeding. RESULTS One half of the participants were age 26 to 40. Eighty-five percent were U.S.-born, and others were born in several African countries. Education varied from some high school to postgraduate. Most had some college or a degree (78%). One half were fathers (51%), and most were single (61%). Most had witnessed breastfeeding (85%), and 58% preferred their infants to be breastfed. Only 47% knew that breastfeeding helps prevent infant infections, and 15% knew it can prevent breast cancer in the mother. Significant differences were found when comparing knowledge and attitudes by place of birth and age. Almost one half of men age 18 to 25 (43%) and age 25 to 40 (48%) felt that breastfeeding should not occur in public compared to only 4% of men older than 40 (p = .005). CONCLUSION Overall, we found that African American men were supportive of breastfeeding, knew that breastfeeding was best for infants, and had positive attitudes toward breastfeeding. However, we found consistent gaps in knowledge about the actual health benefits to mothers and infants and conflicting attitudes toward breastfeeding. Results emphasize the need for health education efforts to improve attitudes toward breastfeeding in public.
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Lenell A, Friesen CA, Hormuth L. Breastfeeding Support in a Community Pharmacy: Improving Access through the Well Babies at Walgreens Program. J Hum Lact 2015; 31:577-81. [PMID: 25829476 DOI: 10.1177/0890334415579418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 03/08/2015] [Indexed: 01/26/2023]
Abstract
Well Babies at Walgreens is a unique community-based corporate partnership program that offers breastfeeding support by a lactation professional in a private room at the pharmacy. Walgreens is a community pharmacy chain with more than 8000 locations in the United States, Puerto Rico, and the US Virgin Islands. The primary goal of Well Babies is to support breastfeeding women using a model that is expandable to other Walgreens pharmacy sites. The Well Babies program offers drop-in services, with a professional consultation by a lactation consultant and baby weight check, if desired. Well Babies creators are developing a business plan for Walgreens and a toolkit that would help other stores implement the program. An additional goal is to improve continuity of care for breastfeeding by engaging pharmacists as vital members of the health care team. Offering breastfeeding support at a pharmacy improves access and encourages support persons to attend while simultaneously allowing the family to complete other errands. This initiative included education for pharmacists to improve the recommendations they make for breastfeeding mothers and to improve awareness among pharmacists of the benefits associated with breastfeeding and the need to preserve the breastfeeding relationship. The first drop-in location opened in April 2012. Grant funding from the US Centers for Disease Control and Prevention, awarded to the Indiana State Department of Health, made it possible to open a second drop-in location in June 2013. Future plans include developing an employee lactation program and expanding Well Babies at Walgreens at other store locations.
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Affiliation(s)
- Amy Lenell
- Well Babies at Walgreens, Indianapolis, IN, USA
| | | | - Laura Hormuth
- Division of Nutrition and Physical Activity, Indiana State Department of Health, Indianapolis, IN, USA
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Johnson DB, Lamson E, Schwartz R, Goldhammer C, Ellings A. A Community Health Clinic Breastfeeding-Friendly Pilot: What Can We Learn about the Policy Process? J Hum Lact 2015; 31:660-70. [PMID: 25832650 DOI: 10.1177/0890334415579656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implementing evidence-based practices and policies for breastfeeding support in community clinics is a promising, but challenging, approach to reducing disparities in breastfeeding rates. OBJECTIVE This study aimed to apply a policy process research framework to increase knowledge of factors that facilitate adoption and implementation of breastfeeding policy changes. METHODS In 2013, Washington State piloted a process to encourage 8 clinics to adopt and implement steps to become breastfeeding friendly. Evaluation data were collected through interviews, project reports, training evaluations, and pre- and post-self-assessments of achievement of the steps. RESULTS In 6 months, clinics increased the breastfeeding-friendly steps that they were implementing from a median (interquartile range) of 1.5 (0-3) to 6 (5-7). Improvements were most likely in the steps that required the fewest resources and administrative changes. Barriers to implementation included misperceptions about breastfeeding and breastfeeding support; lack of administrative "buy-in"; need for organizational changes to accommodate actions like monitoring breastfeeding rates and allowing providers training time; and the social-political climate of the clinic. Several factors, including actions taken by public health practitioners, enhanced the change process. These included fostering supportive relationships, targeting technical assistance, and providing resources for planning and training. CONCLUSION This pilot project demonstrates that it is possible to make changes in breastfeeding support practices and policies in community clinics. Recommendations to enhance future work include framing and marketing breastfeeding support in ways that resonate with clinic decision makers and enhancing training, resources, and advocacy to build capacity for internal and external systems changes to support breastfeeding best practices.
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Affiliation(s)
- Donna B Johnson
- University of Washington Center for Public Health Nutrition, Seattle, WA, USA
| | - Erica Lamson
- University of Washington Center for Public Health Nutrition, Seattle, WA, USA
| | | | | | - Amy Ellings
- Washington State Department of Health, Olympia, WA, USA
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Johnson AM, Kirk R, Muzik M. Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers' Needs for Workplace Breastfeeding Support. J Hum Lact 2015; 31:425-33. [PMID: 25714345 PMCID: PMC4506723 DOI: 10.1177/0890334415573001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/21/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persistent racial disparities in breastfeeding show that African American women breastfeed at the lowest rates. Return to work is a critical breastfeeding barrier for African American women who return to work sooner than other ethnic groups and more often encounter unsupportive work environments. They also face psychosocial burdens that make breastfeeding at work uniquely challenging. Participants share personal struggles with combining paid employment and breastfeeding and suggest workplace and personal support strategies that they believe will help continue breastfeeding after a return to work. OBJECTIVE To explore current perspectives on ways to support African American mothers' workplace breastfeeding behavior. METHODS Pregnant African American women (n = 8), African American mothers of infants (n = 21), and lactation support providers (n = 9) participated in 1 of 6 focus groups in the Greater Detroit area. Each focus group audiotape was transcribed verbatim. Thematic analysis was used to inductively analyze focus group transcripts and field notes. Focus groups explored thoughts, perceptions, and behavior on interventions to support African American women's breastfeeding. RESULTS Participants indicate that they generally believed breastfeeding was a healthy option for the baby; however, paid employment is a critical barrier to successful breastfeeding for which mothers receive little help. Participants felt breastfeeding interventions that support working African American mothers should include education and training for health care professionals, regulation and enforcement of workplace breastfeeding support policies, and support from peers who act as breastfeeding role models. CONCLUSION Culturally appropriate interventions are needed to support breastfeeding among working African American women.
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Affiliation(s)
- Angela Marie Johnson
- Department of Psychiatry and Program for Multicultural Health, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rosalind Kirk
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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Abstract
This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.
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Affiliation(s)
- Katherine M. Jones
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
- Department of Psychology, American University, Washington, D.C
| | - Michael L. Power
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
| | - John T. Queenan
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, D.C
| | - Jay Schulkin
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
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Kadakia A, Joyner B, Tender J, Oden R, Moon RY. Breastfeeding in African Americans may not depend on sleep arrangement: a mixed-methods study. Clin Pediatr (Phila) 2015; 54:47-53. [PMID: 25139664 PMCID: PMC4377646 DOI: 10.1177/0009922814547565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite high bedsharing rates, breastfeeding rates are low among African Americans. OBJECTIVE Describe the association between breastfeeding and bedsharing; elucidate barriers to breastfeeding in African Americans. METHODS African American mothers with infants <6 months were recruited for this cross-sectional, mixed-methods study and completed an infant care practices survey. A subgroup participated in focus groups or individual interviews. RESULTS A total of 412 completed the survey; 83 participated in a focus group or interview. Lower socioeconomic status mothers were more likely to breastfeed exclusively or at all if they bedshared (P = .02 and P = .01, respectively). Bedsharing was not associated with breastfeeding among higher socioeconomic status mothers. Breast pain, lack of support, and maternal skepticism about breastfeeding benefits were barriers; the latter was a recurrent theme among nonbreastfeeding mothers. CONCLUSIONS While bedsharing is associated with breastfeeding in lower socioeconomic groups, it is not in higher socioeconomic African American groups. Skepticism about breastfeeding benefits may contribute to low breastfeeding rates in African Americans.
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Affiliation(s)
| | - Brandi Joyner
- Children’s National Health System, Washington, DC, USA
| | - Jennifer Tender
- Children’s National Health System, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rosalind Oden
- Children’s National Health System, Washington, DC, USA
| | - Rachel Y. Moon
- Children’s National Health System, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Fischer TP, Olson BH. A qualitative study to understand cultural factors affecting a mother's decision to breast or formula feed. J Hum Lact 2014; 30:209-16. [PMID: 24186645 DOI: 10.1177/0890334413508338] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence of barriers is not sufficient to explain breastfeeding rate disparities. A relatively unexplored area in coping with breastfeeding barriers is culture. OBJECTIVE This research aims to better understand the role of culture in a woman's infant feeding decision by using race and socioeconomic status as indicators of culture. METHODS Focus groups and individual interviews were conducted with 42 pregnant women or mothers of infants younger than 12 months. Focus group composition was determined by self-identified African American or white race and self-reported eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or ineligibility (non-WIC). RESULTS Most participants acknowledged that breastfeeding was best, yet differences arose between groups in the perception of, and reaction to, breastfeeding barriers. WIC and non-WIC participants of both races indicated that some circumstances necessitated formula use. WIC participants felt that this was personally and socially acceptable due to need, whereas non-WIC participants felt that this was personally and socially unacceptable. When a barrier arose, WIC participants of both races felt that the infant feeding choice was not theirs and formula use might be inevitable. In contrast, non-WIC participants of both races expressed that they persevered to continue breastfeeding and did so by establishing small, achievable goals and seeking mentors. CONCLUSION Educational and public health efforts to reduce breastfeeding disparities may be enhanced if support is tailored to acknowledge cultural differences among women and address factors that make either breastfeeding or formula feeding acceptable, or even preferable, within their communities.
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28
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Teich AS, Barnett J, Bonuck K. Women's perceptions of breastfeeding barriers in early postpartum period: a qualitative analysis nested in two randomized controlled trials. Breastfeed Med 2014; 9:9-15. [PMID: 24304033 PMCID: PMC3903167 DOI: 10.1089/bfm.2013.0063] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study examined women's perceptions of early infant feeding experiences and identified early postpartum barriers to successful breastfeeding. SUBJECTS AND METHODS We conducted semistructured exit interviews at 6 months postpartum with a subsample of participants (n=67) enrolled in two randomized controlled trials of breastfeeding promotion. Study arms included (1) routine pre- and postnatal visits with an International Board Certified Lactation Consultant (IBCLC) (LC group), (2) electronically prompted guidance from prenatal care providers (EP group), (3) EP+LC combined, and (4) standard of care (control group). Interview transcripts were coded using grounded theory and analyzed in MAXqda. Code matrices were used to identify early postpartum breastfeeding barriers and were further examined in relation to treatment group using a mixed methods analysis. RESULTS The majority of the participants reported experiencing at least one barrier to breastfeeding. Barriers to breastfeeding were more commonly reported in the early postpartum than late postpartum period. The most common barrier during the early postpartum period was the perception of inadequate milk supply ("lactational") (n=18), followed by problems with latch, medical problems that were perceived as precluding breastfeeding, and medical staff and hospital practices. Participants frequently reported that the IBCLCs assisted them in anticipating, managing, and overcoming these barriers. CONCLUSIONS Our findings underscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding.
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Affiliation(s)
- Alice S. Teich
- Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Josephine Barnett
- Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Karen Bonuck
- Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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