Racial Breastfeeding Disparity Disappears at Baby Friendly Hospitals

One of the biggest issues in breastfeeding is the disparity in breastfeeding rates among different races. (Read:  Is there a “soft bigotry of low expectations” when it comes to breastfeeding?)

The gap between African American women and women of other races, while closing, remains the most salient example.  The breastfeeding initiation rate of African American moms, which in 2007 was 60%, compared to the overall U.S. rate of 75%.

But it turns out that a big part of the solution is right in front of our noses.  It’s evidence-based care and following proper infant feeding protocol, neatly packaged as the Ten Steps to Successful Breastfeeding, which forms the basis of the Baby Friendly Hospital Initiative.

Evidence is accumulating that not only does following the Ten Steps improve breastfeeding success rates in general, it actually eliminates or significantly reduces  race-based disparities.

Consider the following examples:

One study of Baby Friendly hospitals in the U.S. found that “breastfeeding rates were not associated with number of births per institution or with the proportion of black or low-income patients.”  In other words, whether you had a large or small population of women who were African American, breastfeeding outcomes were the same.  Disparity?  Poof!

Here’s another study, of Boston Medical Center, which became a Baby Friendly Hospital in 1999.  The rate of breastfeeding among African American women went from 34% in 1995 to 74% in 1999.  Yes, that’s super impressive on its face. But consider this:  the overall breastfeeding rate went from 58% to 78%.  So that means African American moms were within 4 percentage points of the overall hospital rate.  A study found that, “Among a predominantly low-income and black population giving birth at a US Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.”  Disparity?  Gone, baby, gone.

And this data, from the California WIC Association shows that, “for hospitals with policies such as those outlined in the BFHI that support breastfeeding, these disparities
are significantly reduced.”  The California WIC Association, using data from the state Department of public health, reports that overall hospital exclusive breastfeeding rate in California hospitals is 57%.  The rate for African American moms at non-Baby Friendly hospitals is 46%.  At Baby Friendly hospitals?  62%.  This is only slightly lower than the rate of exclusive breastfeeding at Baby Friendly hospitals for all other races.  Disparity?  What disparity?

Yes, we need more culturally-appropriate care.  We need to check our assumptions at the door, and to sustain breastfeeding we need support from “moms like us” in the community.  But the single most important thing we can do is one that benefits all moms: practice evidence-based breastfeeding care, such as found at a BFHI USA hospital.

Did you birth at a Baby Friendly Hospital, or one that follows most of the Ten Steps?  How did these policies (or lack of them) affect your breastfeeding experience?

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