Closing the Gap: Access to All

The theme of World Breastfeeding Week 2024, Closing the Gap: Access to All, highlights breastfeeding inequalities and a need to improve breastfeeding support. 

In the United States, there are significant disparities in breastfeeding initiation, exclusivity, and duration among racial and ethnic groups. While nationwide breastfeeding initiation according to the most recent CDC Breastfeeding Report Card was 84.1% in 2019, the range by race extended from 74% for non-Hispanic Black families to 90.3% for Asian families. In a previous blog, I highlighted the multifactorial reasons for the racial and ethnic disparities and discussed some of the contributing factors including lack of access, insufficient breastfeeding education for both healthcare providers and families, and limited availability of culturally appropriate breastfeeding support. 

Quantifying the Impact of Breastfeeding Support 

A recent study helps quantify the important role of breastfeeding support when looking at ways to address racial and ethnic disparities. Using data from a survey administered to Women, Infant, and Children (WIC) federal nutrition program recipients in Los Angeles County, the researchers examined the impact of breastfeeding support on the racial/ethnic disparities among five different racial groups (Spanish-speaking Latina, English-speaking Latinas, Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Non-Hispanic Asian (NHA)) in this low income population. They examined 2 potential causal pathways for the breastfeeding disparities:

1. The impact of sociodemographic factors (maternal age, education, and income) and birth outcomes (preterm) on breastfeeding rates, and
2. The impact of breastfeeding support on breastfeeding rates.  

Recognizing that sociodemographic factors, birth outcomes, and breastfeeding support all contribute to racial/ethnic difference in breastfeeding disparities, the study authors looked to estimate the mediation effect, or the amount of impact, that breastfeeding support contributes to the differences in breastfeeding rates. 

In this study, access to breastfeeding support was measured through three variables:

1. Living with a partner
2. Workplace accommodations for breastfeeding
3. The number of four Baby-Friendly Hospital (BFH) practices received by the mother at the hospital when delivering.

The four BFH practices were:

1. initiating breastfeeding within 1 hour of delivery
2. not receiving supplemental formula while in the hospital
3. no free formula packages to take home
4. providing telephone resources for obtaining breastfeeding support after hospital discharge.

The study found a 12.2% difference between NHW (53.8%) and NHB mothers (41.41%) in breastfeeding at six months. Access to breastfeeding support alone explained about 8.4%, or 2/3 of that gap. For English-speaking Latina, there was a difference from NHW of 6.3% at 6 months (47.5% vs 53.8%); access to breastfeeding support explained ⅓  or 2.1% of this disparity. In contrast, the difference in breastfeeding rates for Spanish-speaking Latina and Asian mothers was not explained by access to breastfeeding support. 

Access to Breastfeeding Support Makes a Critical Difference

The study by Jiang et al highlights the importance of increasing breastfeeding support to help address disparities. Overall, the lack of access to breastfeeding support explained about ⅔ white/Black gap and ⅓ of white/English-speaking Latina gap at 6 months. Investments in breastfeeding supportive programs and policies have the potential to make a significant difference.  

A Multi-pronged Approach

As healthcare providers, we are in a position to improve access to breastfeeding support for families and help close the gap on breastfeeding disparities. Whether we are an individual practitioner, small practice, or large health system, we can facilitate support. The World Breastfeeding Alliance highlights a warm chain campaign which “places the mother-baby dyad at the core. It strives to link different actors across the health, community and workplace sectors to provide a continuum of care during the first 1000 days.” Healthcare providers and primary care clinics are part of this warm chain, and we can start on the individual scale with increasing education, improving access with team-based lactation support, and creating a breastfeeding-friendly medical office.

How are you going to team-up to expand support today?