Racial Disparities in Breastfeeding at Miss. Hospitals Reduced With ‘Baby-Friendly’ Practices

CHAMPS (Communities and Hospitals Advancing Maternity Practices), a multi-year quality improvement program led by Boston Medical Center (BMC) researchers, has led to increased breastfeeding rates in Mississippi hospitals and reduced racial inequities in breastfeeding initiation.

The results, published in Pediatrics, demonstrate that implementing the Baby-Friendly Hospital Initiative, a set of practices and goals that promote breastfeeding to new mothers, can lead to higher breastfeeding rates, particularly among Black women. The CHAMPS program assists and supports Mississippi hospitals in adopting the “Baby-Friendly” approach.

“Expanding access to breastfeeding support in Mississippi is a critical component of addressing health equity for families both in the short and long term,” says Anne Merewood, PhD, MPH, the study’s corresponding author and director of the  Center for Health Equity, Education, and Research at BMC.

Breastfeeding outcomes are tied to race and place

A wealth of data demonstrates the benefits of breastfeeding for both mother and child. Breastfed children perform better on intelligence tests. They are less likely to be overweight, obese, or develop diabetes later in life. Women who breastfeed are at a reduced risk for breast and ovarian cancers as well as heart disease.

“Two of the biggest factors that play into breastfeeding outcomes are race or racism and where you live, which the CHAMPS program addresses at the hospital level.”Click To Tweet

In Mississippi, and many other southern states, breastfeeding rates have historically been lower than in other parts of the country. The state has among the highest rates of heart disease, obesity, and diabetes. Prior to the start of CHAMPS, in 2014, Mississippi had the lowest breastfeeding rates in the U.S., with an initiation rate of 57.5%, according to data cited in the study. Rates among Black mothers were also the lowest in the country.

“Two of the biggest factors that play into breastfeeding outcomes are race or racism and where you live, which the CHAMPS program addresses at the hospital level, providing the information and support necessary to help all new mothers be successful with breastfeeding,” said Laura Burnham, MPH, associate director of the Center for Health Equity, Education, & Research at BMC and the study’s first author.

Ten Steps to Breastfeeding Success

The Baby-Friendly Hospital Initiative was launched in 1991 by The World Health Organization and United Nations Children’s Fund to raise breastfeeding rates globally. The initiative helps hospitals support mothers in learning the skills and confidence to initiate and continue breastfeeding.

In order for a hospital to be certified as “Baby-Friendly” they must achieve certain goals, including not marketing baby formula in the hospital and adhering to the framework known as the Ten Steps to Successful Breastfeeding.

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast milk, unless medically indicated. 
7. Practice rooming in- allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand. 
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center. 

From zero ‘Baby-Friendly’ hospitals to 22

In 2014, the CHAMPS team enrolled 39 of the state’s 43 birthing hospitals in its quality-improvement program. Hospitals received intense, on-site coaching and technical assistance. Key stakeholders, including local breastfeeding experts and lactation consultants, as well as local and statewide organizations, also provided support. CHAMPS conducted 100 training sessions throughout Mississippi, training 1,837 hospital staff.

As part of its approach to community engagement, the CHAMPS team organized a regional conference, formed mother-to-mother training programs that resulted in 89 “community transformers,” and funded the opening of the first Baby Café in Mississippi.

An analysis of data collected between January 2015 and December 2019 shows that overall breastfeeding initiation rates rose 10 percentage points over the course of the program. For Black mother-baby dyads, rates increased by 21 percentage points; for White mother-baby dyads, rates increased 4%. Exclusive breastfeeding rates increased 11%, with higher monthly increases among Black mother-baby dyads.

The findings show a significant decrease – from 79% to 11% – in the number of hospitals distributing free formula sample packs to patients, and there was a significant reduction in the hospitals that accepted free formula from manufacturers. This demonstrates the hospitals’ commitment to achieving and retaining the “Baby-Friendly” designation.

When CHAMPS launched in Mississippi, there were zero “Baby-Friendly” hospitals in the state. There are currently 22.

“We know there are tremendous health benefits related to breastfeeding for both mother and child, and we need to identify sustainable solutions to maintain these efforts in the future,” says Merewood.

---

HealthCity elevates the conversation around issues of equity in healthcare. Sign up for our newsletter.