Date of Award
2024
Degree Type
Dissertation
Degree Name
Doctor of Philosophy in Nursing
Department
Nursing
First Advisor
Thaís São-João
Abstract
Breastfeeding is the optimal form of infant nutrition and has many health benefits for mothers as well as infants (CDC, 2022a; Victora et al., 2016). Though rates of breastfeeding have improved in recent years, disparities in breastfeeding persist among Black and Hispanic women compared to White women (Beauregard et al., 2019; Chiang et al., 2021), despite similar intentions to breastfeed across all racial/ethnic groups (Hamner et al., 2021). Hospital practices that support breastfeeding, such as the baby being placed skin-to-skin immediately after delivery or staying in the room with the mother throughout the hospital stay, are known to predict breastfeeding outcomes (Barrera et al., 2019; Crenshaw & Budin, 2020; Kivlighan et al., 2020; Nelson et al., 2018; Patterson et al., 2019; Sebastian et al., 2019). Little research had explored disparities in access to hospital breastfeeding support by race and ethnicity. Prior studies focused almost exclusively on Black women and were limited to small samples or certain geographic areas in the US (Gee et al., 2012; Gross et al., 2015; Johnson et al., 2016; Lind et al., 2014; Munn et al., 2018), and only one prior study included Hispanic women (Sebastian et al., 2019). Preliminary research also suggested that hospital breastfeeding support was negatively impacted by the Covid-19 pandemic (Lubbe et al., 2022), though no prior study had shown how hospital breastfeeding support to Black and Hispanic women might have been uniquely affected.
This dissertation aimed to fill the gap in the available literature on racial and ethnic disparities in hospital breastfeeding support. This work serves as a population-based, comprehensive analysis of the association between race and ethnicity and hospital breastfeeding support, and the subsequent effect on breastfeeding outcomes, both before and during the Covid-19 pandemic. Using 2016-2020 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative survey of new mothers in the US, we explored three aims which resulted in three manuscripts. All three manuscripts are data-based research analyses. The first provides a population-based analysis of racial and ethnic disparities in hospital breastfeeding support, the second explores the impact of the Covid-19 pandemic on hospital breastfeeding support by race and ethnicity, and the third investigates the relationship between race and ethnicity and breastfeeding outcomes with hospital breastfeeding support as a mediator of that relationship.
The analyses from our first manuscript revealed that there are racial and ethnic disparities in the receipt of Baby Friendly Hospital Initiative (BFHI) key clinical practices that support breastfeeding in US hospitals. Compared to White non-Hispanic mothers, Black non-Hispanic, Hispanic, and Asian Pacific Islander mothers had lower odds of receiving 100% of key clinical practices that support breastfeeding. In our second manuscript, we found that the Covid-19 pandemic resulted in worsening care for Black non-Hispanic, Hispanic, and Asian Pacific Islander mothers, which exacerbated existing disparities in receipt of hospital breastfeeding support. These findings have important implications for our understanding of racial and ethnic disparities in receipt of BFHI key clinical practices and the impact of Covid-19, resulting in a call for equitable care by race and ethnicity. In our third manuscript, we found that receipt of 100% of BFHI key clinical practices (ideal breastfeeding care) resulted in the elimination of racial and ethnic disparities in breastfeeding outcomes, with no differences in breastfeeding ≥ 10 weeks reported for Black or Hispanic mothers compared to White non-Hispanic mothers. Our findings demonstrate the importance of hospital breastfeeding care on breastfeeding continuation, and offer compelling evidence that ideal breastfeeding care, as represented by the BFHI key clinical practices, has the power to eliminate racial and ethnic disparities in breastfeeding outcomes.
Recommended Citation
Lazar Tucker, Jane, "RACIAL AND ETHNIC DISPARITIES IN HOSPITAL PRACTICES THAT SUPPORT BREASTFEEDING IN THE UNITED STATES" (2024). Open Access Dissertations. Paper 1627.
https://digitalcommons.uri.edu/oa_diss/1627