The role of breastfeeding support in racial/ethnic disparities in breastfeeding practices

Linghui Jiang; Roch A Nianogo; Michael Prelip; May C Wang

doi:10.1016/j.ypmed.2024.107857

The role of breastfeeding support in racial/ethnic disparities in breastfeeding practices

Prev Med. 2024 Feb:179:107857. doi: 10.1016/j.ypmed.2024.107857. Epub 2024 Jan 14.

Authors

Linghui Jiang¹, Roch A Nianogo², Michael Prelip³, May C Wang⁴

Affiliations

¹ Department of Community Health Sciences, University of California, Los Angeles, California, USA.. Electronic address: linghuijiang@ucla.edu.
² Department of Epidemiology, University of California, Los Angeles, California, USA.. Electronic address: niaroch@ucla.edu.
³ Department of Community Health Sciences, University of California, Los Angeles, California, USA.. Electronic address: mprelip@ucla.edu.
⁴ Department of Community Health Sciences, University of California, Los Angeles, California, USA.. Electronic address: maywang@ucla.edu.

PMID: 38224744
DOI: 10.1016/j.ypmed.2024.107857

Abstract

Background: Persistent racial/ethnic disparities in breastfeeding practices in the United States are well documented but the underlying causes remain unclear. While racial/ethnic disparities are often intertwined with socioeconomic disparities in breastfeeding, studies suggest that lack of breastfeeding support from family, health care organizations and workplaces may contribute to racial/ethnic disparities in breastfeeding rates. No studies have investigated the extent to which racial/ethnic disparities in breastfeeding practices can be explained by breastfeeding support.

Methods: We used survey data from participants of a federal nutrition assistance program in Los Angeles County, the most populous county in the United States, to examine causal mechanisms underlying racial/ethnic disparities in breastfeeding in five groups: Spanish-speaking Latina, English-speaking Latina, Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Non-Hispanic Asian (NHA). Applying causal mediation analysis, this study estimated the proportion of racial/ethnic differences in breastfeeding ('any' breastfeeding, i.e., partial or exclusive) rates at 6 months that could be explained by differential access to breastfeeding support from family, birth hospitals and workplaces.

Results: NHB and English-speaking Latina mothers were less likely, and Spanish-speaking Latina mothers more likely to breastfeed through 6 months than NHW mothers. Lack of breastfeeding support from family, hospitals and workplaces accounted for approximately 68% of the difference in any breastfeeding rates at 6 months between NHW and NHB mothers and 36% of the difference between NHW and English-speaking Latina mothers.

Conclusion: These findings highlight the importance of improving support from family, hospitals and workplaces for breastfeeding mothers to reduce racial/ethnic disparities in breastfeeding.

Keywords: Breastfeeding; Causal mediation analysis; G-computation; Mediation effect; Racial/ethnic disparities; Social support.

MeSH terms

Breast Feeding*
Ethnicity*
Female
Healthcare Disparities
Humans
Mothers
Racial Groups*
United States