Table 2 Policy level breastfeeding interventions among women of color in the U.S.

Kapinos et al. [42]

National data

Design: Pre/post observational

Data: 2009–2014 National Vital Statistics System

N = 17,985,584 births;

H: 33.42%; W: 77.04%; AA: 15.72%; AI: 0.99%; A/PI: 6.47%

Before/After Affordable Care Act (ACA 2009 versus 2013, 2009 versus 2014)

ACA implementation associated with AA & AI/AN mothers being 1–2% points more likely than W women to initiate BF.

Low

Hawkins et al. [43]

PRAMS data

Design: Quasi-experimental

Data:2000 & 2008 Pregnancy Risk Assessment Monitoring System (PRAMS) 32 states.

N = 349,780 mothers; 2000–2008:

W:55.7–53.3%; H:12.4–15.1%; AA:18–16.4%; Other:13.6–15%

Before/After BF state laws: 1) worksite breaktime and private space for BF

2) BF anywhere

H mothers had 5.8%-point increase in BF initiation in states with worksite laws. AA mothers had 5.6%-point increase in BF initiation in states with laws for BF in any location.

Low

Smith-Gagen et al. [44]

National data

Design: Pre/Post observational

Data: 2003–2010 U.S. NHANES linked to Policy data

N = 3132;

AA = 609, H = 1078

W = 1445

Before/After

8 BF protection laws^a

At 6 mo AA were half as likely to BF for jury duty exemption; H were more likely to BF with break time from work /pumps access when compared with W.

Low

Li et al. [45]

National data

Design: Pre/Post Observational

Data:2000–2014 NHANES data of WIC eligible < 5 y old children.

2000–2008: N = 2770; W = 25.31%; AA = 22.20%; H = 45.92%. 2009–2014: N = 1538; W = 22.63%; AA = 27.63%; H = 39.92%

WIC eligible participants and non-participants before and after 2009 WIC package.

2009–2014 BF initiation rates improved for WIC participants, and the differences among non-participant became non significant as it was in 2000/2008. No effect on BF duration.

Moderate

Langellier et al. [46]

WIC survey

Design: Pre/post observational

Data: WIC LA County Survey

N = 5524; in 2005 84.9% H; in 2011 80% H

2009 WIC Package revisions; 2011

vs. 2005 and 2008

In 2011 BF initiation, EBF for 3 mo., and EBF at 6 mo. significantly increased. No effect on Any BF at 3&6 mo

Low

Yourkavitch et al. [47]

Data sets

Design: Retrospective

Data: New Jersey birth certificate and medical records data

EBF sample, N = 26,287:

W = 60%;AA = 10%;H = 20%; A/PI = 10%. Any BF, N = 54,117:W = 43%;AA = 13%;H = 33%; A/PI = 12%

Neighborhood (NBHD) disadvantage versus affluence

EBF decreased as NBHD disadvantage increased only for Asian, AA, and H. EBF increased as NBHD affluence increased for H and W. Any BF decreased as NBHD disadvantage increased among H and W.

Low