Table 4 Community level healthcare facility breastfeeding interventions among women of color in the U.S.: Maternity ward

Merewood et al^. [53]

Maternity Hospitals

Design: Prospective

N = 33 hospitals

Data: 2014–17 hospital data

4 Southern states; N = 31 hospitals; N = 210–3953 records; 2–85% AA; 0–90% H, 5–81% W

at least 3 BFH steps

BF initiation and EBF increased.

Inequities in BF initiation between AA and W decreased by 9.6% points

14 hospitals received BFH designation.

Low

Ahluwalia et al. [54]

PRAMS survey

Design: Retrospective

Data: 2004–2006 Pregnancy Risk Assessment Monitoring System (PRAMS) survey

N = 49,135 women in 11 states and NY City 56.5% W; 14.4% AA,

23.4% H

Maternity Care Practices (MCPs)^a

BF ≥ 10 weeks associated with: early BF initiation (AA & W); BF on demand (AA & H); only breastmilk in hospital (all).

BF < 10 associated with: in-hospital pacifier (AA & W), BF support from hospital staff (AA); gift formula pack (H)

Low

Sebastian et al. [55]

PRAMS survey

Design: Retrospective

Data: 2012–2014 New Mexico PRAMS survey

N = 4035 Women who initiated BF; 8.4% Spanish-speaking H; 46% English-speaking H; 13.3% AI; 28.2% W

Supportive vs unsupportive BF MCPs

AI and H less likely to report BF at the hospital and receiving phone number for BF support. English-speaking H least likely to BF, only breast milk, staying in the same room, more likely to receive a gift formula pack.

Low

Nobari et al. [56]

WIC survey

Design: Observational

Data: Los Angeles County (LAC) WIC Survey (2008, 2011, 2014)

N = 1661 children ≤2 y old born at LAC hospitals (BFH; BFH in process; not BFH); 82% H

Exposure to any of 3 MCPs: Only breastmilk at hospital; Hospital gave gift formula; provided phone number for BF support.

Designated and in-process BFH associated with EBF at 1 and 3 mo.

Low

Jung et al. [57]

WIC survey

Design: pre/post Observational

Data: WIC triennial survey (2008, 2011, 2014, 2017)

N = 6449 eligible clients.

74% H

Exposure to any of 3 MCPs: Only breastmilk at hospital; Hospital gave gift formula; provided phone number for BF support.

Children born in a BFH (designated or in process) significantly higher in 2017 vs. 2014. Less formula packs in 2017. Any BF & EBF at 1 mo higher in 2017. BF at 6 mo and EBF at 1, 3, and 6 mo associated with only BF at hospital.

Low

Linares et al. [58] Medical chart

Design: Prospective

Data: Pregnancy survey, medical charts, 1 mo p.p.

N = 97 H; Central Kentucky

Skin-to-Skin Contact (SSC)

SSC vs. non-SCC

Higher EBF at discharge and at 1-mo p.p.; not associated with EBF 1-mo p.p.

Low

Ekambaram et al^. [59]

Medical chart

Design: Pre/post observational

Data: medical charts, 1 mo p.p. phone survey

N = 283 pre; N = 272 post; Philadelphia, Pennsylvania; 100% AA

Pacifier policy: not offering pacifier at the clinics and BF education.

Intervention associated with EBF on day of discharge; no differences on EBF at 1 mo p.p.

Very Low