Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017–2020

IF 2.1 4区 医学 Q2 NURSING Journal of Human Lactation Pub Date : 2024-09-14 DOI:10.1177/08903344241274306
Rebecca C. Robert, Amira A. Roess, Doris Kuehn, Swathi Vinjamuri
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Abstract

Background:Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity.Research Aim:To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black.Method:We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017–2020. Women who delivered a firstborn, singleton infant were included ( N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited.Results:Breastfeeding initiation was 57.4% ( n = 1988) for women delivering in accredited hospitals versus 55.4% ( n = 2540) in non-accredited hospitals and multivariable model results were non-significant ( OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, ( OR = 1.55, 95% CI [1.16, 2.09]).Conclusion:Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.
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2017-2020 年爱婴医院、健康的社会决定因素和低收入人群开始母乳喂养的差异
背景:支持母乳喂养并以母乳喂养启动为目标的组织级干预措施(即:爱婴医院倡议)对于减少母乳喂养差异和促进母乳喂养公平至关重要、爱婴医院倡议)对于减少母乳喂养差异和促进母乳喂养公平至关重要。研究目的:确定美国华盛顿特区妇女、婴儿和儿童特别补充营养计划(WIC)受助者在爱婴医院分娩与开始母乳喂养之间的关联,其中大多数受助者称其种族为黑人。方法:我们对作为华盛顿特区 WIC 计划 2017-2020 年常规 WIC 访问一部分而收集的去标识计划数据进行了二次分析。我们纳入了分娩头胎单胎婴儿的妇女(N = 8225)。多变量逻辑回归模型考虑了健康的社会决定因素和其他因素。一组模型包括二元暴露变量(通过爱婴医院认证的医院与未通过认证的医院),另一组模型包括分类暴露变量(1)通过爱婴医院认证的医院,(2)开展爱婴活动但未通过认证的医院,(3)既未开展爱婴活动也未通过认证的医院)。结果:在获得认证的医院分娩的妇女中,母乳喂养率为57.4%(n = 1988),而在未获得认证的医院中,母乳喂养率为55.4%(n = 2540),多变量模型结果不显著(OR = 0.95,95% CI [0.86,1.05])。然而,与在未获得爱婴医院认证的医院(45.3%,n = 110)分娩的妇女相比,在获得爱婴医院认证的医院(57.4%,n = 1988)或有爱婴活动但未获得认证的医院(55.9%,n = 2430)分娩的妇女开始母乳喂养的人数更多,多变量模型结果与之一致(获得爱婴医院认证的医院 OR = 1.44,95% CI [1.07,1.94];有爱婴活动但未获认证的医院(OR = 1.55,95% CI [1.16,2.09])。结论:组织层面的干预措施能够创造支持母乳喂养的医院环境,对于促进母乳喂养的公平性非常重要,但必须解决母乳喂养结果的潜在社会决定因素。
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来源期刊
Journal of Human Lactation
Journal of Human Lactation 医学-妇产科学
CiteScore
5.00
自引率
11.50%
发文量
100
审稿时长
6-12 weeks
期刊介绍: Committed to the promotion of diversity and equity in all our policies and practices, our aims are: To provide our readers and the international communities of clinicians, educators and scholars working in the field of lactation with current and quality-based evidence, from a broad array of disciplines, including the medical sciences, basic sciences, social sciences and the humanities. To provide student and novice researchers, as well as, researchers whose native language is not English, with expert editorial guidance while preparing their work for publication in JHL. In each issue, the Journal of Human Lactation publishes original research, original theoretical and conceptual articles, discussions of policy and practice issues, and the following special features: Advocacy: A column that discusses a ‘hot’ topic in lactation advocacy About Research: A column focused on an in-depth discussion of a different research topic each issue Lactation Newsmakers: An interview with a widely-recognized outstanding expert in the field from around the globe Research Commentary: A brief discussion of the issues raised in a specific research article published in the current issue Book review(s): Reviews written by content experts about relevant new publications International News Briefs: From major international lactation organizations.
期刊最新文献
Immunological Factors and Macronutrient Content in Human Milk From Women With Subclinical Mastitis. Considerations When Measuring Exclusive Breastfeeding. Bridging the Gap Between Lactation Care and Research in Human Lactation. Utilizing Lactation Acuity to Improve Lactation Services in a U.S. Hospital. Breastfeeding Intentions, Attitudes, and Knowledge Among Medical Students in Croatia.
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