Racial and Ethnic Disparities in Hospital Breastfeeding Care in the US.

Objectives: This study examines the associations between race and ethnicity and receipt of Baby Friendly Hospital Initiative (BFHI) key clinical practices that support breastfeeding in US hospitals.

Methods: National data from 2016 to 2019 CDC PRAMS were analyzed. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We conducted adjusted regression analyses to compare the odds of receiving individual key clinical practices that support breastfeeding, as well as the percent of key clinical practices received.

Results: While some key clinical practices were received at high rates, less than 25% of mothers received 100% of recommended key clinical practices. Compared to White non-Hispanic mothers, mothers from various racial and ethnic groups were at lower odds of receiving 100% of key clinical practices: Black non-Hispanic [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) (0.47-0.65)], English-Speaking Hispanic [AOR 0.79, 95% CI (0.71-0.88)], Spanish-speaking Hispanic [AOR 0.63, 95% CI (0.53-0.73)], and Asian/Pacific Islander non-Hispanic [AOR 0.54, 95% CI (0.47-0.63)].

Conclusions for practice: Despite a steady increase in the number of BFHI hospitals in the US, there are racial and ethnic disparities in the receipt of BFHI key clinical practices. More US hospitals must adopt BFHI key clinical practices and consistently implement those practices for every racial and ethnic group.