Racial Disparities in Patient-Reported Baby-Friendly Breastfeeding Support

OBJECTIVE: We examined associations between patient race and self-reported receipt of the Baby-Friendly "Ten Steps" of breastfeeding support, with and without accounting for medical reasons for nonreceipt. METHODS: This cross-sectional study used stratified sampling to recruit similar numbers of Black and white patients who intended to breastfeed and delivered term, healthy infants, recruited during birth hospitalization over an 18-month period at 2 Baby-Friendly hospitals in Massachusetts. The investigator-designed survey was administered online within 2 weeks of discharge. We calculated adjusted odds ratios (aORs) using logistic regression to examine associations between self-reported race and receipt of steps, with and without accounting for patient-reported medical reasons for nonreceipt (eg, procedure requiring dyad separation), adjusting for prior breastfeeding and birth hospital. We also examined receipt of Ten Steps by birth hospital. RESULTS: Black (49.0%) and white (51.0%) participants (n = 210) had similar breastfeeding histories. Black participants had significantly lower odds than white participants of receiving immediate skin-to-skin contact (step 4) (aOR, 0.49; 95% CI, 0.24-0.99), exclusive breastfeeding in hospital (step 6) (aOR, 0.26; 95% CI, 0.10-0.65), and avoidance of pacifiers (step 9) (aOR, 0.36; 95% CI, 0.19-0.68). After excluding participants with medical reasons for nonreceipt of these steps, the associations were not significant. We also found differences in receipt of steps by hospital. CONCLUSION: We found differences in Ten Steps receipt by birthing parent race and hospital, but after removing those reporting medical reasons for nonreceipt, racial disparities were not observed. Addressing racial disparities in perinatal morbidity and hospital-level differences may improve equitable breastfeeding support.