Leadership,Expertise,and Creativity: The Right Mix for Breastfeeding Research

Abstract

Introduction

Disparity in breastfeeding rate is a major problem in the United States. Low breastfeeding rates are most prevalent among racial minorities, especially blacks.¹ According to the 2014 Centers for Disease Control and Prevention report card, approximately 79% of newborn infants born in the United States initiated breastfeeding.² However, fewer than half (49%) were breastfed for 6 months, and nearly a quarter were breastfed for 12 months. Although the gap in breastfeeding rates is narrowing, black infants have the lowest prevalence of breastfeeding. In 2008, the rate of breastfeeding for whites was 75.2%, whereas only 58.9% of black infants were ever breastfed.¹

Breastfeeding is beneficial to both the mother and her offspring. Breastfed children are less likely to suffer from diseases including ear infections, gastrointestinal infections, asthma, and type 2 diabetes.^3–6 Additionally, breastfeeding has demonstrated to have a protective effect to mothers. Women who never breastfed or wean prematurely have an increased risk of breast cancer, ovarian cancer, obesity, type 2 diabetes, metabolic syndrome, and cardiovascular disease.^4,6,7 Furthermore, the low rate of breastfeeding has a detrimental societal cost. For instance, nearly $13 billion will be saved annually from pediatric costs, if 90% of mothers in the United States exclusively breastfed for at least 6 months.⁸ Furthermore, $18.3 billion could be saved from potentially preventable maternal health costs.⁹

Despite the benefits of breastfeeding, most women in the United States do not breastfeed exclusively or breastfeed in accordance to the recommended duration of breastfeeding. According to the American Academy of Pediatrics, infants should be fed breastmilk exclusively for the first 6 months of life; infants should also continue breastfeeding for 12 months with gradual introduction of solid foods following the first 6 months of exclusive breastfeeding.¹⁰ Reasons for not breastfeeding include lack of knowledge, perceived insufficient milk, technical difficulty in breastfeeding, going back to work after maternity leave, work environment that is not conducive for breastfeeding, smoking, and lack of family and social support.^11–13 Additionally, women who never had their postpartum doctor's visit and reported lack or inadequate support from a healthcare provider are more likely not to breastfeed. In 2011, the Surgeon General's Call for Action emphasized the need to address the prevalent problems influencing breastfeeding practices.¹⁴ Specifically, the document highlighted the importance of tackling lack of knowledge, improving attitudes, skills, self-efficacy, confidence, and commitment to breastfeeding, social and cultural norms, social support, guidance from the healthcare environment, improving the work environment, media influences, and education about breastfeeding in public.

Despite the plethora of research on barriers to breastfeeding, there are areas that are still underinvestigated. According to 2013 statistics from the Centers for Disease Control and Prevention, research is needed to further understand barriers among populations with low breastfeeding rates.¹⁵ Non-Hispanic black women have lower rates of breastfeeding initiation and shorter duration of breastfeeding. According to a 2008 report, 47% of white mothers breastfeed for 6 months, but only 30% of black mothers breastfeed for at least 6 months.¹ Additionally, only 12.5% of black mothers breastfeed for 12 months compared with 24.3% of white mothers.

Similar to national trends, black women in Richmond, VA have lower rates of breastfeeding. Richmond City residents are predominantly black, and breastfeeding rates are much lower. According to 2010 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) data, only 4.3% of WIC recipients chose the full package for breastfeeding (an indication of breastfeeding). This rate is lower than the national rate of 11%.¹⁶

Leadership in Promoting Breastfeeding

The Mayor of Richmond City recognized the low rate of breastfeeding in Richmond and charged the Richmond Healthy Start Initiative (RHSI) to mobilize the community. As part of a broader campaign, known as Healthy Richmond Campaign, Richmond City became the first to establish a Mayor's Breastfeeding Commission in Virginia. With this charge, RHSI brought together major health systems and hospitals, governmental organizations, university researchers, nonprofit organizations, community leaders, the business community, and healthcare providers and advocates to address the low rates of breastfeeding in the city. Work groups were created to address the needs. The work groups worked (1) to tackle issues affecting hospitals, healthcare providers, and community educators, (2) to create strategies for utilizing social media, and (3) to formulate the business case for breastfeeding. The Mayor accepted the work groups' recommendations that encouraged Richmond hospitals and health systems to adopt the 10 Steps of the Baby-Friendly Hospital Initiative, to support and encourage Richmond City businesses to develop and implement comprehensive lactation support programs for their employees, to promote partnerships and education among care providers who come into contact with mothers, fathers, partners, and families before, during, and after childbirth, as well as during the infant's first year of life, and to develop an education/marketing strategy to promote breastfeeding.

City Leadership, Community, and University Partnership

As part of the Mayor's Commission, the RHSI and researchers from Virginia Commonwealth University (VCU) collaborated on research projects to address the needs of the community. The Commission realized that the first step to addressing the needs of the community was to understand barriers to breastfeeding, especially for African American families. The VCU researchers in partnership with RHSI obtained a community engagement pilot funding to identify barriers and facilitators of breastfeeding. The pilot study used a mixed-method approach to obtain qualitative and quantitative data from African American mothers.¹⁷ In addition to the pilot data, longitudinal data were obtained from RHSI program participants. The RHSI program participants included pregnant and interconception women receiving care from home visiting programs and the Richmond Behavioral Health Authority. Data from these sources revealed that women in general understand the benefits of breastfeeding. Additionally, women recognize healthcare providers' efforts to encourage breastfeeding. However, attitudes toward breastfeeding, self-efficacy, and family and social support were identified as barriers. Findings from the RHSI participants also showed the association between obesity and lack of breastfeeding. Informed by these data, Masho et al.¹⁶ examined data from the National Pregnancy Risk Assessment Monitoring Survey and reported the association between prepregnancy obesity and lack of breastfeeding initiation. Considering the high prevalence of obesity, findings from this study provided important information to design interventions to address the needs of women.

Future Research Directions

The citywide effort and the community–university partnerships have provided the infrastructure to design locally appropriate, culturally sensitive interventions in Richmond City. Future studies need to address the economic impacts on employers and working mothers, as well as best practices for management and lactation support, and to understand facilitators of exclusive breastfeeding.¹⁸ Furthermore, research is needed to examine the impact of citywide efforts and examination of breastfeeding policies.

Footnotes

Disclosure Statement

No competing financial interests exist.

References

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