Baby Friendly Hospital Initiative Practices in U.S. Hospitals Mitigate Racial and Ethnic Disparities in Breastfeeding Continuation.

Background: Breastfeeding provides numerous benefits for mothers and infants, but there are disparities in breastfeeding rates by race and ethnicity in the United States.

Research aim: Our study aimed to identify the extent to which Baby Friendly Hospital Initiative (BFHI) key clinical practices during the birth hospitalization influenced breastfeeding success by race and ethnicity.

Method: This study was a secondary analysis of the 2016 to 2019 National Pregnancy Risk Assessment Measurement System (PRAMS), a cross-sectional survey. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We examined the odds of breastfeeding to ≥ 10 weeks by percent of key clinical practices received and racial and ethnic group. Absolute racial differences were calculated to reflect the difference in breastfeeding rates by race and ethnicity overall, and stratified by percent of BFHI key clinical practices received.

Results: BFHI key clinical practices were a significant predictor of breastfeeding at ≥ 10 weeks; receipt of progressively more key clinical practices resulted in higher odds of breastfeeding. Over 75% of mothers who received 100% of key clinical practices breastfed for at least 10 weeks across all racial and ethnic groups. Among mothers who received ideal breastfeeding care, disparities were eliminated; there were no statistically significant differences in rates of breastfeeding ≥ 10 weeks for Black non-Hispanic (adjusted absolute racial difference [aARD] -4.5, 95% CI [-9.5, 0.4]), Hispanic English-speaking (aARD -2.6, 95% CI [-6.6, 1.4]), or Hispanic Spanish-speaking (aARD 1.7, 95% CI [-5.2, 8.6]) mothers compared to White non-Hispanic mothers.

Conclusion: There is a need to renew the push for universal adoption of BFHI by U.S. hospitals to address racial and ethnic disparities in breastfeeding outcomes.