Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts;
Reaching Our Sisters Everywhere, Inc, Lithonia, Georgia.
Pediatrics. 2019 Feb;143(2). doi: 10.1542/peds.2018-1897. Epub 2019 Jan 18.
Race is a predictor of breastfeeding rates in the United States, and rates are lowest among African American infants. Few studies have assessed changes in breastfeeding rates by race after implementing the Ten Steps to Successful Breastfeeding (hereafter referred to as the Ten Steps), and none have assessed the association between implementation and changes in racial disparities in breastfeeding rates. Our goal was to determine if a hospital- and community-based initiative in the Southern United States could increase compliance with the Ten Steps, lead to Baby-Friendly designation, and decrease racial disparities in breastfeeding.
Hospitals in Mississippi, Louisiana, Tennessee, and Texas were enrolled into the Communities and Hospitals Advancing Maternity Practices initiative from 2014 to 2017 and received an intensive quality improvement and technical assistance intervention to improve compliance with the Ten Steps. Community partners and statewide organizations provided parallel support. Hospitals submitted monthly aggregate data stratified by race on breastfeeding, skin-to-skin care, and rooming in practices.
The disparity in breastfeeding initiation between African American and white infants decreased by 9.6 percentage points (95% confidence interval 1.6-19.5) over the course of 31 months. Breastfeeding initiation increased from 66% to 75% for all races combined, and exclusivity increased from 34% to 39%. Initiation and exclusive breastfeeding among African American infants increased from 46% to 63% ( < .05) and from 19% to 31% ( < .05), respectively. Skin-to-skin care after cesarean delivery was significantly associated with increased breastfeeding initiation and exclusivity in all races; rooming in was significantly associated with increased exclusive breastfeeding in African American infants only.
Increased compliance with the Ten Steps was associated with a decrease in racial disparities in breastfeeding.
在美国，种族是母乳喂养率的预测因素，而非洲裔美国婴儿的母乳喂养率最低。很少有研究评估在实施成功母乳喂养的十项措施（简称十项措施）后，按种族划分的母乳喂养率变化，也没有研究评估实施情况与母乳喂养率种族差异变化之间的关系。我们的目标是确定在美国南部的一个医院和社区为基础的倡议是否可以提高对十项措施的遵守程度，导致婴儿友好指定，并减少母乳喂养率的种族差异。
2014 年至 2017 年，密西西比州、路易斯安那州、田纳西州和德克萨斯州的医院参加了社区和医院促进产妇实践倡议，并接受了密集的质量改进和技术援助干预，以提高对十项措施的遵守程度。社区合作伙伴和全州组织提供了并行支持。医院按种族每月提交有关母乳喂养、皮肤接触和母婴同室实践的汇总数据。
在 31 个月的时间里，非洲裔美国婴儿和白种婴儿的母乳喂养起始率差异减少了 9.6 个百分点（95%置信区间 1.6-19.5）。所有种族的母乳喂养起始率从 66%增加到 75%，纯母乳喂养率从 34%增加到 39%。非洲裔美国婴儿的母乳喂养起始率和纯母乳喂养率分别从 46%增加到 63%（<0.05）和从 19%增加到 31%（<0.05）。剖宫产术后皮肤接触与所有种族的母乳喂养起始率和纯母乳喂养率增加显著相关；母婴同室与非洲裔美国婴儿的纯母乳喂养率增加显著相关。
十项措施的遵守程度增加与母乳喂养率的种族差异减少有关。
