Hispanic Health Council, 175 Main Street, Hartford, CT, 06106, USA.
Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
Int J Equity Health. 2021 Mar 6;20(1):72. doi: 10.1186/s12939-021-01388-4.
In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates?
The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies.
We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3).
Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.
在美国，强烈的族裔/种族、社会经济、人口和地理母乳喂养（BF）不平等现象仍然存在，与白人女性相比，非裔美国人和西班牙裔女性更不可能实现母乳喂养目标。本系统评价（SR）旨在回答以下问题：针对美国少数民族妇女的母乳喂养干预措施对提高 BF 起始率、持续时间和排他性有何影响？
本 SR 遵循医学研究所指南和系统评价和荟萃分析首选报告项目清单进行。该研究方案是在事先制定的，并在 PROSPERO（ID#CRD42020177764）中注册。电子数据库搜索是通过团队的专家公共卫生图书馆员使用受控词汇和自由文本查询进行的，并针对现有综述中包含的一组经过验证的相关论文进行了测试。使用 GRADE 方法评估研究质量。
我们纳入了 60 项研究，其中包括随机（n=25）、观察性（n=24）、准实验（n=9）或横断面（n=2）设计。这些研究的重点是多族裔/种族（n=22）、仅西班牙裔（n=24）、仅黑人（n=13）和仅美洲印第安人（n=1）的人群。研究干预措施按照社会生态学模式进行分类：宏系统/政策层面（n=6）；社区层面（n=51），包括医疗保健组织（n=34）、妇女、婴儿和儿童特别补充营养计划（WIC）（n=9）和社区组织/公共卫生机构（n=8）；以及人际层面（n=3）。
通过 WIC、医疗保健机构和社区机构提供的政策和社区层面的干预措施可能会改善有色人种妇女的 BF 结局。尚未在美国少数民族妇女中研究社会生态模式不同层面的干预措施的组合。需要实施科学研究，以了解如何最好地扩大和维持有效的 BF 干预措施，同时考虑到少数民族妇女的需求和愿望。因此，强烈建议开展大规模实施研究，解决如何加强美国有色人种妇女周围的不同健康和社会环境，以改善她们的 BF 结局。
