Researchers evaluated 1,636 black, white, and Hispanic women who delivered in hospitals in Los Angeles; Baltimore, Maryland; Washington, D.C.; and Lake County, Illinois, with a focus on attitudes toward breastfeeding, family history, and introduction to formula while still in the hospital. They then followed up with the moms one month postpartum, and again at the six-month mark.
What they found was a huge discrepancy in the mothers' initial decision to breastfeed. In fact, one of the biggest takeaways was that black mothers were nine times more likely to be given formula in the hospital than white mothers. Whoa!
"This fact alone accounted for about 20 percent of the racial disparity in breastfeeding duration between black and white mothers," explained study co-author Jennifer Hahn-Holbrook, Ph.D. "In-hospital formula introduction is something that hospital policy makers and breastfeeding advocates can seek to change, whereas some other factors that led to breastfeeding disparities in our study are not so easily addressed."
Those other factors include higher rates of poverty and lower levels of education—which were also responsible for the breastfeeding gap between black and white moms, especially when it came to the decision of whether or not to start breastfeeding in the first place.
The study also found that black mothers weaned their infants 10.3 weeks earlier than white mothers, and were less likely to have a family history of breastfeeding and less likely to live with the baby's father. White mothers were far less likely to be introduced to formula in the hospital than black mothers—which was the biggest predictor of breastfeeding duration—and they breastfed nearly seven weeks longer than English-speaking Hispanic mothers, who tended to be younger and lack a college degree.
Interestingly enough, the Hispanic moms were much more likely to have a family member who breastfed than the white or black moms. "This intergenerational factor proved to be the most powerful driving force behind Hispanic mothers' better breastfeeding outcomes," explained lead author and researcher Chelsea McKinney. "A strong family history of breastfeeding, especially on the mother's side, seemed to help Hispanic mothers overcome some of the breastfeeding barriers that impoverished women often face."
"This study finds a relationship between family experience with breastfeeding and Hispanic mothers' success at maternal nursing," added Bernice Hausman, an expert on the cultural aspects of breastfeeding and a professor at the Virginia Tech Carilion School of Medicine. "And also finds that in-hospital provision of free infant formula is related to black mothers' poorer breastfeeding outcomes."
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life, which is why the researchers are now hoping hospitals and policy makers will step up and consider nondemographic factors to help bridge the gap.
"Our results suggest that hospitals and policy makers should limit in-hospital formula introduction and consider family history and demographics to reduce racial and ethnic breastfeeding disparities," explained study co-investigator Madeleine Shalowitz.
"Change is possible," added McKinney. "And we hope to see racial and ethnic disparities in breastfeeding diminish as more hospitals serving low-income populations become 'baby-friendly' and encourage breastfeeding through close maternal-infant contact after birth and discouraging formula use."