Abstract
Background
There is evidence that the Baby-Friendly Hospital Initiative increases breastfeeding initiation for Black women. However, how Baby-Friendly hospitals use an equity approach to improve breastfeeding rates for Black women is not well understood. The aim of this research is to explore equity-oriented approaches and practices intended to support breastfeeding, uncover barriers and facilitators to breastfeeding equity, and identify opportunities to increase the focus on equity.
Methods
An exploratory case study using an action research and appreciative inquiry approach was conducted with two Baby-Friendly Hospitals in the Atlanta, GA metropolitan area. The researcher reviewed publicly available hospital documents, conducted semi-structured interviews with hospital maternity care leaders and providers and community-based key informants, and facilitated a focus group of Black women. An advisory committee was convened and provided recommendations for practice during one cycle of action research. The researcher used a priori codes based on the predefined conceptual framework and emergent codes from the data and performed quantitative content analysis and thematic analysis using MS Excel and MAXQDA.
Results
Despite being from the same hospital system, racial equity approaches for one hospital were more equity-oriented while racial equity approaches for the other hospital were more equality-oriented. While barriers and facilitators were found at all levels of the social ecological model, most were related to racism and antiracism and included differential access to donor milk by race and practices to address implicit bias. Key themes for enhancing breastfeeding equity that spanned across the continuity of care spectrum were increasing access to culturally matched and respectful prenatal care, and providing community-based breastfeeding support post discharge.
Conclusion
Changing systems at the organizational level and incorporating policies and practices that mitigate interpersonal, institutional, and structural racism may be beneficial to advancing breastfeeding equity for Black women.
Keywords: Black women, Baby-Friendly hospitals, breastfeeding, racial equity, antiracism
Keywords
Black women, Baby-Friendly hospitals, breastfeeding, racial equity, antiracism
Included in
Breastfeeding Equity for Black Women: A Georgia Case Study of Baby-Friendly Hospitals
Background
There is evidence that the Baby-Friendly Hospital Initiative increases breastfeeding initiation for Black women. However, how Baby-Friendly hospitals use an equity approach to improve breastfeeding rates for Black women is not well understood. The aim of this research is to explore equity-oriented approaches and practices intended to support breastfeeding, uncover barriers and facilitators to breastfeeding equity, and identify opportunities to increase the focus on equity.
Methods
An exploratory case study using an action research and appreciative inquiry approach was conducted with two Baby-Friendly Hospitals in the Atlanta, GA metropolitan area. The researcher reviewed publicly available hospital documents, conducted semi-structured interviews with hospital maternity care leaders and providers and community-based key informants, and facilitated a focus group of Black women. An advisory committee was convened and provided recommendations for practice during one cycle of action research. The researcher used a priori codes based on the predefined conceptual framework and emergent codes from the data and performed quantitative content analysis and thematic analysis using MS Excel and MAXQDA.
Results
Despite being from the same hospital system, racial equity approaches for one hospital were more equity-oriented while racial equity approaches for the other hospital were more equality-oriented. While barriers and facilitators were found at all levels of the social ecological model, most were related to racism and antiracism and included differential access to donor milk by race and practices to address implicit bias. Key themes for enhancing breastfeeding equity that spanned across the continuity of care spectrum were increasing access to culturally matched and respectful prenatal care, and providing community-based breastfeeding support post discharge.
Conclusion
Changing systems at the organizational level and incorporating policies and practices that mitigate interpersonal, institutional, and structural racism may be beneficial to advancing breastfeeding equity for Black women.
Keywords: Black women, Baby-Friendly hospitals, breastfeeding, racial equity, antiracism
