Table 2 Policy level breastfeeding interventions among women of color in the U.S.
| Study | Study Design/Data collection | Study Population | Intervention/Exposure | Outcomes/Results | Grade |
|---|---|---|---|---|---|
|
Kapinos et al. [42] National data |
Design: Pre/post observational Data: 2009–2014 National Vital Statistics System |
N = 17,985,584 births; H: 33.42%; W: 77.04%; AA: 15.72%; AI: 0.99%; A/PI: 6.47% | Before/After Affordable Care Act (ACA 2009 versus 2013, 2009 versus 2014) | ACA implementation associated with AA & AI/AN mothers being 1–2% points more likely than W women to initiate BF. | Low |
|
Hawkins et al. [43] PRAMS data |
Design: Quasi-experimental Data:2000 & 2008 Pregnancy Risk Assessment Monitoring System (PRAMS) 32 states. |
N = 349,780 mothers; 2000–2008: W:55.7–53.3%; H:12.4–15.1%; AA:18–16.4%; Other:13.6–15% |
Before/After BF state laws: 1) worksite breaktime and private space for BF 2) BF anywhere | H mothers had 5.8%-point increase in BF initiation in states with worksite laws. AA mothers had 5.6%-point increase in BF initiation in states with laws for BF in any location. | Low |
|
Smith-Gagen et al. [44] National data |
Design: Pre/Post observational Data: 2003–2010 U.S. NHANES linked to Policy data |
N = 3132; AA = 609, H = 1078 W = 1445 |
Before/After 8 BF protection lawsa | At 6 mo AA were half as likely to BF for jury duty exemption; H were more likely to BF with break time from work /pumps access when compared with W. | Low |
|
Li et al. [45] National data |
Design: Pre/Post Observational Data:2000–2014 NHANES data of WIC eligible < 5 y old children. | 2000–2008: N = 2770; W = 25.31%; AA = 22.20%; H = 45.92%. 2009–2014: N = 1538; W = 22.63%; AA = 27.63%; H = 39.92% | WIC eligible participants and non-participants before and after 2009 WIC package. | 2009–2014 BF initiation rates improved for WIC participants, and the differences among non-participant became non significant as it was in 2000/2008. No effect on BF duration. | Moderate |
|
Langellier et al. [46] WIC survey |
Design: Pre/post observational Data: WIC LA County Survey | N = 5524; in 2005 84.9% H; in 2011 80% H |
2009 WIC Package revisions; 2011 vs. 2005 and 2008 | In 2011 BF initiation, EBF for 3 mo., and EBF at 6 mo. significantly increased. No effect on Any BF at 3&6 mo | Low |
|
Yourkavitch et al. [47] Data sets |
Design: Retrospective Data: New Jersey birth certificate and medical records data |
EBF sample, N = 26,287: W = 60%;AA = 10%;H = 20%; A/PI = 10%. Any BF, N = 54,117:W = 43%;AA = 13%;H = 33%; A/PI = 12% | Neighborhood (NBHD) disadvantage versus affluence | EBF decreased as NBHD disadvantage increased only for Asian, AA, and H. EBF increased as NBHD affluence increased for H and W. Any BF decreased as NBHD disadvantage increased among H and W. | Low |