Inner-city health centers could do more to boost breastfeeding

Health centers and birth hospitals serving largely minority populations could do more to promote and encourage recommended breastfeeding, according to a new study of Philadelphia safety-net health clinics.

“Breastfeeding is a hot topic. We know it is beneficial for most babies and that many are not getting breastfed,” said lead study author Jessica Robbins, Ph.D., a public health epidemiologist with the Philadelphia Department of Public Health.

Robbins and colleagues analyzed breast-feeding frequency of infants treated in eight inner-city Philadelphia health centers between June 2005 and May 2007, using data from infants’ medical records.

“Our study determined that it does matter what hospital a baby is born in and what health center it is later treated in,” said Robbins. The researchers found differences in initiation rates among patients born in different hospitals, and among patients seen in different health centers.

The study appears in the May issue of the Journal of Health Care for the Poor and Underserved.

“Particularly in disadvantaged communities, barriers prevent many mothers from breastfeeding,” Robbins said. “We need to provide better support, for we know breastfeeding can be successfully promoted among economically disadvantaged mothers.”

In this study’s patient population, race and ethnicity, mother’s age, infant birth weight and prematurity were not associated with breastfeeding initiation or maintenance, the authors found. The birth hospital was associated with initiation, however. In the Philadelphia health centers, breastfeeding was initiated by 42 percent of mothers while 7.5 percent breastfed for 180 or more days.

The study authors also looked at data from the U.S. National Immunization Survey (NIS), which also has included questions on breastfeeding since 2001. Nationwide, 75 percent of mothers who gave birth in 2007 reported that they had initiated breastfeeding, with 43 percent maintaining at infant age six months. Additionally, 13.3 percent breastfed exclusively through six months. Unrelated to the health department survey, local Philadelphia figures from the NIS were lower: 60.6 percent, 28.9 percent and 8.6 percent, respectively.

According to the World Health Organization, breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants.  It helps prevent infections of the middle ear and respiratory tract, as well as diarrhea and pneumonia, and might reduce risk of sudden infant death syndrome.

Breastfeeding mothers might experience less bleeding in their immediate postpartum period, return to pre-pregnancy weight faster and regain uterine tone more quickly. Later maternal benefits include potential lower risks of osteoporosis and of both ovarian and breast cancer.

Jane Heinig, Ph.D., at the UC Davis Human Lactation Center and editor in chief of the Journal of Human Lactation, said she not only agrees with the new study findings, but can support them as a result of her center’s own work reporting hospital breastfeeding data in California.

“This isn’t a feeding decision, it’s a health decision,” Heinig said. “Differences among ethnic groups are diminished and higher breastfeeding rates are associated with well-informed, supportive policies in place at baby-friendly hospitals.”