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Factors in Birthing Centers that Impede Exclusive Breastfeeding among Black Mothers: A Basic Qualitative Approach

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Breastfeeding & Health outcomes in America.

The persistence of racial disparities in breastfeeding amongst Black women is associated with various interconnected factors such as historical, cultural, societal, and psychological. According to Bartick et al. (2017) and Bartick et al. (2016b), suboptimal breastfeeding is attributed to poor health outcomes accounting for more than 2,619 premature maternal deaths and linked to more than 721 infant deaths. Lack of self-efficacy, social support, education, and support from hospital staff in the immediate postpartum period has been identified as individual and environmental factors linked to lower prevalence of breastfeeding among Black mothers’ (Dunn et al., 2015, Louis-Jacques et al., 2017b). 

Healthcare stigmas & Institutional racism 

Racism includes unfair attitudes and violent hostility against another ethnic group (United Nations Educational Scientific and Cultural Organization, 2019). While many Americans who are unaware of social inequities may argue that racism no longer exists in the United States, equality without equity is meaningless in a system founded on racism and discrimination (Kwate, 2014). Institutional racism refers to how institutions operate systematically, both overtly and inherently, via the reinforcement and adoption of racist policies, procedures, operations, and culture that exclude racial minorities or create barriers to access quality health and resources (American Academy of Family Physicians,2019; American Psychological Association, 2019). Race-based inequities against patients during care and the link to implicit bias are documented components of exclusive breastfeeding disparities (Thomas, 2018a). 

Exclusive breastfeeding rates have been on the rise with the help of health communication campaigns triggered by the Surgeon's General Call to Action to support exclusive breastfeeding and the Healthy People 2020 Maternal, Infant, and Child Health goals (CDC, 2018c; Thomas, 2018a). Regrettably, the health gap-disparity between Black mothers and their white counterparts has not decreased regarding exclusive breastfeeding (CDC, 2018c; Thomas, 2018a). Therefore, the results of this study create social change by providing an insight into Black mothers' experiences individually, interpersonally, and within their community regarding exclusive breastfeeding. Furthermore, this study provides insight into the perception of implicit (unconscious) bias, racism, and discrimination within the institutional structure and existing policies of birthing centers that may influence the initiation and duration of exclusive breastfeeding among Black mothers.

Due to structural racism woven into the United States' social and institutional structure, racial health disparities continue to impact people who self-identify as Black negatively. Therefore, this study also provides an understanding of how the individual, interpersonal, and community factors, as well as the organizational structures and existing policies within birthing centers, are perceived by Black mothers. In addition, the study provides more insight into how Black mothers identified and characterized these perceptions of racial discrimination after giving birth within a birthing center. As a result, this study can provide insight into (a) reducing exclusive breastfeeding disparities rates that are associated with race/ethnicity and (b) assisting with developing best practices for the management of exclusive breastfeeding. Subsequently, leading to strategies that yield higher breastfeeding rates among Black mothers, which would significantly impact Black maternal and child health (McGuire, 2011; NCHEC, 2015; Office of the Surgeon General U.S. Department of Health & Human Services [HHS], 2011; Trent et al., 2019).


Negative attitudes towards health-seeking &  under using health services.


"I think they looked at me as a, black Medicaid patient and they were going to keep me there for as long as Medicaid was covering it. And they cover four days. And after that, they were; they didn’t care what state I was in. I was going home." 


This study identifies inequities within

  • Health care protocol

  • Health care practices

  • Birthing & breastfeeding resources

  • Health care procedures

that new mothers need to engage in positive health-seeking behavior of initiating and sustaining exclusive breastfeeding of their newborn infant.











This awareness may promote healthy discussions within birthing centers on how to serve this population of mothers better.

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