Experiences of Racism and Breastfeeding Initiation and Duration Among First-Time Mothers of the Black Women’s Health Study

• Published in: Journal of racial and ethnic health disparities Vol. 5; no. 6; pp. 1180 - 1191
• Main Authors: Griswold, Michele K., Crawford, Sybil L., Perry, Donna J., Person, Sharina D., Rosenberg, Lynn, Cozier, Yvette C., Palmer, Julie R.
• Format: Journal Article
• Language: English
• Published: Cham Springer Science + Business Media 01-12-2018; Springer International Publishing; Springer Nature B.V
• Subjects: Adult; Black or African American - statistics & numerical data; Black people; Black white relations; Breast cancer; Breast feeding; Breast Feeding - statistics & numerical data; Breastfeeding & lactation; Diabetes; Epidemiology; Fairness; Female; Health disparities; Health status; Housing; Humans; Inequality; Lactation; Life course; Logistic Models; Medicine; Medicine & Public Health; Mortality; Mothers; Neighborhoods; Obesity; Odds Ratio; Oppression; Physiology; Police; Prospective Studies; Quality of Life Research; Questionnaires; Racial differences; Racial discrimination; Racism; Racism - statistics & numerical data; Residence Characteristics; Residential segregation; Review boards; Secondary analysis; Segregation; Social Inequality; Social Segregation; Social Structure; Statistical analysis; Stereotypes; Systemic racism; Time Factors; White people; Women; Womens health; Workplace; United States > US; Equity; Duration; Breastfeeding; Initiation; Racism; Life course
• ISSN: 2197-3792; 2196-8837; 2196-8837
• DOI: 10.1007/s40615-018-0465-2

Background
Breastfeeding rates are lower for black women in the USA compared with other groups. Breastfeeding and lactation are sensitive time points in the life course, centering breastfeeding as a health equity issue. In the USA, experiences of racism have been linked to poor health outcomes but racism relative to breastfeeding has not been extensively investigated.
Aims
This study aims to investigate the association between experiences of racism, neighborhood segregation, and nativity with breastfeeding initiation and duration.
Methods
This is a prospective secondary analysis of the Black Women’s Health Study, based on data collected from 1995 through 2005. Daily and institutional (job, housing, police) racism, nativity, and neighborhood segregation in relation to breastfeeding were examined. Odds ratios and 95% confidence intervals were calculated using binomial logistic regression for the initiation outcomes (
N
 = 2705) and multinomial logistic regression for the duration outcomes (
N
 = 2172).
Results
Racism in the job setting was associated with lower odds of breastfeeding duration at 3–5 months. Racism with the police was associated with higher odds of breastfeeding initiation and duration at 3–5 and 6 months. Being born in the USA or having a parent born in the USA predicted lower odds of breastfeeding initiation and duration. Living in a segregated neighborhood (primarily black residents) as a child was associated with decreased breastfeeding initiation and duration relative to growing up in a predominantly white neighborhood.
Conclusion
Experiences of institutionalized racism influenced breastfeeding initiation and duration. Structural-level interventions are critical to close the gap of racial inequity in breastfeeding rates in the USA.