The Carolina Global Breastfeeding Institute (CGBI) is dedicated to support for equity in all aspects of maternal and child health. To this end, we have undertaken a series of activities to address the special needs of vulnerable populations. Lack of equity in support for breastfeeding has been identified as a barrier for breastfeeding across racial, ethnic, low wealth and specific age groupings. Informed by the existing published and grey literature, and in direct support of the US Call to Action to Support Breastfeeding and NC Blueprints for Action on Breastfeeding, we have formulated a series of studies of the state of breastfeeding at various levels, using the socio-ecological model as our framework. We have been especially interested in policy and practice as related to inequities in support and practices in North Carolina and have been working in regular communication with the NC State Department of Public Health and others interested in this issue.
Our activities have included:
1. Review of available literature and state data, and ecological analysis, to illustrate the concurrence of low breastfeeding rates and high illness and mortality rates in the African American and low wealth populations of North Carolina.
2. Development of an estimate of deaths that could be averted by breastfeeding and impact on infant mortality rate (Odds Ratios were used to demonstrate that, if all women in NC breastfed optimally, an estimated 100-150 deaths might be averted, bringing NC infant mortality rates closer to average for the US.)
3. Calculation of disability adjusted life years (DALYs): more than 250,000 unnecessary years of illness and reduced productivity are created annually in NC due to limited breastfeeding levels.
4. Review of the literature on Achieving Exclusive Breastfeeding (EBF): identified inequities and established the need for comprehensive, multi-level action, including social marketing.
5. Survey of WIC breastfeeding support activities by county. This reflected misdistribution associated with racial profile and disclosed inequity in WIC services associated with the racial/ethnic composition of the population served in past.
6. Qualitative research study on breastfeeding attitudes and values as they compare between white and African American church women: provided background on differences in information available to populations in popular media. Specifically, Black women tended not to be aware of breastfeeding advantages for women, only for infants, while White women were aware of this.
7. A community-based participatory research project – BEST for Babies Alliance – to increase breastfeeding rates among African-American women in Durham, NC: Formative research indicated that African Americans may disproportionately experience inadequate support for breastfeeding. This lack of support was reported in the home, the workplace, among peers, and from healthcare providers.
8. Support provided to UNC-G Center for Women’s Health and Wellness in an intervention study with low-income, predominantly African American and Hispanic adolescent mothers. Based on this, working group materials were designed for their needs and concerns, e.g., fear of physical discomfort, time constraints and lack of support, were pilot tested.
9. Ongoing work to increase equity includes hospital-based and child care center-based research in low wealth populations, and CBPR with the YWCA of Greensboro in support of their mandates in this area.
