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Dr. Nathan Nickel, assistant professor, community health sciences and a research scientist at the Manitoba Centre for Health Policy.

Study reduces racial inequities in breastfeeding rates

February 5, 2019 — 

Lessons learned from a study that reduced racial inequities in breastfeeding rates in the southern United States can be applied in Canada, according to a University of Manitoba researcher involved in the study.

Dr. Nathan Nickel, assistant professor, community health sciences and a research scientist at the Manitoba Centre for Health Policy, is the methodologist for a study that closed the gap on breastfeeding rates between African American and white families, and Hispanic and white families.

Between 2014 and 2017, 33 hospitals located in Mississippi, Louisiana, Tennessee and Texas took part in the Communities and Hospitals Advancing Maternity Practices (CHAMPS) program out of Boston Medical Center’s Center for Health Equity, Education and Research.

“I was shocked that we reduced inequities,” Nickel said. “I really was, because we haven’t seen that [in the past].”

Over three years, breastfeeding initiation at the participating hospitals rose from 66 per cent to 75 per cent, and among African Americans, it rose from 43 per cent to 63 per cent. The gap between white and black breastfeeding rates decreased by 9.6 per cent.

 “In the South, the history of slavery and racism really, really impacts the quality of care that black families receive from the hospitals and from the health-care providers,” Nickel said.

When the study began, researchers saw significant inequities in how black families were treated by hospital staff compared to white families, he said. African American infants were not given skin-to-skin contact with their mothers after birth, and infants were separated and placed in nurseries, unlike white newborns. The study found that African American mothers wanted to breastfeed, but the hospitals’ practices became barriers to breastfeeding.

Nickel said hospital staff had preconceived ideas that black and Hispanic mothers didn’t want to breastfeed. A significant component of the project was helping hospital staff overcome these ideas about whether African American and Hispanic families wanted to breastfeed.

Another component of the study was introducing the World Health Organization and UNICEF’s Baby-friendly Hospital Initiative and its 10 Steps to Successful Breastfeeding, which recommends immediate skin-to-skin contact after birth, and keeping mothers and babies together in the same room. The 10 Steps are about removing barriers to breastfeeding for moms that want to breastfeed, and providing optimum care, he said.

Nickel would like to see changes in Canada as well based on the study’s results.

“We need to decolonize the health-care system,” he said. “The States has its horrible legacy of slavery, as well as how it treated First Nations people. In Canada, we have the history of institutional racism and historical trauma which impact health and well-being, including breastfeeding.”

Nickel said the language and rhetoric is similar in Canada and can turn to blaming families rather than looking at underlying social and systemic determinants of health.

“Many of the steps that are part of Baby Friendly are just returning to traditional practices for First Nations, Inuit, and Métis people. I think it can be part of decolonizing our health-care system,” he said. “The lessons we learned in the States may help improve maternity care here in Canada.”

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