Black Mothers, Exclusive Breastfeeding, and Nursing Care

Abstract Purpose: Given persistent racial disparities, we examined whether exclusive breastmilk feeding rates are lower in hospitals with more Black women giving birth and whether nursing resources moderate racial disparities therein. Design and Methods: This cross-sectional study used 2016 survey data from RNs in 256 hospitals linked to hospital-level data in California, Florida, and New Jersey. Multivariable regression modeling examined the relationship between the percentage of Black women giving birth at a hospital and the Joint Commission’s exclusive breastfeeding rates. Models adjusted for nurse staffing, nurse work environment, Medicaid coverage, and Baby-Friendly Hospital designation. Interaction terms tested whether nursing resources moderated racial disparities in exclusive breastmilk feeding. Although the data were collected nearly a decade ago, persistent disparities support their continued relevance to today’s health care trends. Results: A 10-percentage point increase in the Black women giving birth at a hospital was associated with a 5.1-percentage point decrease in breastfeeding rates. Hospitals with top-quartile nurse work environments had 9 percentage points higher breastfeeding rates. Each additional patient per nurse was associated with a 2 percentage point decrease. No significant interaction was found between the racial composition of women giving birth and nursing resources. Baby-Friendly designation was not a significant covariate. Clinical Implications: Exclusive breastfeeding rates are lower in hospitals serving more Black women.