Is the association between Arabic, Somali, and Russian maternal origin and exclusive breastfeeding mediated by health service use and peer support?

Aims: To examine differences in maternal and child health service utilization between Somali-/Arabic-speaking, Russian-speaking, and Finnish-speaking mothers, and to explore whether health service use and breastfeeding peer support mediate the association between maternal origin and exclusive breastfeeding (EBF). Methods: We used data from the FinChildren 2020 survey. The analysis included 5348 mothers with infants aged 4–5 months: 78 Somali-/Arabic-speaking, 123 Russian-speaking, and 5147 Finnish-speaking mothers. Mediation analysis was used to examine the potential mediating role of health service use and breastfeeding peer support in the association between maternal origin and EBF. Results: Among the infants born to Somali-/Arabic-speaking mothers, 23% had not attended routine child health clinic visits, compared with 1.7% of Russian-speaking and 0.4% of Finnish-speaking mothers ( p < 0.005). Somali-/Arabic-speaking mothers were less likely to be offered postpartum nurse home visits (50% vs. 62% and 72%, respectively; p < 0.005) and to report adequate breastfeeding peer support (50% vs. 57% and 69%, respectively; p < 0.005). In unadjusted mediation analyses, breastfeeding peer support and the offer of a postpartum nurse home visit showed the largest indirect effects (−0.013 and 0.002, respectively). Using child health clinic services showed small effects. After adjustment for potential confounding factors, all indirect effects were attenuated and no longer statistically significant. Conclusions: Somali-/Arabic-speaking mothers experienced disparities in health service use and breastfeeding support. Although these differences partly accounted for the association between maternal origin and EBF, this was no longer observed after adjustment. Further research is needed to identify mechanisms underlying these disparities and to identify ways to promote equitable access to these services and support.