Maternity Care Practices and Breastfeeding Experiences of Women in Different Racial and Ethnic Groups: Pregnancy Risk Assessment and Monitoring System (PRAMS)

Research shows that maternity care practices are important to promoting breastfeeding in the early post partum period; however,
little is known about the association between maternity care practices and breastfeeding among different racial and ethnic
groups. We examined the association between maternity care practices and breastfeeding duration to ≥10 weeks overall and among
various racial and ethnic groups using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS). PRAMS is a state,
population-based surveillance system that collects information on maternal behaviors. We used maternity care practices data
from 11 states and New York City with response rates ≥70% from 2004 to 2006. Multiple maternity care practices were examined
and the analysis adjusted for demographic characteristics, participation in the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC), lifestyle, and infant variables. The outcome variable for multivariable analysis was breastfeeding
duration to <10 weeks or ≥10 weeks. PRAMS data show that 22.1% of women did not breastfeed, about 27.7% breastfed for <10 weeks
and 50.2% breastfed for ≥10 weeks. Breastfeeding patterns varied with white and Hispanic women reporting highest breastfeeding
initiation and duration prevalence. Overall, practices positively associated with ≥10 duration were: breastfeeding initiated
within the first hour after birth (adjusted OR [AOR] = 1.29; 95% CI: 1.16–1.45); fed breast milk only (AOR = 2.40; 95% CI:
2.15–2.68); breastfed on demand (AOR = 1.23; 95% CI 1.08–1.40) and receiving telephone support (AOR = 1.20; 95% CI: 1.03–1.39).
Maternity care practices associated with breastfeeding to ≥10 weeks varied across three racial/ethnic groups. One practice,
that of giving newborns breast milk only, was positively associated with breastfeeding duration of ≥10 weeks across all three
groups. Maternity care practices associated with breastfeeding continuation to ≥10 weeks varied by race/ethnicity. For example:
breastfeeding within the first hour, baby given a pacifier, and assistance from hospital staff, were significantly associated
with breastfeeding duration among black and white women and not Hispanics. The practice of breastfeeding on demand was significantly
associated with breastfeeding to ≥10 weeks for black and Hispanic women and not for whites. Hospitals may want to examine
the implementation of specific practices in relation to the cultural backgrounds of women to promote breastfeeding.