74 - Paths to Program Improvement: Identifying Disparities in Breastfeeding Initiation Among Nurse-Family Partnership Home Visiting Participants

Abstract Information:

Background: Nurse-Family Partnership (NFP) is one of the largest home visitation programs in the United States, serving roughly 55,000 first-time, low-income birthing capable people and their babies every year. Overall, 70% of NFP clients self-identify as BIPOC. While breastfeeding rates in the United States have been increasing over the last decade, racial and geographic disparities in breastfeeding persist. Given the population NFP works with, a topic of importance has been to identify disparities in breastfeeding initiation between clients of different racial identities and states of residence.

Study Question: What, if any, disparities in breastfeeding initiation exist between NFP clients of differing racial identities, and are these disparities minimized or amplified depending on a client’s state of residence?

Methods: NFP survey data was used to identify 65,435 clients who gave birth during the period of July 1, 2020, to June 30, 2023. Infant birth data collected by each client’s NFP nurse-home visitor was extracted from the NFP data warehouse and used to create a binary variable indicating if the client initiated breastfeeding for any length of time immediately after their child’s birth. Descriptive statistics indicated that in addition to accounting for the largest proportion of NFP clients (33.8%), Hispanic clients also had the second-highest rates of breastfeeding initiation during the study period (94.4%). For these reasons, Hispanic clients were used as the reference group for logistic regression comparing breastfeeding rates between racial groups. Logistic regressions were run at the national and state geographic levels, and an alpha of .05 was set for identifying statistical significance. Analysis limitations included small sample sizes for some states.

Results: Apart from Asian and Pacific Islander clients, all racial groups of NFP clients were significantly less likely to initiate breastfeeding than their Hispanic counterparts. Black NFP clients experienced the lowest rates of breastfeeding initiation among all racial groups (81.5%) and were 74% less likely to initiate breastfeeding than Hispanic NFP clients. When the model was run for individual states, Louisiana was shown to have some of the lowest overall breastfeeding initiation rates in the country (72.1%) and experienced the greatest disparities in breastfeeding by race; while 87.8% of Hispanic NFP clients in the state breastfed, 64.6% of Black clients breastfed, and were determined to be 75% less likely to initiate breastfeeding than their Hispanic counterparts. Conversely, NFP clients in Washington had some of the highest breastfeeding initiation rates (95.3%), and no racial groups significantly differed in likelihood of breastfeeding.

Conclusion: Almost every racial group of NFP clients is less likely to initiate breastfeeding than Hispanic NFP clients. This disparity appears most consistently among Black clients and is most pronounced in the state of Louisiana.

Public Health Implications: NFP clients of differing races and locations are facing the same systemic barriers and discrimination as the general US birthing population when it comes to breastfeeding. By identifying who is most affected and where they live, the NFP network can implement program improvement efforts that empower the clients experiencing the greatest barriers to initiate breastfeeding.