Breastfeeding Patterns in a Community of Native Hawaiian Mothers Participating in WIC

Abstract

Although Hawaii has high breastfeeding initiation rates (89%), Native Hawaiian WIC* participants have much lower initiation (64%) rates. Little is known about why these disparities occur. The study's aim was to describe the breastfeeding patterns of Hawaiian/part-Hawaiian women enrolled in the WIC who had initiated breastfeeding. Retrospective descriptive data (N = 200) were gathered from WIC records. Descriptive and parametric statistics with univariate and multivariate analysis of breastfeeding patterns were completed. Mothers exclusively breastfeeding at initiation weaned significantly later and were significantly more likely to breastfeed for 6 months than were mothers who partially breastfed. Practice and policy implications of these findings are discussed. Keywordsbreastfeeding; Native Hawaiian; Women; Infants and Children Supplemental Nutrition Program INCREASING breastfeeding initiation, exclusivity, and duration rates is a priority preventive health behavior and also a national public health goal. 1 The many infant health benefits of breastfeeding (eg, reduction in respiratory, gastrointestinal, and allergic conditions, childhood cancers, type I and type II diabetes later in life) are dose dependent; thus, infants exclusively breastfed for longer periods of time receive greater benefits. 2 Because of these increased benefits, the American Academy of Pediatrics 2 has recommended exclusive breastfeeding for the first 6 months and continued breastfeeding with the introduction of solid foods during the second 6 months of life. Improving children's health both in infency and in later life is possible by increasing the dose (exclusivity and duration) of breast milk during the first 6 months of life. Receiving appropriate and timely breastfeeding services has been shown to improve exclusivity and duration. 1 "Ensuring that breastfeeding mothers have access to comprehensive, up-to-date, and culturally tailored lactation services provided by trained physicians, nurses, lactation consultants and dietitians" (p19) is one of the recommendations made within the DHHS Blueprint for Action on Breastfeeding ,1 the document setting the national agenda concerning breastfeeding. Some interpretation of who might be underserved may be projected from the maternal characteristics and breastfeeding rates collected in existing national and state databases; however, it is not a The breastfeeding initiation rate in Hawaii (89.6%) is higher than the national average (70%) and exceeds the 2010 Healthy People (2000) goals (≥75%). 2,6 Researchers have found that breastfeeding initiation for women of Hawaiian ancestry (64.0%) is well below state and national rates. 7 Healthy People 20108 sets a goal of 50% of mothers continuing to breastfeed at least 6 months; however, national rates (33%) are well below this target. 2 In Hawaii again this rate is higher than national rates, except for Native Hawaiian and other Pacific Islander women. Many factors may influence the decreased rates (eg, increased teen pregnancies, higher rates o...

Health Care and Social Service Providers' Descriptions of Pacific Islander Mothers' Breastfeeding Patterns

“…Despite recommendations and numerous health care benefits attributed to breastfeeding, 5 rates of breastfeeding remain low, particularly within low‐income and some ethnic populations. In Hawaí, the breastfeeding initiation rate is higher (89.6%) than the national average (70.0%), except within Native Hawaiian and Pacific Islander (46.5%) populations 6,7 . Similarly low rates are also found in other US at‐risk populations and have been associated with teen pregnancy, drug abuse, and poverty 6 …”

“…In the past, children grew up seeing mothers and family members breastfeeding and had the benefit of family and community support. Currently many extended families are fragmented; if mothers and grandmothers are available, they may not have breastfed 6,8 . The provision of ongoing support has been shown to increase the proportion of women who continue to breastfeed for up to 6 months 11 .…”

Breastfeeding Discontinuation Not Associated with Maternal Pregravid BMI But Associated with Native Hawaiian or Other Pacific Islander Race in Hawaii and Puerto Rico WIC Participants

“…However, the number of NHOPI women was very small (n = 15) and the wide confidence interval suggests that a larger sample size may be needed to produce a more precise estimate of effect. Other studies have reported lower rates for breastfeeding discontinuation in NHOPI women in Hawaii (Dodgson et al 2007), although, in comparison to other races, the percentages of NHOPI women who discontinued breastfeeding were higher. A small study of postpartum Native Hawaiian women in Hawaii enrolled in WIC during 2003–2005 reported that 48% of the women discontinued breastfeeding before 6 months postpartum (Dodgson et al 2007).…”

“…Other studies have reported lower rates for breastfeeding discontinuation in NHOPI women in Hawaii (Dodgson et al 2007), although, in comparison to other races, the percentages of NHOPI women who discontinued breastfeeding were higher. A small study of postpartum Native Hawaiian women in Hawaii enrolled in WIC during 2003–2005 reported that 48% of the women discontinued breastfeeding before 6 months postpartum (Dodgson et al 2007). According to the 2014 PRAMS, 28% of low-income NHOPI women in Hawaii who initiated breastfeeding discontinued breastfeeding before 8 weeks postpartum (“Hawaii IBIS Query Builder Hawaii’s Pregnancy Risk Assessment Monitoring System Data,” n.d.).…”

“…In Puerto Rico, the breastfeeding rate at 6 months is low at 38.1%, which is about 17% lower than the national average (Centers for Disease Control and Prevention 2017). In Hawaii, although the rate of breastfeeding at 6 months was 62.9% in 2014 (Centers for Disease Control and Prevention 2017), it was previously reported that Native Hawaiian participants in Hawaii’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) had much lower rates of breastfeeding at 6 months postpartum, at 52% among initiators (Dodgson et al 2007). …”