PRAMS data by Racial/ethnic identity Effective Practices PRAMS data by Racial/ethnic identity Rachel A. Sebastian, MA Medical Sociologist Child Policy Research Consulting, LLC

Maternity Care Practices PRAMS Questions about Maternity Care Practices Hospital staff gave me information about breastfeeding. My baby stayed in the same room with me at the hospital. I breastfed my baby at the hospital. I breastfed in the first hour after my baby was born. Hospital staff helped me learn how to breastfeed. My baby was fed only breast milk at the hospital. Hospital staff told me to breastfeed whenever my baby wanted. The hospital gave me a breast pump to use. The hospital gave me a gift pack with formula. The hospital gave me a telephone number to call for help with breastfeeding. My baby used a pacifier at the hospital.

Characteristics of Respondents, PRAMS 2012-2013 Maternal Race/Ethnicity/Acculturation English-Speaking Hispanic 40.4% Spanish-Speaking Hispanic 7.7% Non-Hispanic Native American 14.1% Non-Hispanic White 27.3% Collected 2012-2013 Total of 4,035 women Maternal Age < 20 years 12.1% 20 – 29 years 56.7% 30+ years 31.3% Maternal Education Less than HS Diploma or GED 19.1% HS Diploma or GED 26.8% Any Post-Secondary Education 54.1%

% Breastfed at least 2 months Breastfeeding Duration by Race, Ethnicity, & Acculturation, PRAMS 2012 - 2013 Percent of Women who Breastfed for at Least 2 Months, Phase 7 Only % Breastfed at least 2 months 1 2 Sig. Race/Ethnicity   White, non-Hispanic1 vs Non-White2 73.2% 60.8% 0.000 Hispanic1 vs Non-Hispanic2 59.4% 68.7% Native American1 vs Non-Native American2 64.7% 64.1% 0.254 Language English1 vs Spanish2 70.3% 63.6% Acculturation English-Speaking Hispanic1 vs Spanish-Speaking Hispanic2 57.4% 70.0%

Maternity Care Practices Associated with an Increased Likelihood of Breastfeeding for At Least Two Months English-Speaking Hispanic Women 1. Breastfed at the hospital. 2. Baby only had breast milk at hospital. 3. Staff encouraged on-demand breastfeeding. Spanish-Speaking Hispanic Women 1. Staff encouraged on-demand breastfeeding. 2. Baby only had breast milk at the hospital. 3. Hospital provided information on breastfeeding. Non-Hispanic Native American Women 1. Staff encouraged on-demand breastfeeding. 2. Breastfed at the hospital. 3. Hospital provided phone number for breastfeeding support. Non-Hispanic White Women 1. Breastfed at the hospital. 2. Baby only had breast milk at hospital. 3. Breastfed within the first hour of birth.

Data  Practice Some maternity care practices are universally helpful: Breastfeeding at the hospital; Feeding only breast milk at the hospital; Staff encouraging on-demand breastfeeding. We need a better understanding of how maternity care practices are impacting all populations of patients: Is the hospital providing information that is culturally sensitive, appropriate, and relevant? How do hospital practices interact with cultural practices associated with breastfeeding? Are they consistent or conflicting? Are there linkages between all populations of women and existing resources? We need qualitative data to better understand women’s experiences in the hospital and how these experiences influence breastfeeding duration and exclusivity. What does this mean for improving maternity care practices in hospitals and reducing breastfeeding disparities?

Effect of Maternity Care Practices on Likelihood of Breastfeeding for at Least Two Months by Race, Ethnicity, & Acculturation Non-Hispanic White Non-Hispanic Native American Spanish-Speaking Hispanic English-Speaking Hispanic Breastfed at hospital (1) (2) Breastfed w/in first hour (3) Only breast milk Same room Used a pacifier at the hospital Gave gift pack with formula Provided pump Provided information Helped learn On demand Phone number

Effect of Maternity Care Practices on Likelihood of Breastfeeding for at Least Two Months by Race, Ethnicity, & Acculturation Non-Hispanic White Non-Hispanic Native American Spanish-Speaking Hispanic English-Speaking Hispanic Breastfed at hospital 2.304 0.000 2.166 1.804 0.003 2.030 Breastfed w/in first hour 1.806 0.445 0.564 1.049 0.244 Only breast milk 1.855 1.443 4.834 1.548 Same room 1.211 0.063 1.054 0.708 1.574 0.148 0.814 Used a pacifier at the hospital 0.601 1.723 0.717 0.002 0.674 Gave gift pack with formula 0.555 0.417 1.391 0.800 Provided pump 1.553 0.904 0.084 0.848 Provided information 0.625 0.821 0.254 2.543 0.684 Helped learn 0.759 0.499 0.259 0.599 On demand encouraged 1.173 0.016 2.180 6.508 1.446 Phone number 1.453 1.842 0.641 1.430