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      Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review

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          In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates?


          The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team’s expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies.


          We included 60 studies that had randomized ( n = 25), observational ( n = 24), quasi-experimental ( n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial ( n = 22), only Hispanic (n = 24), only Black ( n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level ( n = 6); community level (n=51), which included healthcare organizations ( n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ( n = 9), and community organizations/public health institutions ( n = 8); and  interpersonal level (n = 3).


          Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended  to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12939-021-01388-4.

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          Most cited references 111

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

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              GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

              This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.

                Author and article information

                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                6 March 2021
                6 March 2021
                : 20
                [1 ]GRID grid.414176.1, ISNI 0000 0000 9687 4255, Hispanic Health Council, ; 175 Main Street, Hartford, CT 06106 USA
                [2 ]GRID grid.47100.32, ISNI 0000000419368710, Yale School of Public Health, ; 135 College Street, New Haven, CT 06510 USA
                [3 ]GRID grid.47100.32, ISNI 0000000419368710, Harvey Cushing/John Hay Whitney Medical Library, Yale School of Public Health, ; New Haven, USA
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funded by: FundRef http://dx.doi.org/10.13039/100000867, Robert Wood Johnson Foundation;
                Award ID: N/A
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                Systematic Review
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                © The Author(s) 2021

                Health & Social care

                breastfeeding, ethnic/racial minorities, policy, socioecological model


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