Perceptions of the Facilitators and Barriers of Breastfeeding Initiation: Increasing Initiation Through a Tailored, Multi-Level Intervention Approach for African-American Mothers and the Community

The rate of breastfeeding initiation among women in the U.S. is approximately 81.1%. While this rate falls below industrialized nations around the globe, U.S. breastfeeding initiation has continued to improve since 1972. Improvements in breastfeeding initiation rates, however, have not been achieved equally across all racial/ethnic groups. Rates of breastfeeding initiation among African-American mothers continue to be significantly lower than White and Hispanic mothers (66.3% vs. 84.3% and 83.0%), respectively. Breastmilk is identified as the optimal form of nutrition for infants during their first year of life. Despite the known benefits of breastmilk, critically low rates of breastfeeding initiation among African-American mothers have left African-American infants at highest risk for developing diseases and chronic health conditions. Decreases in mortality and morbidity may be realized within the African-American infant population if improvements could be made in breastfeeding initiation rates among African-American mothers. This reality of persistently low breastfeeding initiation rates among African-American mothers indicates the need for additional research and action. While some research has indicated that the state of breastfeeding initiation in African-American mothers is a result of prevalent factors such as socio-economic inequalities, education, and marital status, this only explains some of the African-American vs. White/Hispanic disparity. Quality research and program evaluation in the modifiable domains of cultural and social environment are essential to fully understanding breastfeeding initiation rates in African-American mothers. This dissertation will expand the level of knowledge and understanding concerning the barriers and facilitators influencing breastfeeding initiation among African-American mothers within the U.S. Using qualitative methodology, this research will facilitate steps toward addressing gaps in the research and translating breastfeeding initiation among this cultural group. This dissertation concludes with a causal loop diagram interpreting the relationships of multiple variables within the system influencing breastfeeding initiation and Plan for Change. The Plan for Change offers a four-pronged strategy designed to address the barriers experienced by African-American mothers on multiple levels. Ultimately, the goal of this Plan for Change and dissertation is to transform the state of breastfeeding for African-American mothers through normalizing breastfeeding, improving breastfeeding initiation rates, and increasing the number of women sustaining breastfeeding for years to come.Doctor of Public Healt