PC2019: A Community Needs Assessment of Socio-cultural Influencers of Breastfeeding Among Black Immigrants in Johnson County, Iowa

Purpose/Objectives: Breastfeeding initiation rates are high, but retention rates remain a problem nationwide. Disparities in breastfeeding duration are more pronounced among non-Hispanic blacks (a group that includes Black immigrants) as compared to majority white population. However, there is little known about the specific socio-cultural factors contributing to the low breastfeeding rates among the Black immigrant community in Johnson County, Iowa. The purpose of this community needs assessment was to explore factors influencing breastfeeding duration among Black immigrants in the county. The findings will inform the design of breastfeeding quality improvement interventions that address the unique socio-cultural needs of Black immigrants in the Johnson County area.

Design/Methods: A community advisory group of three community members were trained to assist with recruitment and administration of online surveys over the phone. Forty Black immigrant mothers with children 0 to 2 years were recruited from major community clinics and apartment buildings using flyers translated into four languages. Survey questions were aimed at identifying breastfeeding knowledge, attitudes and practices, access to lactation services, breast pump perceptions, and workplace support.

Results: A total of 37 participants completed online surveys. Participants immigrated from the Democratic Republic of Congo, Togo, and had lived in the United States for 3 to 11 years. Most were married, 14% had no health insurance while about 48% had completed a college diploma. Participant ages ranged from 27 to 40 years with an average of 3 children. 88% reported ever breastfeeding, about 22% reported that they were not able to breastfeed for as long as they had planned. Gaps in knowledge included breastfeeding benefits, need for supplemental formula, and the recommended breastfeeding duration. The top 5 reasons why mothers stopped breastfeeding included, having received formula from WIC, being sick and having to take medicine, baby was hungry too often, the baby was sick and could not breastfeed, and not producing enough milk. 80% of participants indicated that they received no assistance while breastfeeding, reasons for not receiving lactation assistance included not knowing how to get help (29%) or lack of insurance or perception that insurance would not pay for lactation services (22%). Doctors or other health professionals were the most (20%) perceived as wanting to stop breastfeeding, followed by mother (12%) and baby’s father (7%). 35% indicated that their employer was not supportive of breastfeeding. Most (80%) did not feel comfortable with using a breast pump at work.

Conclusion/Discussion: This community needs assessment identified factors potentially influencing breastfeeding practices in this Black immigrant community. Community focused interventions in the quality improvement project will be tailored to address gaps in knowledge of breastfeeding benefits and duration, accessing lactation services, use of breast pumps, disincentivizing formula receipt from WIC and leveraging the influence of interpersonal relationships on breastfeeding attitudes.