(303) Exclusive breastfeeding by race/ethnicity before and after nurse engagement policies were implemented

To compare exclusive breastfeeding rates (EBR) before and after a series of nurse engagement policies were implemented and describe differences by race/ethnicity.

Study Design:

Retrospective cohort study of all patients delivered between 1/1/2019 and 6/30/2022, divided into 2 groups before (pre-implementation) or after (implementation) September 1, 2021.  A single interrupted time series analysis evaluated EBR before and after implementation and chi square tests were used to evaluate race/ethnicity differences in EBR. Line plots were created to examine post-implementation changes in EBR by race/ethnicity.

Results: There 16280 births between 2019 and June 2022 with complete data on admission date, race/ethnicity, and feeding type (13,108 patients in the pre-implementation time period, 3,172 admitted post-implementation). In both time periods, White patients had the highest EBR of any group (pre-implementation 64.2% versus 49.3%, 47.2%, 47.1%, 52.6% for Black, Asian, Hispanic, and Other, respectively [p < 0.001]: post-implementation 53.1% versus 39.0%, 34.7%, 40.9%, 44.0%, respectively [p < 0.001]). Interrupted time series analysis revealed EBR were decreasing by 0.3%/month (p = 0.02) before implementation. Post-implementation the EBR had a positive slope of 0.2%/month but this was not statistically significant (p = 0.70) (Figure 1). Line plots of post-implementation rates by race/ethnicity suggested the slopes for White and Asian patients appeared flat whereas the slopes for Black and Hispanic patients appeared to be upward-trending (Figure 2).

Conclusion:

Although the EBR was lower in the post-implementation period, interrupted time series analysis showed a pre-existing downward trend.  Implementation of the nurse engagement policies was associated with a halting of the downward trend and possibly a developing upward trend in Black and Hispanic patient groups. More work is needed to understand barriers to exclusive breastfeeding since this is an important national quality metric.