Reducing Disparities in Breastfeeding: "Breast for Success" Excels a Second Time.

Breastfeeding is a key public health priority with known racial inequities. Despite the well-described and far-reaching health benefits of breastfeeding for mothers and infants, rates of breastfeeding initiation, continuation, and exclusivity lag meaningfully among African American and Black (AA/B) women compared with other racial and ethnic groups due in main to current and historical structural racism. The study objective was to assess the replicability of Breast for Success (BFS) on breastfeeding rates among home-visited low-income predominantly AA/B mothers. The BFS Excels a Second Time (BEST) trial was an observational study conducted at the Neighborhood Health Association, Toledo, OH, enrolling expectant women (June 2022-March 2023, followed to October 2023) participating in the Moms and Babies First (MBF) Community Health Worker (CHW)-led home visiting program. The exposure, BFS, includes 11 CHW-delivered breastfeeding-supportive modules, breastfeeding supplies, and a postnatal lactation visit. All MBF mothers received BFS; those who agreed to data sharing were BEST participants. The outcomes were breastfeeding initiation, and breastfeeding continuation, and exclusivity at 1 month. The majority of participants were AA/B (48, 83%), had an income <200% poverty level (55, 95%), and were unmarried (57, 98%); mean age was 25.8 years (SD 5.5). Of the 58 participants, 57 (98%) initiated breastfeeding and continued breastfeeding at 1 month postpartum; 53 (91%) were exclusively breastfeeding at 1 month postpartum. BFS piggybacks seamlessly onto CHW-led home-visiting curricula and increased breastfeeding rates among women at high risk for not breastfeeding. Public health programs can add BFS to fill a critical curricular and impact gap with respect to breastfeeding support.