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There are demographic, socioeconomic, and geographic factors associated with poor birth outcomes that intersect with race and ethnicity in complex ways. Places where people face heightened socioeconomic disadvantage are more likely to have poor birth outcomes. The state of Mississippi has the nation’s highest rate of poverty with particularly high rates of inequality in health outcomes between racial groups, especially in areas of maternal and child health. The Delta region of the state is especially vulnerable and has had some of the highest rates of premature births, low and very low birthweight births, due in part to the unique magnitude of the social and economic conditions seen in the region. Breastfeeding is particularly important for preterm and low weight babies, yet many women face challenges in attempting to breastfeed. Breastfeeding success is associated with a number of determinants, such as self-efficacy, intention to breastfeed, and attitudes toward breastfeeding. Support and information are needed from multiple domains to lessen barriers and help women breastfeed for the recommended duration. As such, there is a need to understand the association that different sources of information and support have with establishing sustainable breastfeeding practices.
Methods
Between 2017 and 2019, 72 interviews were conducted with mothers in the Mississippi Delta Region. Mothers were recruited and interviewed at Community Health Centers (CHCs) who were seeking care and who had given birth within the previous 36 months. Interviews were performed by 2 community health workers and 2 social workers. Questions focused on experience with prenatal care, birth, and breastfeeding and were accompanied by a demographic questionnaire.
Findings
The majority of the mothers (94%) were African American with an average age of 28 years and tended to be single (84%). They were primarily unemployed with low household incomes (84% less than $20,000 in the past year). The babies averaged nearly 31 weeks of gestation, ranging from 23 to 37 weeks, and an average birthweight of 1,476 grams (ranging from 510 grams to 2,520 grams). The interviews uncovered important issues needing further exploration. Mothers who received breastfeeding education, saw advertisements for breastfeeding, and/or had a support network receptive to breastfeeding reported a better understanding of its benefits and were more likely to breastfeed their newborns. Mothers were aware of an array of resources and services available to them and attempted to use them when possible, identifying the Women, Infants, and Children Nutrition Program (WIC), Supplemental Nutrition Assistance Program (SNAP), and Medicaid as examples. Respondents indicated beliefs that focused breastfeeding initiatives could help increase awareness and normalize the idea of encouraging and supporting mothers to breastfeed as they reported some negative social perceptions.
Implications
When in need of services, mothers may go to a range of different providers. In doing so, there are several factors involved, including proximity, insurance, and level of care. Therefore, efforts like hospital-CHC networks should coordinate across organizations. Further, efforts must include increased outreach to urban providers in order to enhance their familiarity with resources and services available in rural communities.