Impact of Breastfeeding Interventions Among United States Minority Women on Breastfeeding Outcomes: a Systematic Review




Sofia Segura-Pérez, Amber Hromi-Fiedler, Misikir Adnew, Kate Nyhan, and Rafael Pérez-Escamilla

Brief Type

Journal Publication


  • Other Models
  • Parents as Teachers (PAT)


Background: In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates? Methods: The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team’s expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies. Results: We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3). Conclusions: Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes. (author abstract)

Data Collection Methods



For More Information

Segura-Pérez, S., Hromi-Fiedler, A., Adnew, M., Nyhan, K., & Pérez-Escamilla, R. (2021). Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review. International journal for equity in health20(1), 1-25. https://doi.org/10.1186/s12939-021-01388-4
Author Contact Information:
Sofia Segura-Pérez


  • Participant Characteristics
  • Program Enhancements, Innovations, and Promising Approaches