One Step for a Hospital, Ten Steps for Women: African American Women’s Experiences in a Newly Accredited Baby-Friendly Hospital

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Despite strides made by the Baby-Friendly Hospital Initiative to improve and normalize breastfeeding, considerable racial inequality persists in breastfeeding rates. Few studies have explored African American women’s experience in a Baby-Friendly Hospital Initiative system to understand sources of this inequality.

Research aim:

This study aimed to explore African American women’s experiences of the Ten Steps to Successful Breastfeeding at a women’s center associated with a university-affiliated hospital that recently achieved Baby-Friendly status.


Twenty African American women who had received perinatal care at the women’s center and the hospital participated in qualitative interviews about their experiences. Data were organized using the framework method, a type of qualitative thematic analysis, and interpreted to find how African American women related to policies laid out by the Ten Steps to Successful Breastfeeding.


Three key themes emerged from the women’s interviews: (a) An appreciation of long-term relationships with medical professionals is evident at the women’s center; (b) considerable lactation problems exist postpartum, including lack of help from Baby-Friendly Hospital Initiative sources; and (c) mothers’ beliefs about infant autonomy may be at odds with the Ten Steps to Successful Breastfeeding.


Hospitals with Baby-Friendly status should consider models of breastfeeding support that favor long-term healthcare relationships across the perinatal period and develop culturally sensitive approaches that support breastfeeding beliefs and behaviors found in the African American community.

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