Familismo and Social Determinants of Health: Critical components of Exclusive Breastfeeding Disparities in Hispanic mothers

Racial and ethnic variations in breastfeeding duration and exclusivity contribute to lifetime disparities in maternal and child health outcomes and costs. Compared with non-Hispanic white children, Hispanic children have an increased risk of excess diseases attributable to suboptimal breastfeeding. Hispanic mothers’ breastfeeding practices are impacted by various factors, including cultural norms, social support, and access to culturally congruent care. Most interventions targeting Hispanic women have effectively increased breastfeeding rates but have had only a modest impact on exclusivity. Our pilot study among immigrant Hispanic mothers produced promising evidence that a novel, tailored, culturally and linguistically appropriate intervention, entitled Cultural Early RISk-Reduction among Hispanics (ChERISH), was well accepted and engendered both initiation of EBF and longer duration of exclusivity after birth compared with usual care. However, this intervention did not specifically evaluate challenges to EBF that may be related to social determinants of health (SDOH), including Familismo among Hispanic mothers. These SDOH may include income, food insecurity, education, health care access, marginalization, discrimination, and literacy, which contribute to health inequities impacting Hispanics and affecting intervention efficacy. We are proposing a mixed-method approach to assess the interconnection of Familismo, ethnic identity, and other SDOH, and to evaluate whether these affect the intention of EBF and the infant feeding method at 1-month after birth. A clearer understanding of this context will be used to revise and improve the ChERISH intervention, which will retain the culturally and linguistically tailored aspects of the original intervention while also expanding the inclusivity by incorporating family-oriented aspects. This enhancement of the intervention will support women in their commitment to family while also helping them make changes to improve the initiation and duration of EBF. The new, improved intervention will be the basis of an RCT proposal that will be submitted to the National Institute on Minority Health and Health Disparity.