While breastfeeding rates among low-income women are rising (39% (1992) to 59% (2002)) they remain well below the average US rate (70%). Significant barriers remain despite HHS's national breastfeeding strategy and CDC program recommendations to eliminate economic, ethnic, and education-based disparities in breastfeeding initiation and duration. A woman's infant feeding decision is a complex product of personal, family, health care provider, community, and societal influences. These influences, particularly for low- income women, are inconsistent and often competing. Societal messages about female sexuality, community norms about infant feeding, commercial promotion of breastfeeding substitutes, friends'and families'stories about breastfeeding all interact (and potentially conflict) with advice from health care professionals and breastfeeding promotion programs. Health care providers themselves are susceptible to the social and institutional environment and societal norms that affect both what message they chose to deliver and how they deliver it. Breastfeeding promotion programs are often generic - designed absent input from the target population, they may be culturally inappropriate and therefore ineffective. If efforts to improve breastfeeding initiation and duration are to succeed, they must address the interrelation of personal and community influences on breastfeeding patterns. Effectively addressing these interrelationships, while beyond the scope of a single program, is well suited for interventions designed and evaluated through a community based participatory research approach. To increase BF initiation, duration, and exclusivity among minority and low-income women this project will use an ecological approach to: 1) Establish the Community Partnership for Breastfeeding that will include health and human service providers, researchers, and members/leaders from the local community (representing low income neighborhoods, childbearing women, ethnic minorities). The CPB will: a) promote participation in research and interventions among minority and low income women;b) guide intervention design;c) evaluate intervention deployment;and d) interpret findings. 2) Conduct additional formative research (qualitative and quantitative) to understand the common and conflicting provider and community influences on breastfeeding among minority and low-income women. 3) Develop and deploy interventions targeted at both providers and consumers under the guidance of the CPB and based on the formative research findings. 4) Expand the community's system of BF support through an interagency referral system and enhanced peer counseling resources and through efforts to gain """"""""Baby Friendly Hospital"""""""" designation for all local hospitals. 5) Analyze changes in breastfeeding attitudes, experience with breastfeeding promotion and support and breastfeeding outcomes through conducting surveillance across the entire community.
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