Abstract
Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI.
Highlights
Obesity prevention begins with breastfeeding [1] and infancy (0 to 3 years) is a critical period in obesity development [2]
Because Native Hawaiians and Pacific Islanders (NHPI) are often conflated with Asian Americans and other Pacific Islanders in national and state-level data, disparities among them are often unnoticed
When breastfeeding data are disaggregated by race and ethnicity, studies show that NHPI have lower breastfeeding initiation and exclusive breastfeeding (EBF) rates and have shorter breastfeeding duration than other populations [25,26,27]
Summary
Obesity prevention begins with breastfeeding [1] and infancy (0 to 3 years) is a critical period in obesity development [2]. When breastfeeding data are disaggregated by race and ethnicity, studies show that NHPI have lower breastfeeding initiation and EBF rates and have shorter breastfeeding duration than other populations [25,26,27]. This is concerning because NHPI populations experience higher rates of obesity and obesityrelated comorbidities and mortality than other populations, but improving breastfeeding practices can ameliorate obesityrelated issues [28,29,30,31,32,33,34]. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI
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