Mississippi CHAMPS addressed racial inequities in breastfeeding by implementing community and hospital-based practice changes in accordance with the BFHI and by parallel community work.


Race is an important predictor of breastfeeding prevalence in the United States, with rates being lowest among Black populations. The Communities and Hospitals Advancing Maternity Practices (CHAMPS) program works with hospitals and communities to implement the Baby-Friendly Hospital Initiative, increase breastfeeding rates, and decrease racial disparities in breastfeeding. The aims of Mississippi CHAMPS were to (1) increase breastfeeding initiation and exclusivity and (2) decrease racial disparities in breastfeeding by increasing the number of Baby-Friendly hospitals in the state from 2014 to 2020.


Mississippi hospitals enrolled into the CHAMPS initiative from 2014 to 2019 and received an intensive quality improvement and technical assistance intervention to implement the Baby-Friendly Hospital Initiative. Community partners and statewide organizations provided parallel support. Hospitals submitted monthly aggregate data stratified by race on breastfeeding (outcome measure), skin-to-skin care, and rooming-in practices (process measures).


Between 2014 and 2020, the number of Baby-Friendly hospitals in Mississippi rose from 0 to 22. Breastfeeding initiation in the hospitals increased from 56% to 66% (P < .05), and the disparity between Black and White dyads decreased by 17 percentage points, an average of 0.176 percentage points each month (95% confidence interval: −0.060 to −0.292). Exclusivity increased from 26% to 37% (P < .05). Skin-to-skin and rooming-in rates increased significantly for all dyads: 31% to 91% (P < .01) for skin-to-skin after vaginal birth, 20% to 86% (P < .01) for skin-to-skin after cesarean delivery, and 19% to 86% (P < .01) for rooming-in.


Over the course of the CHAMPS program, there were significant increases in breastfeeding initiation and exclusivity, and decreases in racial inequities in breastfeeding initiation.

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