Wednesday, January 31, 2001

Nursing vs. bottles: Why are African American breastfeeding rates so low?

Nursing vs. bottles: Why are African American breastfeeding rates so low?
By Pamela Appea

Adina Gittens-Smith, a 30-year-old mother of two young boys, knew she wanted to breastfeed even before her children were born. “I read so many things and everything said breastfeeding was good,” said the Maryland school administrator.

Being a health-conscious vegetarian also played a part for Gittens-Smith. “I wanted to make the best nutritious selection for my child,” she says. And joining a local African-American breastfeeding group also helped Gittens-Smith get the information and support she needed.

But as a group, African-American mothers aren’t breastfeeding their babies as much, or for as long, as other mothers, according to a new report out from the federal Department of Health and Human Services. And experts like Dr. Yvonne Bronner of Morgan State University go as far to say the “culture of breastfeeding has been lost, especially in the low-income African-American community.”

Using data from a 1998 survey, “The Health and Human Services Blueprint for Action on Breastfeeding” report found only 45% of African-American mothers breastfeed their babies even for a brief period. Almost every other racial group surveyed reported higher breastfeeding rates.

The survey found 66% of Latina mothers and 68% of white mothers breastfeed their babies for at least a few weeks. About 54% of low-income Asian and Pacific Islander mothers breastfeed, along with 59% of Native American and Alaska native mothers, for a similar period.

“The time has come for us to work together to promote optimal breastfeeding practices,” says U.S. Surgeon General Dr. David Satcher, who oversaw the HHS report. Satcher found breastfeeding rates to be “alarmingly” low for African-American mothers.

While breastfeeding rates have increased over the last decade, the report also found only 29 percent of all mothers, and a mere 19 percent of black mothers, reported breastfeeding their babies six months after their birth.

The American Academy of Pediatrics recommends their mothers breastfeed their children for at least 12 months, with breastmilk as the only food for the first six months of life. In a policy statement released in 1997, the AAP described breastmilk as “uniquely superior for infant feeding,” and cited its effectiveness in decreasing the incidence and severity of diarrhea, respiratory infections, ear infections, allergies and other illnesses. In addition, the AAP argues that nursing is beneficial to mothers, helping ease postpartum bleeding, delay[s] resumption of ovulation and reduce[s] the risk of ovarian and premenopausal breast cancers. Not only that: the report estimates a savings of at least $400 annually for mothers who choose to nurse rather than formula feed their infants.

But some black mothers say they don’t have the luxury to breastfeed for six months. Marie Charles, a Brooklyn mother of one, said black women who work generally don’t have the time to breastfeed like wealthier white women.

Charles, who is nine months pregnant with her second child, breastfed her son for six weeks and plans to do the same for her second baby. But Charles adds her husband thinks she should go back to work as soon as possible. “It’s just easier for working women to use infant formula,” she says.

The pressure to return to work, especially in jobs that do not offer progressive maternity leave policies, is one reason for low breastfeeding rates. Another is the ubiquitousness of commercial baby formula (which is often given to new mothers when they leave the hospital after giving birth, and is included in the WIC nutrition program.) In addition, women are less likely to breastfeed without support from their partners and other significant people in their lives. Having a mother, grandmother, aunt and close friend who has breastfeed, or who supports breastfeeding, can improve the likelihood that a new mother will choose to nurse her baby.

Dr. Michal Young, M.D., director of the neonatal intensive care unit at D.C. General Hospital, says the rate of black women patients in the District who breastfeed was dismally low when she started her career in 1985. Today, breastfeeding rates there hover around 35%, up 30 percentage points from the 5% breastfeeding rates in the mid-eighties.

Black women who choose to nurse their children report satisfaction, but some frustrations.

“I breastfeed because it’s physically, mentally and emotionally healthier for baby than bottles,” said Martha Ajiwe, a 37-year-old Maryland mother of three who breastfed her first two children till they were nine months, and her third child until she was a year old.

“Physically, breastfed babies get sick less often and breast milk transfers immunity [temporarily] from mom to baby. Mentally, breastfed babies develop better intellectually. Emotionally, babies and moms bond during feeding.”

“Breastfeeding is not sexy,” Ajiwe jokes. I think mothers who are more mature choose to breastfeed because they have developed more understanding of [the] needs of [the] baby and are more willing to do whatever it takes to put [the] baby’s needs first.”

Denise White, a 29-year-old Virginia mother, says she made it a priority to breastfeed her three children even through work, school and other commitments took her time.

“I found it quite difficult to breastfeed and work at the same time,” says White, who works as an office manager for an adolescent substance abuse prevention organization, and is a part-time student.
“Black women, I think, are more afraid of the idea of breastfeeding than white women,” says White. “I think [it’s because of] the idea they would have to be there with the child a large majority of the time, because they are ‘the bottle,’ is what keeps them from doing it.

Nursing mothers who work in an office environment can express breastmilk to be given to their babies in a bottle by other caregivers, but many women work in environments that do not accommodate this.

The breastfeeding advocacy group La Leche’s classic book, The Womanly Art of Breastfeeding encourages women not only to nurse their babies, but to draw power and self-respect for being able to sustain their children, something White and others say can be a particularly hard concept for younger African-American mothers to grasp.

“I think younger moms and moms who were not breastfed themselves are less likely to breastfeed because they have difficulty perceiving their bodies as source of sustenance,” Ajiwe says.

Eugenia Hull, a Lanham, Maryland-area natural childbirth instructor, says she appreciates what groups like La Leche League have done. But, recognizing the need to give black mothers a culturally-sensitive space, she founded Adero, a black breastfeeding support group in the early ‘90s.

Other African-American women say La Leche League seems to cater mostly to upper-middle class white women, many of whom do not have to work. But Dr. Michal Young adds that while La Leche League groups in the United States may be homogenous, there is a significant racial shift at international conferences.

It’s ironic so few African-Americans breastfeed today, Young says. Infant formula made its debut in the United States in 1940, but black women largely due to poverty, were the last group to adopt its use in larger numbers.

Breastfeeding rates for African-American women look especially low when compared with patterns among black mothers outside the United States. In Africa, breastfeeding rates are extremely high, ranging from 75% to 100% across the continent. And many of these mothers nurse their children for at least a year, the period recommended by the AAP.

In a tragic paradox, healthy breastfeeding patterns that have persisted in Africa despite inroads by multinational formula manufacturers are now being reassessed in light of the dangers of AIDS. Women who are HIV-positive should not nurse their children, experts now caution, as the disease can be transmitted in breastmilk.

Charles, a Haiti native, says that while more Haitian women breastfeed, women who work in her home country who work outside the home face the same problems as American women: lack of time.
According to Dr. Young, however, low breastfeeding rates in the United States have less to do with the pressure to work than with lack of support of education.

Most mothers who quit nursing stop just seven to ten days after giving birth, Young says, largely due to not knowing how to breastfeed properly. A new mother’s milk does not come in, typically until three days after birth. Young says (before the milk arrives, a fluid called co lustrum is produced, which itself confers powerful benefits and is all the nutrition a newborn needs.) But the typical HMO’s 48-hour discharge policy for childbirth means many women go home without ever receiving adequate breastfeeding education. “We have to educate our providers,” Young says.

“Breastfeeding is not supposed to hurt,” says Melissa Clark Vickers, a lactation consultant and an accredited La Leche League Leader based in Tennessee, writing for the informational Website. “Pain is a red flag that something is not right—most often due to improper positioning,” she says. On the other hand, many experts point out that initial soreness and discomfort is normal and can be easily corrected by advice from a lactation consultant—or in communities in which breastfeeding is still common, from an experienced mother.

In our culture, Young says doctors and hospitals have to do their part in getting the word out. She admits that some negative attitudes women have towards breastfeeding can be traced towards to lack of encouragement and support among medical practitioners. “We have to take our licks too,” Young says. But Young believes insurance companies have a share in not giving women health insurance coverage at a critical point after birth.

There are other ways the larger society can help promote breastfeeding. Young points to legislation sponsored by Congresswoman Carolyn Maloney (D-NY) that supports the “civil rights” of women who want to breastfeed or express milk in the workplace during lunch breaks.

In a statement made last year at a breastfeeding promotion rally in the District of Columbia, Rep. Maloney described how several women have been kicked out of federal parks, federal museums, federal buildings and even the U.S. Capitol for doing “the most natural thing in the world— breastfeeding a child.” Many women blame the nature of American culture, which equates breasts only with sexuality, not with their nutritional and maternal function, for an attitude that discourages mothers from nursing their children (even discretely) in public places.

Another piece of Maloney-backed legislation, this one successfully enacted, requires states to use more of their WIC dollars on breastfeeding promotion and support, instead of just distributing free infant formula to low-income mothers. Young commends WIC for works to promote breastfeeding among low-income mothers, unlike in past decades.

Experts say public service campaigns educating African-American women and others about the merits of breastfeeding will be key in getting more women to breastfeed. The only way more women will start to breastfeed is if they make a conscious decision to not use infant formula, experts say.

“It’s a struggle,” Young says. “Breastfeeding is just not the norm in America. Before breastfeeding rates increase, cultural and social norms must change. We’ve got some ways to go.”

Originally published January 31, 2001