Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA
Celebrating successes and overcoming barriers
Back in 2013, the Centers for Disease Control and Prevention (CDC) indicated a favorable trend in an increasing breastfeeding rate in African-American women that narrowed the gap in the infant mortality rate. It noted:
“From 2000 to 2008, breastfeeding initiation increased … from 47.4% to 58.9% among blacks. Breastfeeding duration at 6 months increased from … 16.9% to 30.1% among blacks. Breastfeeding duration at 12 months increased from … 6.3% to 12.5% among blacks.”
Much of this wonderful increase in breastfeeding rates among African-Americans has come from efforts within that community.
We can celebrate the successes. But there is more to do. Although the rates of infant mortality have dropped, African-Americans babies are still twice as likely to die. Although rates of breastfeeding have increased among African-Americans, they are still lower than they are for other ethnic groups.
Breastfeeding initiation and duration prevalences for each year between 2000–2008 were significantly lower among black infants compared with white and Hispanic infants. However, the gap between black and white breastfeeding initiation narrowed from 24.4 percentage points in 2000 to 16.3 percentage points in 2008.
A systematic review in 2015 found that the research underscores the need for culturally appropriate breastfeeding promotion strategies for African-American women, describing breastfeeding disparity as an important public health challenge, and encourages further work to overcome this challenge.
The review highlights:
“the importance of addressing excess stress, lack of support, and discrimination as factors that may underlie disparate breastfeeding outcomes … Additional research should target the development of culturally appropriate interventions that mirror the psychological, social, cultural, and societal needs of African American mothers to effectively engage them in the growing breastfeeding community through all levels of the social ecological system.”
Barriers to overcome
In order to continue this wonderful upward trend in breastfeeding rates, we need to acknowledge possible barriers to breastfeeding among African-American women. Here are a couple I’ve observed. They are not the only ones, that’s for sure. But these are the ones I’ve consistently encountered. There will not be quick fixes but they can be overcome, if we recognize them and take appropriate action.
Pathways into professions
In Birth Ambassadors: The Re-Emergence of Woman-Supported Childbirth in America, Christine Morton and Elayne Clift highlight a problem for doulas that also has relevance for International Board Certified Lactation Consultants (IBCLCs): most doulas (and IBCLCs) are white, middle-class women. And the reason? This is the only demographic that can afford to train and work in these professions. The low pay and lack of entry for non nurse-IBCLCs restrict job opportunities in this profession for women who do not have additional sources of income. As we limit tracks for peer counselors into the IBCLC profession, we also limit the opportunities for women of color to join our field. Recently, I met a young African-American who told me that she would love to become an IBCLC, but she couldn’t get the contact hours required to sit for the exam. That’s a shame. (I did refer her to someone I knew could help.)
We need to dialogue about how we can bring along the next generation of IBCLCs. We need to recognize the structural barriers that make it difficult for young women of color to enter our field. And these discussions can start within the profession. Sherry L. Payne, in a webinar, Welcoming African American Women into Your Practice, recommends that professionals who work in communities of color find their replacement from the communities they serve. Even if you only mentor one woman to become an IBCLC, you can have a tremendous impact in your community. If we all do the same, we can change the face of our field.
Hear an interview with Sherry L. Payne on Fighting Breastfeeding Disparities with Support.
Bedsharing and breastfeeding
This is an issue that is becoming more heated. But it is a reality. As we encourage more women to breastfeed, a higher percentage of them will bedshare. As recent studies have repeatedly found, bedsharing increases breastfeeding duration. This is particularly true for exclusive breastfeeding.
Bedsharing is a particular concern when we are talking about breastfeeding in the African-American community. Of all ethnic groups studied, bedsharing is most common among African-Americans. It is unrealistic to think that we are going to simultaneously increase breastfeeding rates while decreasing bedsharing rates in this community. The likely scenario in that instance would be for breastfeeding to falter. It’s interesting that another recent CDC report, Public Health Approaches to Reducing U.S. Infant Mortality, talks quite a bit about safe-sleep messages decreasing infant mortality, yet barely mentions breastfeeding. A more constructive approach might be to talk about how to bedshare safely. As long as the message is “never bedshare,” there is likely to be little progress, and such a blanket restriction could potentially act as a barrier to breastfeeding.
Reason for hope
Even with these barriers, and others I haven’t listed, Baby-Friendly hospitals are having a positive effect. When hospitals have Baby-Friendly policies in place, racial disparities in breastfeeding rates seem to disappear. For example, a study of 32 U.S. Baby-Friendly hospitals revealed breastfeeding initiation rates of 83.8% compared to the national average of 69.5%. In-hospital exclusive breastfeeding rates were 78.4% compared with a national rate of 46.3%. Rates were similar even for hospitals with high proportions of black or low-income patients (Merewood, Mehta, Chamberlain, Phillipp, & Bauchner, 2005). This is a very hopeful sign, especially as more hospitals in the U.S. go Baby-Friendly.
We have made significant strides in reducing the high rates of infant mortality, particularly among African-Americans. I am encouraged by people’s interest in this topic and the number of different groups working towards this goal. Let’s keep up the good work. I think we are reaching critical mass. Thanks for impacting your community—one mother at a time.
Johnson, A., Kirk, R., Rosenblum, K. L., & Muzik, M. (2015). Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions. Breastfeeding Medicine, 10(1), 45–62. doi:10.1089/bfm.2014.0023
Merewood, A., Mehta, S. D., Chamberlain, L. B., Phillipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in U.S. Baby-Friendly hospitals: Results of a national survey. Pediatrics, 116(3), 628–634. doi:10.1542/peds.2004-1636
Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA