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Legislation on breast feeding: how does it affect Black women?

By Dr. Tyeese L. Gaines

This past July, the last two states – Idaho and Utah – passed legislation finally making public breastfeeding legal in all 50 states. But, with breastfeeding in public such a highly-debated topic, and Black infants dying at higher rates than any other ethnic group, what implications does this move have for Black women in America?

“We’re all mothers trying to do what’s best for our children,” says Ta’Veca Collins, 36, an African-American mom in Fort Lauderdale, Fla. with two children. “We shouldn’t have to constantly justify our decision to breastfeed or feel uncomfortable about nursing in public. I often would plan to not be in public to avoid the crazy looks or unsolicited advice.”

Collins hopes that the new legislation will help mothers become more confident and not feel ashamed to breastfeed in public.

“I struggled with this during my journey,” she recalls. “Breasts are so hypersexualized that I was so afraid to ever be caught without a nursing cover.”

This new legislation is even more important for African-American moms, says Tangela Walker-Craft, 48, of Lakeland, Fla. who breastfed her daughter until the age of two.

“It makes the decision to breastfeed easier for moms,” says Walker-Craft, who also created and patented the Kushies GoPillow, which she says aids with breastfeeding in public. “African-American moms and everyone else will see breastfeeding as a common practice, not something that’s taboo, or that needs to be hidden.”

Dr. Tyree M.S. Winters, a practicing pediatrician and associate program director of the Pediatric Residency Program at Goryeb Children’s Hospital in New Jersey applauds the legislation as well.

“Eliminating the stigma associated with public breastfeeding can help mothers feel supported and encourage more breastfeeding,” Winters says.

Black women breastfeed their children less often

It is well-known that black women have the lowest breastfeeding rates in the United States of any ethnic group. Only 69 percent of non-Hispanic black mothers have ever breastfed, according to the CDC’s latest statistics. That’s significantly less than the 89 percent of Asian mothers, 86 percent of non-Hispanic white mothers, and 85 percent of Hispanic mothers who do.

This gap persists regardless of income and educational attainment.

“We’re underrepresented when it comes to breastfeeding. I was told so many times that I was doing white people s–t by breastfeeding and that I needed to just go ahead and feed my baby formula,” Collins says. “Since when is feeding your child, in the way that a woman’s body was designed to do, based upon race?”

Generational perceptions of breastfeeding and support of other women has proven to play a role in breastfeeding rates among black mothers.

“I didn’t have any other black moms that gave me advice, because most of my family and friends decided that breastfeeding wasn’t for them,” Collins explains. “I think black women have been conditioned to believe that breastfeeding is too difficult and restrictive on our lives.”

African-Americans have an uncomfortable past with regards to breastfeeding. In slavery days, black women served as “wet nurses,” breastfeeding not only their own children, but the slave owners’ children as well. This practice often continued even after slavery ended. In some instances, black women were forced to feed only the slave owners’ babies, while denying that benefit to their own offspring. In other instances, slave owners would stop black women from breastfeeding early because it reduced fertility and her ability to continue to breed. Thus, some black women feel conflicted regarding the practice of breastfeeding, and have passed this on to subsequent generations.

In the 1930s, due to successful advertising campaigns, baby formula became associated with sophistication, compelling many mothers – not just black mothers – to prefer formula over breast milk. However, as the information about the benefits of breastfeeding were reintroduced to the public in later years, the news made it to higher-educated, white communities first.

Walker-Craft was the first person in her family to practice “extended breastfeeding” since the introduction of baby formula. And she is a rarity: the number of black mothers breastfeeding at the 6-month mark drops to 45 percent, and drops to 24 percent at the 1-year mark.

“I experienced lots of questions,” Walker-Craft says. While her family and friends were supportive, she also received criticism.

“Unwanted advice came from people who had never breastfed,” she recalls. “People tried to scare me into weaning my daughter by telling me that if I breastfed for too long it would be more difficult to wean her. They told me things like she was going to start biting my breast when her teeth came in. That never happened.”

Benefits of breast milk

“Breastfeeding is important for the health of babies, and creates a lasting bond between the mother and child,” Winters explains. “Breast milk is like medicine for your baby. The milk contains so many healthy nutrients and supports your child’s immune system.” Breastfeeding can also reduce stress-related illnesses in both mom and baby, he adds.

Breastfed infants have lower rates of asthma, obesity, diabetes and sudden infant death syndrome (or SIDS) – all conditions that affect black infants more often. Breastfeeding has been associated with fewer respiratory infections in children ages 4 and under. Exclusive breastfeeding has also been shown to decrease the number of allergic diseases in children. The longer the duration of breastfeeding, typically greater than six months, the better the health benefits.

Recent statistics continue to show that black babies die 2.3 times more than non-Hispanic white babies. The World Health Organization advocates for breastfeeding as a means of decreasing child mortality. Other studies suggest that breastfeeding could reduce infant mortality among black babies.

And the effects aren’t just for baby – breastfeeding also lowers a mother’s risk of high blood pressure, diabetes, ovarian cancer and breast cancer, according to the CDC.

It may be natural, but it’s not easy

Even with the proven health benefits, some women find it too difficult. Societal pressures such as shaming of public breastfeeding, not having enough dedicated breastfeeding areas in public establishments and not having a national maternity leave law are often cited as reasons that all women have difficulties in breastfeeding. For black women in certain communities or in certain types of employment, it’s even more difficult.

“I have several friends that said they stopped only because they had to go back to work,” says Jacquelyn Baston, 40, a fitness and wellness professional in Bloomfield Hills, Mich. who currently breastfeeds her 9-month old son. “There was not enough time or resources provided to maintain pumping on the job, no break time, no space to [pump] privately, no proper storage solutions for breast milk.”

This is not unique. In 2015, the theme of World Breastfeeding week was breastfeeding and work. The World Health Organization and the International Labor Organization advocated for paid maternity leave to help women breastfeed without losing as much income; and for options such as working from home, on-site child care, and allowing mothers to bring their babies to work.

Collins cites her job as one of her biggest challenges in breastfeeding the second time around. With her daughter, now five years old, she went back to work at the three-month mark, first part-time then full-time, and she had her own office where she could close the door and pump in private. But, with her son, now two years old, she worked in the field as a registered social worker doing in-home therapy, so there was no office in which to pump.

“With my son, I went back at nine weeks,” Collins recalls. “I remember very clearly coming home one day with my husband saying I couldn’t keep driving and pumping in the car.”

However, even offices are not always breastfeeding-friendly.

“I have an unfortunate story of a friend that had to pump in a bathroom stall at her workplace because that was her only option,” says Baston.

While many tout that breastfeeding is “free,” some critics have pointed out that breastfeeding does come at a cost. There is the time involved, the cost of a pump when it is not covered by insurance, as well as the impact on work advancement and performance – all creating more barriers.

Starting at birth

For some black women and their newborns, the disparity starts in the hospital, with the very healthcare providers tasked to care for them.

Black mothers’ newborns were more likely to be fed formula in the hospital than white newborns, despite the intent of the mother to breastfeed or not, according to findings in a 2016 study. Giving formula early on can make it more difficult to establish a pattern of exclusive breastfeeding, the authors of the 2016 study explain. Just two years prior, the CDC also documented higher rates of supplemental feeding in hospitals serving black communities, and less breastfeeding promotion.

“In my case, it was prejudiced notions and attitudes that the staff held – both black and white staff – starting with the pediatrician all the way down, about how badly I did or didn’t want to breastfeed,” says Lisa Kirsic, 41, an accountant in New York City.

“A white woman who shared a room with me had a dedicated lactation expert who was at her side all night as she battled to get her supply started,” Kirsic explains. “On the other side of the curtain, I was encouraged to give my children formula.”

Kirsic left the hospital after her C-section unsure about what to do, and without enough breast milk to feed her twins. But, she didn’t give up.

“I privately hired a lactation consultant three weeks after giving birth, after having been about 90 percent formula-dependent,” Kirsic says. “I got my milk supply up with the consultant’s help, and I was able to remove formula from my twins’ feeding equation within two weeks of the consultation.”

In 1991, after realizing the importance of initiating breastfeeding as early after birth as possible, the World Health Organization and UNICEF teamed up to create the Baby-Friendly Hospital Initiative. The BFHI assists specially-designated “Baby-Friendly Hospitals” in supporting mothers to successfully start and continue breastfeeding, and limit the influence of infant formula makers.

In a NICU in Boston, breastfeeding rates increased significantly among black mothers after the hospital received its Baby-Friendly distinction.

However, an analysis five years ago found that most of the U.S. Baby-Friendly hospitals were in communities that did not serve a large population of African-American mothers. In the five cities with the highest percentage of African-Americans – New York, Detroit, Chicago, Philadelphia and Houston – there were only two Baby-Friendly hospitals.

As a result of BFHI’s efforts, there are now 23 Baby-Friendly hospitals in these cities. Yet, simply having the designation isn’t enough for black mothers. A study of African-American women’s experiences in a Baby-Friendly hospital showed a need for culturally-sensitive and culturally-specific approaches to support breastfeeding in this group of women.

The National Association of County and City Health Officials, in conjunction with the CDC, also funded 72 community sites with the goal of developing innovative breastfeeding projects in African-American and other marginalized communities. The project resulted in 92,000 one-on-one encounters for families and over 3,000 support groups hosted. They too found that providers must understand community challenges and modify programs to meet their needs; that continuous outreach is important; and that including family members, partners and siblings is important, especially in African-American and Hispanic communities.

“On My Own”

“I have several younger African-American moms who decided to stop breastfeeding within a few days from delivering their babies,” he says. “The most common reason was related to limited support at home when problems occurred such as poor latching or low milk supply. When asked if they reached out to a lactation consultant, they were unable to access the resources available to them.”

Baston says she can relate.

“When I was pregnant, I read, I Googled, and I asked every mom I encountered what their [breastfeeding] experiences were,” says Baston. “I used that to create this vision of my son naturally latching on and successfully nursing every two to three hours. What really happened was sore, cracked nipples, engorged breasts, sleepless nights, and painful back and shoulder muscles from fatigue and poor posture.”

Baston recalls a sense of panic that she wasn’t producing enough milk, followed by a sense of guilt and tears.

“Although the hospital staff was helpful in giving me guidance, I did feel rushed in the learning process,” she explains. “They gave me a few pointers and then I was on my own.”

Winters suggests that moms reach out to their obstetrician-gynecologist or pediatrician for a referral to a lactation consultant.  He also recommends support groups such as the La Leche League, that provides resources online.

Collins says she found support online as well.

“Black moms who breastfeed is an exclusive club,” she says. “We need as much support and guidance to ensure that we are not on this journey alone. I joined a lot of black moms’ breastfeeding groups on Facebook and followed a few blogs on Instagram and they soon became my breastfeeding support group!”

Collins also points out the need for black women spokespersons. Historically, the fight for breastfeeding has been led by middle-class white women, and black women may not feel like they can relate.

It’s still a choice

Yet, even with the proper education and support, not every mom can or wants to breastfeed.

“Moms who are unable to breastfeed should take comfort in knowing that formula is a great substitute,” says Winters. “I become concerned that mothers may beat themselves up for not being able to breastfeed, but they should know that their babies can still have a long and healthy life with formula feeds.”

He points out that research does show a slighter higher risk for developing ear infections, diabetes and obesity in formula-fed children.

“But, the benefit of making sure that the baby is receiving adequate nutrition far outweigh those slightly high risks,” Winters adds.

Dr. Tyeese L. Gaines, is a board-certified emergency medicine physician as well as a 16-year news veteran. She currently serves as chair of the Minority Affairs Section of the American Medical Association. With her firm, Doctor Ty Media, she offers public relations services and media training for physicians and medical practices.

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