Lisa Uncles, a certified nurse-midwife who's the acting clinical director of the Family Health and Birth Center in Washington, D.C., visits a new mother a day after she gave birth. Clients of the center have fewer premature births, low birth weights and cesarean sections as compared with the city's African-American population overall.
Lisa Uncles, a certified nurse-midwife who's the acting clinical director of the Family Health and Birth Center in Washington, D.C., visits a new mother a day after she gave birth. Clients of the center have fewer premature births, low birth weights and cesarean sections as compared with the city's African-American population overall. Andrea Hsu/NPR
American mothers as a whole do not breast-feed their babies as much as health experts would like, but African-American moms have the lowest rates of all — by some measures, they are half as likely to nurse as whites and Hispanics.
The federal government, some hospitals and nonprofits are trying different strategies to close this nursing gap, though no one seems sure exactly why the disparity exists.
When Kathi Barber gave birth a decade ago, she was the first in her family in generations to nurse, and was dumbfounded to realize she had no role models. Barber became obsessed with encouraging nursing among black moms, as numerous studies show that exclusive breast-feeding can reduce a baby's chances of developing diabetes, obesity, ear infections and respiratory illness.
Yet Barber was frustrated that for many new mothers, their only image of this age-old act may come from a museum or a National Geographic documentary.
Nursing Rates And Demographics
For children born in 2006, a smaller percentage of African-American women exclusively breast-fed for three months.
"Tribal women, with elongated breasts, earrings and tribal jewelry. And let's say we're trying to promote that to a 25-year-old, mmm ..." she laughs. "I don't think that's going to do the trick."
So Barber founded the African-American Breastfeeding Alliance and wrote The Black Woman's Guide to Breastfeeding. As a lactation consultant, she travels the country putting on workshops and training sessions, and encouraging hospitals and family clinics to reach out to this community.
Partnership And Peer Counseling
"People tell me it hurts," says 16-year-old Dijonna Hunter, due with her first child in February. But at the Developing Families Center in northeast Washington, D.C., where she's come for her maternal care, Hunter has learned about the health benefits of nursing. Hunter says she's determined to try it despite what her friends and mother tell her.
Experts say a supportive partner is key for successful breast-feeding, and Hunter's boyfriend, Anthony Frost, is trying. He's even taken to watching baby shows on television. But when asked if his mother nursed him, Frost makes clear that he finds the very notion disgusting. Angela Ewing-Boyd, the center's program manager, says she hears that a lot, even from women.
People say, "I can't imagine doing that to my child, and that's just nasty," she says. "It's like the primary function of the breast is one-dimensional."
So Ewing-Boyd has organized weekly peer-counseling sessions for pregnant women. On a recent afternoon, about a dozen of them sat in a circle, shifting to find a comfortable position on their folding chairs.
The U.S. has set 2010 targets for increased breast-feeding rates, but experts say they will largely go unmet.
Public health officials have waged two campaigns to promote breast-feeding in the U.S. The first was a century ago, when infant deaths from diarrhea were linked to spoiled, diluted or unpasteurized cow's milk in baby formula. The other was earlier this decade, when the Health and Human Services Department called for a mass-marketing effort to promote not just the benefits of breast-feeding, but the dangers of formula feeding. That led to these television ads:
"I have a car," said counselor Joan Brickhouse, holding up a matchbox racer. "What does this have to do with breast-feeding?" She sent the car zooming across the floor as the women tossed out guesses — some sincere, a few snarky.
Brickhouse then told them, "You can take your breasts with you anywhere. On the airplane, you know, you can just whip it out!"
Other objects in this educational pop quiz stressed the health benefits of nursing and the economic advantage: breast milk, of course, is free, while formula can easily run $150 and more a month, which makes it all the more baffling why lower-income mothers of all races are more likely to choose formula.
In fact, the older, more educated and higher-income a mother is, the more likely she is to breast-feed. But experts say the disparity for African-Americans is so great it transcends socio-economics.
Barber says work is clearly a huge barrier, and black moms may be more likely to hold lower-wage jobs with no breaks allowed for nursing. African-Americans have also had to earn money since long before the women's liberation movement.
In fact, Barber thinks you can trace part of the problem all the way back to the breakup of families under slavery, and the enduring, negative image of so-called mammies — slaves made to serve as wet nurses for their master's white children.
That practice continued for domestic servants well past the end of slavery, and for Barber, it helps explain the ironies that played out later. In the 20th century, it was white, wealthy women who led the march to formula feeding, and minorities followed. But when white elites backtracked and made breast-feeding hip, most African-Americans didn't buy it.
"Infant formula became a thing of prestige," says Barber. "Breast-feeding was thought to be something that lower-class women did. So, if you can think of it as a political issue, it really is."
From Formula To Breast
Barber and others say another factor in low breast-feeding rates is aggressive marketing by the multibillion-dollar baby formula industry, which has convinced hospitals to hand out its products for free.
Barbara Philipp is medical director of the Birth Place at Boston Medical Center, and says numerous studies have looked at this.
"When I, as a physician in a white coat, or when a staff nurse with her hospital badge on, hand out that diaper bag that we get for free from the formula company," she says, "that mom and baby will go on to exclusively breast-feed for a shorter period of time."
The Way We Work: The Nurse-Midwife
A decade ago, Boston Medical Center launched a broad campaign to promote breast-feeding. It educated both its staff and clients. It started putting newborns in the same room with their mothers instead of carting them off to the nursery. And it stopped handing out free formula, something Philipp says caused a ruckus.
"It was seen as denying a free gift to poor women," she says.
But the number of mothers at the center who start out nursing has shot up to 90 percent, well above the national average for black mothers.
In fact, national rates have been rising for African-Americans — a study last year found that the number initiating breast-feeding had jumped from 36 percent in 1993-1994 to 65 percent in 2005-2006.
But that number still lags far behind whites and Hispanics, and figures from the Centers for Disease Control and Prevention show the proportion who continues nursing exclusively soon plunges into single digits. Washington's Developing Families Center tries to stem this drop with follow-up visits to new moms.
Home Visit Lends Support
Counselor Tina Pangelinan steps into Kala Blue's small apartment five days after Blue delivered baby Kamya.
For the past two days, an exhausted Blue has struggled to get Kamya to latch on, and has instead been using the free formula the hospital gave her. The women sit side by side on the love seat as Pangelinan offers tips and suggestions, and Blue tries again and again, holding her frustrated baby first one way and then another.
Finally, after 20 long minutes, she succeeds. But Blue admits it just doesn't feel right. Pangelinan offers to come back tomorrow with a breast pump, so Blue can express her milk into a bottle.
"We're here for you," she tells Blue.
Whatever it takes to keep one more African-American baby getting mother's milk.