Archive | Black Breastfeeding Week

Breastfeeding and Racial Disparities in Infant Mortality: Celebrating Successes and Overcoming Barriers

As a part of Black Breastfeeding Week, Lactation Matters is reprinting (with permission) two editorials from Clinical Lactation, the official journal of the United States Lactation Consultant Association. Up today: a focus on the successes so far and places where IBCLCs can support change. Throughout the post, check out additional links that author Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA, has asked Lactation Matters to highlight as additional resources for our community.

Many exciting changes occurred in 2013 in the breastfeeding world. One of the best trends was the increase in breastfeeding rates in the African American community. The CDC indicated that increased breastfeeding rate in African American women narrowed the gap in infant mortality rates. As the CDC 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. In 2013, we saw the first Black Breastfeeding Week become part of World Breastfeeding Week in the U.S. Programs, such as A More Excellent Way, Reaching Our Sisters Everywhere (ROSE), and Free to Breastfeed, offer peer-counselor programs for African American women.


Check out the Black Mothers’ Breastfeeding Summit


We can celebrate these successes. But there is still more to do. Although the rates of infant mortality have dropped, African Americans babies are still twice as likely to die. In addition, although rates of breastfeeding have increased among African Americans, they are still lower than they are other ethnic groups.

For each of the 2000–2008 birth years, breastfeeding initiation and duration prevalences 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.

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, surely. But they are ones I’ve consistently encountered. They will not be quick fixes, but they can be overcome if we recognize them and take appropriate action.

1) Pathways for IBCLCs of Color. In their book, Birth Ambassadors, Christine Morton and Elayne Clift highlight a problem in the doula world that also has relevance for the lactation world: most doulas (and IBCLCs) are white, middle-class women. And there is a very practical reason for this. This is the only demographic of women that can afford to become doulas (or IBCLCs). The low pay, or lack of job opportunities for IBCLCs who are not also nurses, means that there are limited opportunities for women without other sources of income to be in this profession. Also, as we limit tracks for peer-counselors to become IBCLCs, we also limit the opportunities for women of color to join our field. I recently met a young African American woman who told me that she would love to become an IBCLC, but couldn’t get the contact hours needed to sit for the exam. That’s a shame. (I did refer her to someone I knew could help.

2) We need to have some 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. ILCA has started this dialogue and held its first Lactation Summit in July to begin addressing these issues.

These discussions can start with you. Sherry Payne, in her recent 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.

3) Bedsharing and Breastfeeding. This is an issue that I expect will become more heated over the next couple of years. But it is a reality. As we encourage more women to breastfeed, a higher percentage of women 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 in 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 is that breastfeeding would 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 messaging, with barely a mention of breastfeeding in decreasing infant mortality. A more constructive approach might be to talk about being safe while bedsharing. But as long as the message is simply “never bedshare,” there is likely to be little progress, and it could potentially become a barrier to breastfeeding.


Don’t miss the Interview with Sherry Payne on Fighting Breastfeeding Disparities with Support.


Reason to 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.


Click here to watch the Teach Me to Breastfeed Rap!


In summary, we have made significant strides in reducing the high rates of infant mortality, particularly among African Americans. I am encouraged by the large interest in this topic and the number of different groups working towards this goal. Keep up the good work. I think we are reaching critical mass.

And thanks for impacting your community—one mother at a time. Wishing you a happy and healthy 2014.

Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA

Editor-in-Chief, Clinical Lactation

Reference

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.

Reprinted with permission from Clinical Lactation, Vol. 5-1

About the Author

Dr. Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the Owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett is Editor-in-Chief of Clinical Lactation, Fellow of the American Psychological Association in Health and Trauma Psychology, President of the APA Division of Trauma Psychology, and Editor-in-Chief-elect of Psychological Trauma. She is a Clinical Associate Professor of Pediatrics at the Texas Tech University School of Medicine in Amarillo, Texas and Research Associate at the Crimes against Children Research Center at the University of New Hampshire. Her most recent books include The Science of Mother-Infant Sleep (with Wendy Middlemiss) and Psychology of Trauma 101 (with Lesia Ruglass). Her websites are KathleenKendall-Tackett.com and UppityScienceChick.com.

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Seven Ways To Support Black Breastfeeding Week

 

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This week marks the second annual Black Breastfeeding Week (learn more here). We asked Kimberly Durdin, IBCLC, SMW, to share with us her reflections on her path to becoming an IBCLC, why we need Black Breastfeeding Week, and how we as IBCLCs can support Black women in our profession.

23 years ago, I was a brand new mom, with a weeks old baby daughter, who I was struggling to breastfeed. In spite of the support my mother (who had breastfed) and my husband, I needed more. I struggled with sore nipples, Caesarian recovery and thoughts of giving up. A new mom friend told me about our local La Leche League group and one day, I stumbled into the monthly meeting with my baby in my arms.

I received the support and help that I needed, and with the help of that leaders encouragement, I came back to more meetings and gained a community I didn’t even know was forming around me. Four months into nursing my daughter, this leader encouraged me to do more . . . she suggested I become a La Leche League leader.  I had no idea what that entailed and I surely felt unqualified to even attempt that journey. Patiently she keep after me, reminding me of what she said when the suggestion first left her lips: “There are not a lot of black women doing this [breastfeeding and becoming La Leche League Leaders].  You’d be a great role model.”

Although it took me four years and a winding path to actually make that happen, I did become a LLL Leader (yes, one of the few African American ones). I also became a breastfeeding peer counselor through the WIC program and, years later, an IBCLC. Although I have had many mentors over the years that I continue to value and learn from, I can’t thank enough Lucy Koteen, long time La Leche League Leader from Brooklyn, NY for not only seeing something in me that I didn’t see in myself, but for also being such an outstanding, open-minded person. She was aware not only of her privilege, but also of the issues around her, beyond the ones in her immediate world (for example, breastfeeding in the Black community) and sought ways in which she could be of support.

She believed that all women should have support for breastfeeding and sought out ways to bring the information to underserved audiences such as young black and brown pregnant and parenting girls. She knew that someone who looked like them could perhaps deliver a message that may have more impact than hearing it (in her case) from a “wealthy older white lady telling these girls that they should breastfeed.” She got out of the way . . . it wasn’t about her. She didn’t need money and she didn’t have an agenda but to help as many woman as she could. She wasn’t a lactation consultant, and never became one. Because of her, a seed was planted in me and slowly, very slowly – and with the help of many other mentors along the way – a lactation professional emerged. As I grew into this profession, it was not only my own actions, but the support (and sometimes that support was strictly financial) of others who believed in me that actually made my dream of becoming a lactation consultant a reality. I could not have done this without the support of folks like Lucy. Actually, I could have done it, I would do whatever it took, but they helped me navigate looming obstacles. In the process I’ve been able to help innumerable families, many who look like me and many who don’t.   (I’ve also been able to help women who look like me enter the profession, too.)

This past July, I attended the Inaugural and historical Lactation Summit 2014 hosted by ILCA, LEAARC and IBLCE. Afterwards, I talked with a number of Summit attendees from the dominant culture. I was surprised to learn that many were unaware of the struggle that women of color have experienced in breastfeeding their own children, in receiving culturally competent care, and in obtaining the required education, mentoring, opportunities and financial support needed to sit for the IBCLC exam. The barriers are financial, cultural, systemic and logistical. When dominant culture women aren’t aware of the challenges that women of color face, that lack of awareness becomes a barrier of its own. 

Many also told me their eyes have been opened in a new way to inequities on various levels. These inequities harm Black women, but they also derail our profession.

Would you like to help? Are you wondering what support looks like? Here are some ways you can take action in your community:

One: Give to an educational scholarship of your choosing that will directly benefilt a candidate of color. A great way to do this is to list your educational scholarship or opportunity with The Grand Challenge.

Two: Contribute to cost of trainings for candidates of color.

Three: Offer to mentor candidates.  Bring them into your practice. Open doors for them that they wouldn’t have possibly been able to open without your connection.

Four: Contribute to expenses related to obtaining certification such as traveling expenses and testing fees.

Five: Contribute to educational fees associated with obtaining CERPs.

Six: Offer free/reduced price or scholarships for classes you may offer to  expectant and breastfeeding parents so that more community members can be educated, and also this helps to seed and grow the next generation of lactation and childbirth pros.

Seven: Respect and understand that some women of color are much more open to receiving health messages from other folks of color. Dominant culture women must learn to respect that and not feel threatened by it. Events like Black Breastfeeding Week help to strengthen cultural pride and awareness around our herstory of breastfeeding . . . our struggles challenges and triumph that are unique to our community, our shared herstory.

I hope that dominant culture breastfeeding supporters do not perceive Black Breastfeeding Week as some sort of woman of color protest. Black women rarely see images of women who look like them breastfeeding. Many breastfeeding promotion campaigns do not include images of black women breastfeeding. Events like Black Breastfeeding Week help black women see breastfeeding as something they do, too . . . not just something white women do. 

kimberly_james_largeKimberly Durdin, IBCLC, SMW, is an internationally board ­certified lactation consultant, childbirth educator, speaker, trainer, former birth and postpartum doula and a retired La Leche League Leader. She has helped thousands of families have a satisfying and empowering experience of pregnancy, birth, breastfeeding and parenting. Kimberly has served families in New York City, Los Angeles and Washington, DC, where she was named one of the best lactation consultants in 2004 by Washington Families magazine. Learn more here.

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