Breastfeeding rates for black US women increase, but lag overall: Continuing disparity raises concerns
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* Donya Currie

As a middle-class black woman living in Baltimore, Kathi Barber said she had a difficult time finding peers who breastfed.

“When I looked for support, there was nothing there,” Barber, author of “Black Woman’s Guide to Breastfeeding: The Definitive Guide to Nursing for African American Mothers” and the forthcoming “Cultural Competency in Lactation Management,” told *The Nation’s Health*. “There were no other women in my peer group or even in my family who had breastfed.”

Kimarie Bugg, MSN, MPH, FNP-BC, CLC, had a different experience because she lived in a Georgia community where “everyone” breastfed, from her aunts to her grandmother to members of her church. She founded the national nonprofit group Reaching Our Sisters Everywhere, or ROSE, in 2011 as a way to target the consistently wide disparity in breastfeeding rates for black women.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/43/3/1.3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/43/3/1.3/F1)

Corinne Graff, left, holds Christian Rich during a breastfeeding class at the Breastfeeding Center for Greater Washington in Washington, D.C., in 2005. At right is Pat Shelly, a lactation consultant and the center’s director. While breastfeeding rates for black women have improved, disparities persist, data show.

Photo by Jeff Hutchens, courtesy Getty Images

“We can truly reform health care through breastfeeding,” said Bugg, who breastfed her five children, who now range in age from 17-33. “It’s definitely a public health issue.”

According to the latest numbers from the Centers for Disease Control and Prevention, breastfeeding rates improved nationwide in 2000-2008, and some of the greatest improvement was among black women. However, only about 59 percent of black mothers breastfed in 2008, compared to 80 percent of Hispanic mothers and about 75 percent of white mothers. For 2008 rates of breastfeeding at a baby’s first birthday, the number was about 23 percent overall but only 12.5 percent for black mothers. That low rate still marks a near doubling of rates among black mothers compared to the year 2000.

“It’s gotten better, but it’s definitely not where it should be,” said Bugg, who is the regional faculty member providing coaching to 33 southern hospitals as part of the Best Fed Beginnings initiative. The CDC-supported project is “a nationwide effort to make quality improvements to maternity care to better support mothers and babies to be able to breastfeed.”

In 2011, “The Surgeon General’s Call to Action to Support Breastfeeding” pressed for expansion of some methods that have been proven to improve breastfeeding rates for all women. Those include programs that provide mother-to-mother support and peer counseling as well as more “baby-friendly” hospitals. Such hospitals have all nurses trained in breastfeeding support and follow World Health Organization recommendations such as helping mothers initiate breastfeeding within an hour of birth and avoiding formula unless medically necessary. CDC recommends that babies be breastfed exclusively for at least the first six months of life.

“It has significant short- and long-term benefits for both the mother and child,” Ann Dozier, PhD, RN, chair-elect of APHA’s Maternal and Child Health Section and a breastfeeding researcher at the University of Rochester, told *The Nation’s Health*.

While improved institutional policies such as baby-friendly hospitals and bans on formula marketing are helpful, progress requires improved community norms, supportive personal relationships and a shift in mothers’ attitudes and beliefs, she said.

“If we keep pushing women and we don’t have responsive communities, we don’t have responsive institutions, we’re just going to create frustration,” said Dozier, whose research is moving away from what she termed a “blame the mother” approach. “It’s a ‘think globally, act locally’ piece. It needs to be individualized to the community. Each community has different types of supports, different experiences.”

At the African American Breastfeeding Alliance of Dane County Inc. in Wisconsin, peer support and community education are key, said lactation consultant Hershey Barnett-Bridges, RN, IBCLC, RLC. A public health professional for 33 years, she said that the disparity in breastfeeding is contributing to other disparities such as higher infant mortality, asthma rates and obesity among black children.

“We know that breastfeeding can actually decrease certain illnesses, ear infections, asthma, eczema,” she told *The Nation’s Health*.

Infant mortality rates are more than twice as high in black infants as white infants. A 2005 National Vital Statistics report concluded that reducing the black infant mortality rate to that of whites would save 6,000 children’s lives each year. Because of its many health benefits, breastfeeding can play a role in reducing those rates, advocates say.

Angela Ewing-Boyd, IBCLC, is working on a grant project with Barber and the Maryland Breastfeeding Coalition to identify breastfeeding obstacles and solutions for black women. She works as a senior health promoter with Healthy Babies Begin With a Healthy You, a project of the Montgomery County Minority Infant Mortality Reduction Pilot Project in Maryland. One of her areas of interest is how music and other media messages affect black girls by promoting sexuality but disempowering them to make healthy choices such as breastfeeding.

“Everything in our society impacts breastfeeding,” she told *The Nation’s Health*.

As a pediatrician with Children’s National Medical Center and president of the D.C. Breastfeeding Coalition, Sahira Long, MD, said she is seeing more women who are breastfeeding. Part of the upward trend, she believes, can be credited to the coalition’s efforts to help city hospitals earn the baby-friendly designation indicating they follow practices that strongly support breastfeeding. Half of the city’s eight hospitals are on track to earn that designation by the end of the year, she told *The Nation’s Health*.

“I’m starting to see a lot more moms who are coming in and exclusively breastfeeding,” she said. “I think as more is done to move it from a feeding choice to a public health choice, I think we’ve seen the shift in some folks’ minds.”

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/43/3/1.3/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/43/3/1.3/F2)

Breastfeeding rates have doubled among black mothers since 2000, but they lag far behind rates for Hispanic and white mothers.

Photo by Christopher Futcher, courtesy iStockphoto

Ewing-Boyd said cultivating some existing grassroots initiatives, along with bolstering workplace support and efforts in health care settings, can work together to improve breastfeeding rates among black women.

“I think one of the biggest barriers to breastfeeding is how insulated our communities are,” Ewing-Boyd said. “We’re not breastfeeding in a community of aunties and grandmothers and sisters. We’re often doing it alone.”

When she meets with expectant mothers in the Washington, D.C. area, she tries to connect them with the local chapter of Mocha Moms, a group that links black women of all income and education levels to help them nurture themselves and their families.

The decision to breastfeed and to continue to do so for the recommended timeframe hinges on a complex interplay of factors that include employment, community norms, education level and family support, according to research into breastfeeding rates and disparities. A 2004 study in the *American Journal of Obstetrics and Gynecology* found if expectant fathers attended a two-hour class on infant care and breastfeeding led by a peer educator, mothers were almost twice as likely to breastfeed. A study published Feb. 18 in *Pediatrics* found 60 percent of mothers who breastfeed quit earlier than they planned for reasons that ranged from concerns with infant nutrition and weight to a need to take medication or problems pumping milk.

“Images mean so much, and we find a lot of times that folks are just saying, ‘There are so many people I know who are 30 years old who have never seen anybody breastfeeding,’” Bugg said. “If we can project more positive images, it will make a big difference.”

For more information on the CDC study, published in the Feb. 7 issue of *Morbidity and Mortality Weekly Report*, visit [www.cdc.gov/mmwr](http://www.cdc.gov/mmwr).

*   Copyright The Nation’s Health, American Public Health Association