Abstract
Breastfeeding Success Is Up to All of Us
Growing a first food movement requires support from all of us. We need everyone at the table—physicians and healthcare professionals alongside advocates, policymakers, public officials, business people, community members, families, and mothers. For we know that breastfeeding success is up to all of us.
Indeed, the W.K. Kellogg Foundation confirmed this in a nationwide poll conducted at the end of February, just ahead of our First Food Forum. The results of the poll are clear: 68% of Americans strongly agree that hospitals should be Baby-Friendly, 66% strongly agree that workplaces need to support breastfeeding mothers, and 61% strongly agree that everyone can play a role in making it easier for mothers who want to breastfeed. 2
The Kellogg Foundation's Commitment to First Food
The W.K. Kellogg Foundation continues to be a strong advocate for improving breastfeeding rates in our country. Breastfeeding ties directly to our core mission—working alongside communities to create conditions that enable vulnerable children to thrive.
We believe that all children deserve a healthy start in life, that babies who receive exclusive access to breastmilk for the first 6 months of their lives have better health, educational, and emotional outcomes, and that a mother's breastmilk is the optimal first food to give children a healthy start so they can thrive in school, work, and life.
Along with our focus on vulnerable children, the Foundation has a deep and abiding commitment to racial equity. This commitment is woven through all of our program areas. It touches everything we do. And so our First Food approach emphasizes working with communities where breastfeeding rates are significantly lower and health disparities are much higher. More often than not, these are communities of color—underserved communities in which the structures of poverty and racism have historically played, and continue to play, a significant role in determining health outcomes.
Women of Color and Breastfeeding
As Dr. Gail Christopher, our Vice President, often says, “The debate is over.” We recognize the importance of breastfeeding to improving the lives of vulnerable children and families. And we have the research to back it up. We have quantified the potential benefits to society and can add these to the undeniable qualitative benefits of breastfeeding to mother and child. A recent study by Bartick et al. 3 goes even further to show the benefits of breastfeeding for maternal health.
What's important now is to get out there and implement the best practices, especially in marginalized communities, where often our best practices are needed the most. The statistics on racial disparities in breastfeeding rates are well known within the First Food movement but still are sobering. Although nearly 75% of white mothers initiate breastfeeding, just 58% of African American mothers start breastfeeding their babies.
In six states—Alabama, Arkansas, Kentucky, Louisiana, Mississippi, and South Carolina—the breastfeeding initiation rate among African American women is less than 45%. These inequities are the result of many factors and must be seen in the context of broader disparities in health and access to health care for women of color.
Kimberly Seals Allers, founder of the MochaManual.com blog for African American moms, puts it like this: “The reasons why more African American women aren't relying on the first food for their newborns are a multifaceted mosaic—ripe with political nuances, deep racial undertones, social taboos, and complex cultural subtleties.” 4
We must acknowledge this reality. We must consider breastfeeding in the larger context of community. It's not just about a hospital experience. Mothers come home, they go to work, they go to school, they go to church. They are part of a community—a network of families, grandmothers, fathers, sisters, and brothers who play an important role. Understanding these dynamics and appreciating cultural nuances helps us build trust and meaningful relationships with communities.
Promising Best Practices from the Field
The promising news is there are culturally competent community partnerships that are addressing these dynamics. These partnerships include healthcare providers working closely with communities and community members working closely with each other.
The Supplemental Nutrition Program for Women, Infants and Children, otherwise known as WIC, varies from place to place, but there are some best practices in WIC that I hope will spread. New Mexico WIC offers one of the best examples of mother-to-mother support with a breastfeeding peer-counseling program that has expanded to more than 50 clinics across the state in homes and in communities. The peer counselors are past or current New Mexico WIC mothers who have successfully breastfed their own babies.
Programs like the one in New Mexico are leading the way, although it saddens me that in June 2013, an amendment to ensure the availability of $60 million in funding for the WIC breastfeeding peer-counselor program was defeated by the House Appropriations Committee. Peer counselors play an incredibly vital role for women, especially young women, in building supportive social networks. Now is not the time to cut back on a program that is so important to the movement and to the lives of vulnerable women and children.
In Hawaii, an organization based on the island of Molokai called Ka Honua Momona, or KHM for short, seeks to model sustainability through reviving cultural traditions, including breastfeeding practices that engage multiple generations and fathers, too.
In Detroit, MI, advocate and mother Kiddada Green is extending the reach of her organization, Black Mothers' Breastfeeding Association, and the regular meetings of its mother-to-mother breastfeeding support group, the Black Mothers' Breastfeeding Club. The Black Mothers' Breastfeeding Association is not only working with mothers. Recently the group hosted its fourth national seminar to strengthen the support bridge between African American families and the healthcare professionals who serve them.
I received a call from the program coordinator at St. John's Hospital in Detroit, who has brought the community to the hospital by hosting weekly Mother Nature peer support groups. She began to tell me how the support groups were overflowing, that women were coming week after week, lots were breastfeeding, some had completed breastfeeding their children, and others had never breastfed. They had been referred by community groups, physicians, family members, and the support group. Breastfeeding is a means and an end. It is central in supporting mothers, children, and families, and it builds community and a social support network that are so essential in enabling children to thrive. It is collaborative and community-based efforts like these that give me hope.
Signposts of Progress
I'm also optimistic about encouraging signs of progress. I hear from more and more women among family and friends and colleagues who are feeling comfortable about breastfeeding. But I also hear from my circle that those who are breastfeeding their babies are facing more challenges. They are calling on their family and friends for support.
There's more pushback because more women are breastfeeding. And you can't have movement forward without some pushback. Nothing good or great ever comes gently. The good news is that the pushback is a sure sign we're gaining ground. On top of that, we have hard numbers from the Centers for Disease Control and Prevention. Breastfeeding rates are increasing among all groups. And there's a robust, ongoing conversation about breastfeeding taking place across society—in the media and among our circles of friends. This is real progress.
We need to see this through, to continue the conversation, to keep things moving in the right direction. Soon we will start to see the positive long-term outcomes in our communities. We've come a long way, but this isn't the end. We need to keep working together, collectively, as a movement, in partnership with community.
Footnotes
Disclosure Statement
No competing financial interests exist.