Barriers to Breastfeeding for Hispanic Mothers

Abstract

The National Association of Hispanic Nurses (NAHN) is a professional society representing nurses of Hispanic/Latino origin and nurses and other healthcare providers with interest in Latino health issues. NAHN believes that breastfeeding is the ideal method of infant nutrition. There are many benefits to breastfeeding and among them, and of interest to Latinos, is a significantly reduced risk for children to be overweight if they are breastfed. Studies have also indicated that the longer the duration of breastfeeding, the higher the odds of not being overweight and that it is possible that this protection may persist into the teenage years and adulthood. Obesity and diabetes are among conditions that disproportionally affect Latinos in the United States.

Breastfeeding Among Latinos

According to the Centers for Disease Control and Prevention's (CDC's) 2013 Breastfeeding Report Card, the percentage of U.S. infants who begin breastfeeding is high, at 77%, and continued progress has been made over the last 10 years.¹

According to the CDC National Immunization Survey, 80.6% of Latinas ever breastfed versus the U.S. national rate of 75.0% of women.² Unfortunately, as with non-Latinas, breastfeeding rates decrease rapidly when looking at data for 6 months after birth and beyond.²

Barriers to Breastfeeding

There are multiple prenatal and postnatal barriers to breastfeeding among Latinas. Some of these barriers are shared by women not of Latino heritage. Among these common barriers are socioeconomic factors: mothers of a younger age, lower income, less maternal education, and unmarried status tend to have lower rates of breastfeeding.

The most frequently noted barrier to initiation and continuation of breastfeeding is the need to return to work/school. Many women in low-wage positions cannot afford to take extended unpaid maternity leave and may not have access to flexible schedules. Others may not take advantage of work accommodations out of fear that they will be embarrassed or fired. Many women cannot afford adequate child care and may need to leave their children with friends or family members who are not supportive of breastfeeding.

Additional barriers include privacy and sexualization of the breast (objectification). Men are not always supportive of their partner's breastfeeding. They may be concerned that breastfeeding changes the appearance of breasts or of negative public perception of breastfeeding in public.

Conditions related to initiating breastfeeding may be barriers: pain at the beginning, bleeding in the nipple, difficulty latching-on, and insufficient breastmilk.

Other barriers to breastfeeding more related to racial/ethnic background include factors related to acculturation (whether an immigrant population is settled or newly arrived). The longer Latina immigrants live in the United States, the more likely they are to think using formula is the American way and therefore feed their babies formula. In addition, in some Latin American countries, breastfeeding is perceived as a practice of the poor who are not able to purchase formula because of economic limitations—this perception is retained in the U.S. Hispanic community. This is expressed by not valuing pumped milk and discarding it. Another consideration may be the fear that transitioning from breast to bottle will harm the baby when they need to go back to work.

These barriers are exacerbated by a general lack of health services information. Many hospitals are unprepared for the needs of immigrant women. Lack of cultural background and competency make it harder for mothers to receive information and have questions answered.

There are also some cultural myths and urban legends that impact how mothers view breastfeeding. Some mothers may be worried that their baby is not receiving enough nutrition and may decide to do both breastfeeding and bottle-formula feeding. Family members may also encourage mothers to supplement if the infant is not “gordito” (chubby), which is seen in Latino culture as a healthy baby. Some mothers worry that negative emotions and stress can impact the quality of the milk and harm the baby or that some spicy foods will also impact the baby.

Overview of Some Potential Solutions

Maternity care practices

It is important to use appropriate culturally specific guidelines in pre- and postnatal breastfeeding promotion and support programs. One study showed that women who attended prenatal classes were about half as likely to bottle feed and received better information on breastfeeding than those not attending.³

Hospitals must support breastfeeding by having trained bilingual and bicultural hospital staff who understand the written breastfeeding policy and are available to work with the mother. Other recommended practices are to promote increased immediate and continued contact between mother and baby at the hospital by implementing rooming-in and by having mothers initiate breastfeeding within ½–1 hour from birth (skin-to-skin contact). Hospitals should also show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants. The hospital should also link the mother to maternity facilities and networks in the community that support breastfeeding. It is also advisable to do extra home visits or outpatient visits, especially for teens within the first few days following hospital discharge.

Support for breastfeeding in the workplace and outside the home

In recognition of the importance of promoting breastfeeding, Section 4207 of the Patient Protection and Affordable Care Act (PPACA) under the Fair Labor Standards Act of 2011 (known as Break Time for Nursing Mothers) now requires employers to provide reasonable break time and a private place other than a bathroom for hourly paid workers to express breastmilk at work. Employers are required to provide this until the employee's baby turns 1 year old. PPACA also requires that health insurance plans provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. However, employers that employ less than 50 employees are not subject to the requirements, if such requirements would impose an undue hardship. It is also important to support the availability of breastfeeding-“friendly” public areas, as well as encourage churches, hospitals, and other locations to have accommodations for breastfeeding. Childcare facilities should be encouraged to allow breastmilk in the bottle, and facilities in other types of locations should provide ways to store expressed milk. For school-age mothers, it is important to provide continuous support before and after birth, including the availability of on-site school daycare, so teen mothers can successfully continue breastfeeding.

Peer support

Latinos value and are influenced greatly by their families—“familismo.” For this reason, it is important to focus on the support needed from and for the father, family, and community that creates a breastfeeding-friendly environment. Besides the families of breastfeeding mothers, it is very important that breastfeeding is supported by creating or expanding the coverage of culturally based peer counseling programs within and outside organizations where mothers go for help. International Board Certified Lactation Consultants (IBCLCs) can also lend support and supervise peer counselors. Latinos are one of the biggest users of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). For this reason, it is important that WIC also provides culturally specific support and information.⁴

Educating mothers—prenatal and postnatal

It is important to have honest conversations with mothers about challenges and benefits of breastfeeding, providing culturally competent, balanced information about breastfeeding. Many mothers, although they may have a vague idea that breastfeeding is important, may not have information or knowledge about the actual act of breastfeeding an infant, such as a baby's stomach size or feeding needs. Discussions must address breastfeeding “myths,” such as the benefits of feeding pumped milk to the baby rather than discarding and that feeding “las dos” (formula feeding and breastfeeding simultaneously) may interfere with early breastfeeding success. Encourage mothers to ask questions and to ask for help with proper positioning and latching-on and to tell the hospital staff they are exclusively breastfeeding. Anyone who has contact with new mothers should be trained to promote breastfeeding (local health departments, women's health centers, health insurance plans, etc.). Prepare mothers for their hospital stay. Second-time mothers need guidance on breastfeeding. Don't assume they know because they are breastfeeding a second child. To facilitate breastfeeding continuation, it is also important to provide information on how to manage new family responsibilities.

Professional support

Because women who are encouraged by a doctor or nurse in the hospital are four times as likely to start breastfeeding as mothers who are not encouraged, it is critical that the healthcare team supports breastfeeding and assists the mother with any issues. This is especially impactful if the healthcare provider is bilingual and bicultural. It is also important that daycare workers, Head Start and WIC employees, community health workers, and others are trained to promote breastfeeding. It is also a good idea to promote the establishment of sustainable walk-in breastfeeding clinics staffed by IBCLCs.

Media and social marketing—messaging

Culturally and linguistically appropriate and relevant breastfeeding messages will be more effective than generic calls to breastfeed. Among Latinos, the use of TV and radio commercials and other media (social sites, texting) for breastfeeding-friendly campaigns has been effective. It is also impactful to use expert spokespersons and Latina celebrity sponsors whenever possible. The messages must target the whole community (mothers, fathers, families, and the public) and emphasize the benefits of breastfeeding.

Conclusions

NAHN is committed to improve the health of all Americans, especially the Hispanic community, and part of that aim is to promote healthy practices, including breastfeeding, that reduce health disparities and create a healthier society.

Footnotes

Disclosure Statement

No competing financial interests exist.

References

National Center for Chronic Disease Prevention and Health Promotion. Breastfeeding Report Card. United States/2013. Available at www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf (accessed May 2014 ).

Centers for Disease Control and Prevention. National Immunization Survey. Available at www.cdc.gov/nchs/nis.htm (accessed May 2014 ).

Spinelli

, Buglio

, Donati

, et al. Do antenatal classes benefit the mother and her baby?. J Matern Fetal Neonatal Med, 2003; 13:94–101.

Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Breastfeeding: A Magical Bond of Love. A Social Marketing Campaign to Promote Breastfeeding Among Hispanic Women. Available at www.nal.usda.gov/wicworks/Learning_Center/LS/MBOL/projectsummary.pdf (accessed May 2014 ).