You may know that there are significant disparities in breastfeeding rates among racial and ethnic groups in the U.S. Probably the clearest example of this is the breastfeeding initiation rate of African American moms, which in 2007 was 60%, compared to the overall U.S. rate of 75%.
There are a number of reasons why the rates are different, and I explored some of them in an interview with Kathi Barber, founder of the African American Breastfeeding Alliance.
One reason we didn’t discuss, but which I’ve heard a number of times, is an assumption among health care providers that African American moms don’t plan on breastfeeding. The result of this expectation is that moms sometimes get poor or no support in the hospital at getting breastfeeding off to a good start.
So, is there a “soft bigotry of low expectations” when it comes to breastfeeding support? I certainly hear stories reflecting that, like this one in which a mother who is committed to breastfeeding gets no help (but plenty of formula samples) from her postpartum nurse, who “seemed surprised to find [her] breastfeeding.”
But I’ve been wondering whether any research might bear that out, so I spent some time looking at the limited literature on this topic, and I think the studies below add up to a “yes.”
Here’s what we found:
- One study examined racial disparities according to women’s self-report of advice received from health care providers during pregnancy about breast-feeding, among other topics. It found that “the difference [in advice] between Blacks and Whites…approached significance for breast-feeding.” Another study concluded that “the prenatal period may be a critical time to influence a prospective black mother’s decision to breastfeed.”
- One recent study of WIC breastfeeding support in North Carolina found that “those with higher African American populations were significantly less likely to offer clinic-based breastfeeding support services and trended toward fewer services in general” and found that “differences in the availability of breastfeeding support services were associated with the racial/ethnic composition of the catchment area.”
- A study using older data found that “being African American was associated with less likelihood of breastfeeding advice and greater likelihood of bottlefeeding advice from WIC nutrition counselors.”
- A small interview-based study of African American women and breastfeeding found that “support and advice about infant feeding from the health care system were uneven.”
Why is strong provider support important? Because study after study has found that when African American women (and all women, for that matter) are given good advice and support, breastfeeding rates go up and up.
Take for example, Boston Medical Center, which became a Baby Friendly Hospital in 1999. The rate of breastfeeding among African American women went from 34% in 1995 to 74% in 1999.
Another study found that Baby Friendly Hospitals, whether they serve high or low proportions of African American mothers, all had similarly high breastfeeding rates. In other words: disparity, what disparity?
Is there good news to share on the disparity front? Yes. The gap between black and other mothers’ breastfeeding rates is closing at a strong rate, declining from a gap of 19% down to 15% in just seven years (2000–2007).
This is a real achievement, and something to celebrate. But when it comes to getting more Black moms to breasfeed, continued progress will only occur with the full support of our health care providers.
Do you think your race had any impact on your providers’ assumptions about whether you would breastfeed? Have you experienced a "booby trap" based on your race?
Tanya Lieberman, IBCLC, is a lactating consultant and blogger. This article originally appeared at Best for Babes.