Jennifer Fernandez
Last week, nine students took part in a “white coat” ceremony on the campus of North Carolina A&T State University in Greensboro, North Carolina, the day before nearly 190 people gathered for an in-depth look at how to normalize breastfeeding in the black community.
They are among more than 40 participants trained in what organizers say is the first breastfeeding training program held at a public, historically black college or university in the United States.
This historic step was taken by NC A&T four years ago, and the new students represent a sign of progress in a field that has had a severe shortage of Black, Hispanic, Native American and Asian lactation professionals.
Andrea Serrano, interim executive director of Reaching Our Sisters Everywhere, an organization created to address breastfeeding disparities in communities of color, was heartened to see the freshmen receive their lab coats to wear during their school days.
“With so much work still to be done to diversify the field and the lactation field, it was great to see all of the new candidates preparing to become colleagues in this line of work, and I felt like that set the tone for the meeting,” Serrano said.
The next day, people from around the country, including lactation specialists, maternal health workers and those involved in breastfeeding and childbirth, gathered at the A&T Extension and Research Farm Pavilion to discuss ways to increase breastfeeding rates among Black mothers.
Breastfeeding is natural, but it's not always easy. Lactation consultants help families overcome the challenges of breastfeeding, like treating sore nipples, getting your baby to latch on, and finding the right position for your baby to breastfeed.
While only about 10% of lactation consultants nationwide are black, the number of black mothers with newborns is far greater, reaching 21.5% of all mothers in North Carolina by 2022, according to data from that state.
Janiya Williams, founder and executive director of the A&T program, said there is always a demand for more diverse lactation consultants, such as those who have completed A&T's program.
“Our community members and patients get to see people who look like them doing this work,” she said.
Williams came up with the idea to host a conference in 2021 while seeking grant funding to support maternal and child health programs through the Blue Cross Blue Shield of North Carolina Foundation, which included plans for the conference to focus on “Black and Brown breastfeeding.”
The two-day Uplifting Black and Brown Lactation Success Conference, held August 8th and 9th, was co-hosted by NC A&T's Pathway 2 Human Lactation Training Program and Reaching Our Sisters Everywhere, a national nonprofit organization working to normalize breastfeeding in the black community.
Serrano said participants came from California, Texas, Michigan, Georgia and New York.
Janiya Williams (far left) talks with panelists Jade Chiu (seated left), Kimberly Moore Salas and Lynnells Higuera Ansidy during the first day of the Advancing Breastfeeding Success Conference for Black and Brown Women at NC A&T State University in Greensboro, N.C., on Aug. 8, 2024. Photo by Jennifer Fernandez/NC Health News The Importance of Breastfeeding
Studies have shown that breastfed babies are less likely to suffer from asthma, type 1 diabetes, ear infections and gastrointestinal infections. They also have a lower risk of obesity and sudden infant death syndrome.
A 2004 study published in the journal Pediatrics found that “breastfeeding reduces the risk of neonatal mortality by 21 percent for all infants and by 31 percent for black infants.”
Breastfeeding also has benefits for expectant parents, reducing the risk of high blood pressure, type 2 diabetes, and breast and ovarian cancer, according to the US Centers for Disease Control and Prevention.
The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first six months of life before introducing nutritious supplements.
North Carolina ranks in the middle of the pack compared to other states when it comes to breastfeeding babies at any point through the age of six months.
According to CDC data, 60.3% of children born in North Carolina in 2021 (the last year for comprehensive data) were breastfed at some point during their first 6 months of life. By the time children turned 1 year old, that percentage dropped to 38.4%.
An even smaller percentage of children are exclusively breastfed: About half of North Carolina infants are exclusively breastfed during the first three months of life. By six months of age, just over a quarter are exclusively breastfed.
The number has been increasing in recent years.
Nationwide, the percentage of babies initiating breastfeeding increased between 2004 and 2021, reaching 84 percent.
In North Carolina, the overall percentage of children who are breastfed, either partially or exclusively, has increased from 2009 to 2021. During that same time, the percentage of children who are breastfed during the first 6 months of life increased from 40.3% to 60.3%. The percentage of children who are exclusively breastfed during the first 6 months of life increased from 13.9% to 28.3%.
Breastfeeding disparities
Nationwide, about 75 percent of black infants are breastfed, compared with an overall average of 84 percent, according to the CDC.
Williams and Serrano said it's essential to promote the benefits of breastfeeding to birthing women of color.
“We know that Black and brown babies have the lowest breastfeeding rates and the highest infant mortality rates,” Williams said, “and we know that breast milk can counter some of the causes of infant mortality.”
Serrano added, “There has always been a roughly 15 to 20 percentage point gap between breastfeeding rates in our community and other racial and ethnic groups, and that gap is perpetuated by systemic issues.”
Andrea Serrano
Serrano said Black families aren't always counseled about breastfeeding at clinics or hospitals. The information they receive may not be accurate or culturally centered. They may not be properly evaluated. And Black families are often encouraged to use formula, she said.
A CDC study published in 2019 found that maternity facilities in areas with large black populations are less likely to offer postpartum breastfeeding support, and that black infants are more likely than white infants to be fed formula without medical direction.
Another study published in the journal Pediatrics found that black babies were nine times more likely than white babies to be given formula while in the newborn unit.
Serrano said that while it's common for breastfeeding rates to decline for everyone in the weeks after birth, the decline is much larger for black babies.
Her organization looked at the National Pregnancy Risk Assessment Measurement System and found that breastfeeding rates among black families dropped 21 percent each week in the first four weeks after birth.
Barriers to breastfeeding
Jade Chiu, a breastfeeding peer counselor with the Guilford County Health Department, said with so many differences within the community, lactation consultants need to be conscious of their own biases not only when working with cultures different from their own, but also within their own culture.
“Even within the same nationality, same ethnicity, same race, there are a lot of nuances and differences,” she said, “so just because I feel this way doesn't mean someone else in my community feels the same way.”
Kimberly Moore Salas, a peer counselor and lactation educator at Arizona Native Community Health Centers, shared the story of one patient that made her realize how important representation is in this type of work.
A new mother was at the hospital when someone took her baby away, and she pleaded with Moore-Salas, “Please don't let me wash my baby. He still has the starry sky in him.”
“And that resonated with me,” she said, “because as Indigenous people, we believe we were born from the stars.”
Minority families face a variety of other barriers to breastfeeding.
Linells Higuera Ansidi, “Ready, Set, Baby” facilitator at the Carolinas International Breastfeeding Institute at the University of North Carolina Gillings School of Global Public Health, encouraged participants to be sure to bring an interpreter when working with families who speak a different language.
“Don't use your husband as a translator. Don't use your partner. Don't use your brother. Stop it,” she said. “They need to share that moment with the people they love and support.”
Six in 10 mothers stop breastfeeding sooner than they planned. According to the CDC, many factors influence how long a mother breastfeeds, including issues with breastfeeding or baby's latch, concerns about infant nutrition or weight, unsupportive hospital practices and policies, concerns about taking medications while breastfeeding or breastfeeding, cultural norms, lack of family support, unsupportive workplace policies, and lack of parental leave can also play a role.
The country's history of enslaving black mothers and forcing them to breastfeed white babies still resonates today, Williams and others say. Slave labor requirements prevented black mothers from breastfeeding their children. Because of generations of being denied the ability to breastfeed, many black people today have relatives who have never breastfed or who don't think twice about it.
Sierra Bizzell, a birth doula and certified lactation consultant studying to be a midwife, said she sees a lot of misinformation: some mothers endure pain but think it's normal, while others are told by their families that they won't produce enough breast milk and should use formula.
Recently, I've come across many mothers who are worried about whether they will be able to breastfeed their babies.
“I think this is just too much information from different sources that may or may not be qualified to provide information,” she said.
“We need more education from people who look like us who can talk about these misconceptions,” Bizzell added, “because even though we all grew up in different places, many of us have had similar experiences in terms of what was said to us and what was taught to us.”
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