November 20, 2019
By Andrea Serano, IBCLC, CLC, Reaching Our Sisters Everywhere (ROSE) Inc.
Reaching Our Sisters Everywhere (ROSE) Inc. was founded to address breastfeeding disparities for communities of color. ROSE works to normalize breastfeeding by providing resources and networking opportunities for individuals and communities. As a national expert, and in partnership with communities, we build equity in maternal and child health through culturally competent training, education, advocacy, and support. Through our mission, support from the W.K. Kellogg Foundation, and collaboration with HealthConnect One, created Saving Tomorrow Today: An African American Breastfeeding Blueprint. Before we can explore our publication, we must first recognize the landscape of Breastfeeding Blueprints.
In 2001, the United States Surgeon General Dr. David Satcher spearheaded the Health and Human Service Blueprint for Action on Breastfeeding. This publication provided a thorough review and analysis of breastfeeding rates in the United States, along with recommendations for implementation strategies to address challenges and barriers to breastfeeding. Ten years later in 2011, United States Surgeon General Dr. Regina Benjamin, issued The Surgeon General’s Call to Action to Support Breastfeeding. Expanded to the 2001 Blueprint, this publication provided a robust analysis on the landscape of breastfeeding in the United States, and specific call to actions for Mothers and Their Families, Communities, Health Care Providers, Employers, Research and Surveillance, and the Public Health Infrastructure. Since the release of these two knowledge filled publications, North Carolina and Illinois have released their own state Breastfeeding Blueprint. The Illinois Breastfeeding Blueprint serves is an excellent example of a targeted state Blueprint and was created in partnership with HealthConnect One.
In 2016, ROSE leadership and team determined it imperative to have a national breastfeeding blueprint that explored the racial inequities impacting breastfeeding rates for African American families. In our work, ROSE elevates the importance of breastfeeding for our communities, as it strongly impacts the lifetime health outcomes for infants and provides profound maternal health benefits. In an effort to not reinvent the wheel, we utilized the framework established by previously published Breastfeeding Blueprint to delve into African American breastfeeding rates, barriers, challenges, and recommendations for next steps.
Throughout the three-year development process, amplifying a different narrative remained at the core of this work. African American families DO breastfeed! All too often, in other forms of research and articles, the inaccurate repetitive message that African American families do not breastfeed and it is to a fault of their own unwillingness to do so is a gross misanalysis of the greater issue on institutionalized and structural racism, and thus perpetuates the harmful practice of inadequate care and support.
Dr. Termeh Feinberg, expertise served as one of the integral partners in the implementation process for creating the blueprint, especially on data gathering and analysis. National surveillance data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2009-2015 was used to identify breastfeeding trends among African American mothers. Qualitative data gathered from key stakeholder engagement through focus groups, interviews, and listening session reflect the current relevant concerns, issues, barriers and triumphs in promoting, protecting and supporting breastfeeding for African American families. Key stakeholders consisted of African American breastfeeding women, families, lactation support providers, community advocates, researchers, and healthcare providers. All of which are experts in their respective field and experiences, and very much appreciated for sharing their knowledge and feedback throughout the creation of our Breastfeeding Blueprint.
As a result, this process equated to an enriching landscape assessment. Highlighted below are a few key findings.
Breastfeeding Initiation
Breastfeeding initiation for African Americans has continued to climb, to date the Center of Disease Control and Prevention reports that the current initiation rate is 74 (+/-3.6). This clearly indicates that more than half of African Americans do initiative breastfeeding.
Duration
Breastfeeding Duration in the first 4-weeks is clearly a crisis window for intervention and support. For African Americans, breastfeeding decreases by approximately 20% each week after birth. Improvement on duration is possible with equitable access to breastfeeding support and resources during this time period when families are getting accustomed to their new baby.
When looking at the trends for reasons women gave for “Why They Stopped Breastfeeding”, we can see that all of the common concerns could be address with equitable and adequate breastfeeding support.
Findings from this nationally-representative study demonstrate the need for equitable access to funding for the implementation of breastfeeding support programs and initiatives, the effects of systemic racism on breastfeeding and the importance of addressing gaps in data collection on breastfeeding and African American families. This landscape assessment provides an opportunity to identify strategic direction for investment of resources in order to create an equitable First Food environment for African American families. To further explore our findings, we recommend downloading the Saving Tomorrow Today: An African American Breastfeeding Blueprint at http://www.breastfeedingrose.org/aablueprint/ for a complete review of the data trends and listening sessions feedback.