Anankhka Roger breastfed all four of her children. But in her African-American neighborhood in Middletown, New York, she was an anomaly.
“They’d say, ‘Why would you do that?’” she remembers. “Out of 10 or 15 moms in my church group, maybe two or three would breastfeed. Sometimes I was by myself.”
The majority of black women have opted for formula for generations, say breastfeeding advocates. Until recently, researchers have only been able to guess at why, but a study presented at the October 2010 national conference of the American Academy of Pediatrics in San Francisco may provide some fresh insight.
Two doctors at an inner-city hospital in Camden, New Jersey asked formula-feeding mothers a simple question: Why did you decide not to breastfeed? What they found surprised them. Fifty-five percent of black women reported “lacking a desire to breastfeed” (as compared to 27 percent of all other mothers studied). Typical answers were: “I think it’s disgusting,” “I just don’t want to,” and “Nobody I know does that.”
The study tested only a small population—145 mothers, 62 of them black—and leaves many important questions unanswered. But the researchers think that their findings get at a new and unexplored aspect of the breastfeeding problem. “We just thought there would be similarities between why formula-feeders formula-feed. We didn’t know their answers would differ by race and ethnicity,” says Cooper University Hospital pediatrician Dr. Lori-Feldman Winter, one of the study’s authors. And they didn’t expect that attitude would play such a big role.
Educating moms about the health benefits of breastfeeding is the focus of most advocacy groups. But the study indicates that more education might not solve the problem, says Feldman-Winter. “The black women in our study seemed to be aware of the benefits,” she says. “Pounding away that there are benefits is not the answer.” Instead, she thinks using motivational techniques—trying to convince formula-feeders one-on-one to change their minds, rather than just presenting them with the evidence—might work better.
Many professional breastfeeding advocates agree on the importance of working with women one-on-one, but they think that spreading the word about breastfeeding’s benefits is still the answer. The federal Women, Infants, and Children (WIC) program, for example, funds advocates who provide individual counseling that helps educate moms-to-be and their spouses and families about the benefits of breastfeeding. Many advocates don’t think that the new data provides any reason to modify their approach. The evidence of the health benefits, they think, does the convincing for itself.
Research has indicated that African-American babies are more likely to be underweight and to suffer Sudden Infant Death Syndrome. Later in life, they’re at higher risk for diabetes and asthma. These are all problems that have been associated with lower rates of breastfeeding in some medical studies. It’s also thought that babies who aren’t breastfed may have an increased risk of getting infectious diseases like bacterial meningitis and respiratory tract infections, and of developing certain cancers, according to the American Academy of Pediatrics.
Low breastfeeding rates aren’t only a problem among African-Americans. The World Health Organization recommends that mothers breastfeed exclusively for the first six months of the baby’s life and continue breastfeeding—supplementing with appropriate foods—until the baby is two years of age or more. However, a recent report by the federal Centers for Disease Control and Prevention shows that while 75 percent of new mothers start out breastfeeding, only 43 percent are still nursing by the time their babies are six months old. The numbers for black mothers are significantly lower. According to the most recent CDC data, from 2009, only 49 percent initiated breastfeeding, and just 20 percent were still at it when their babies were six months old.
Whether they support or question current education strategies, experts believe that longstanding cultural barriers are the main reason many African-American women refuse to nurse. “Black women were used as wet nurses for the wealthy,” says Feldman-Winter. “When they were no longer slaves, not breastfeeding was seen as a source of freedom.” After generations of shunning the practice, there’s no cultural framework for breastfeeding, say experts, and so new moms lack role models and supportive communities.
Many breastfeeding advocates believe that whether or not attitude is the cause of the problem, the only way to change a cultural pattern is to empower individuals with knowledge and let them make their own decisions. “That black women don’t want to breastfeed—that’s not the point,” says Stephanie Sosnowski, deputy director of the New York-based Maternal-Infant Services Network. “It just comes down to raising mom’s awareness and raising the awareness of the people around her.”
Anankhka Roger has seen firsthand that good education can overcome cultural barriers. Once a recipient of WIC food stamps herself, she now works for the program, educating moms and moms-to-be about the benefits of breastfeeding. “One mom came in and told us “I’m going to feed formula because of x,y, and z,” she laughs. “By the time she was ready to leave, she was saying ‘You guys have me convinced!’”