Healthy Births, Healthy Moms: Black Maternal Health in America

Part: 12

'Baby-Friendly' Hospitals Bypass Black Communities

Thursday, August 29, 2013

Very few of the maternity wards that have won a seal of approval for providing breastfeeding support are located in communities with a significant population of African Americans, a Women's eNews analysis finds.




Baby in the hospital

Credit: Crystal Marie Lopez/LaBellaVida on Flickr, under Creative Commons (CC BY-ND 2.0)

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(WOMENSENEWS)--Breast milk is the most local of all foods and one that can have an outsized impact on the health of mothers and infants.

However, for many African American parents finding a maternity ward that supports the process immediately after birth can be extremely difficult.

That's the finding of Women's eNews' review of the U.S. locations of so-called Baby-Friendly hospitals, maternity hospitals that have passed a set of stringent standards established by the World Health Organization to assist brand-new parents to begin breastfeeding.

A Women's eNews analysis finds that 45 percent of U.S. Baby-Friendly hospitals are in cities and towns that have African American populations of 3 percent or less.

A full 83 percent of U.S. Baby-Friendly hospitals are in communities where the African American portion of the population is 13 percent or less.

This geographic segregation of breastfeeding care and support may play a significant role in the lower breastfeeding rates among African American mothers, which in turn means the mothers and the infants do not enjoy the health benefits of breastfeeding.

Moreover, despite their potential role in improving the nation's health, the "Baby- Friendly" designation is not widely understood, even in the highest public health circles, anecdotal evidence suggests.

At a recent conference on medical issues surrounding breastfeeding, one questioner asked Dr. Ana Pujol McGee, chief medical officer and executive vice president of the Joint Commission, the agency that sets standards for hospitals nationwide, about the lack of support for Baby-Friendly hospitals at the highest levels of the health system.

"Why is there no leadership from the commission on Baby-Friendly hospitals?" McGee was asked.

"What's a Baby-Friendly hospital?" McGee replied.

The attendees moaned in response. Later, in the hallway outside the meeting, Trish MacEnroe, executive director of , gave McGee a quick briefing.

Local Champions

The location of Baby-Friendly hospitals depend on what many call "champions," someone within a hospital who has the leadership skills, time and determination to lead the change. Hospitals must volunteer to change their breastfeeding support practices and pass inspection by Baby-Friendly USA in order earn the Baby-Friendly status.

This dependence on local leadership has led to a haphazard distribution of breastfeeding support throughout the United States, affecting all parents. However, given that black mothers are the least likely to breastfeed, the lack of assistance during the crucial hours after birth seems at least a major missed opportunity as well as a reflection of the cost of racial segregation that persists throughout most of the United States.

One of the key Baby-Friendly rules--designed to limit the influence of infant formula makers--requires the hospital buy its own infant formula and not provide free formula to departing parents, including the free diaper bags provided at no cost by formula companies with a handy six-pack of formula inside.

Few Baby-Friendly hospitals can be found in big urban centers with large African American communities and other low-income residents.

New York City, for example, home to more than 2 million African Americans--9 percent of all African Americans nationwide-- has only two Baby-Friendly hospitals, but none in the areas outside Manhattan where most African Americans live.

Detroit, now seeking to avoid its pension obligations in bankruptcy court, has a population of 700,000 that is 83 percent African American and has no certified Baby-Friendly hospitals. A suburb does though; the affluent Grosse Point, with a community that is 3 percent African American.

Kiddada Green lives in Detroit and is founding director of the Black Mothers' Breastfeeding Association, a national organization that aims to eradicate the racial disparity in breastfeeding rates among African American women. Green is among the leaders of grassroots advocacy and service organizations declaring the week of Aug. 25 Black Breastfeeding Week.

Demographic Disparities

The geography of Baby-Friendly hospitals concerns Green.

"In order to increase the number of black babies who are breastfed, we must look specifically at the regional and racial demographics of the locations of Baby-Friendly hospitals and identify ways to increase the number of Baby-Friendly hospitals in areas that are highly populated with African American families," she said.

The cities other than New York and Detroit with the largest African American populations are, in order, Chicago, Philadelphia and Houston. None of these cities has a Baby-Friendly hospital and yet, combined, 1-in-8 African Americans live in these five cities.

Based on births in 2009, the Atlanta-based Centers for Disease Control and Prevention (CDC) reported two years ago that, overall, Baby-Friendly hospitals were relatively scarce across the country.

Nebraska had the highest percentage of infants born in Baby-Friendly hospitals, with more than 20 percent. Nine states, mostly in the South and Midwest, had none.

For Nearly 1-in-5 Black Americans No 'Baby-Friendly Hospital In-State
Less than 5 percent of the 166 U.S. hospitals meeting criteria for the WHO'S Baby-Friendly Hospital Initiative are in the nine states plus District of Columbia with the highest concentrations of black Americans; areas home to one-third of the country's black population. Nationwide, almost one-fifth of black Americans live in states without a single hospital meeting the WHO's 22 year-old standard of care.

Hospital data as of July, 2013. Population data from 2010 U.S. census.

 

Legend

 WHO-designated 'Baby-Friendly' hospitals

Percent of total county population identifying as Black alone, or in combination with other races, 2010

 0 to 5.1%
 5.1% to 16.3%
 16.3% to 38.4%
 38.4% and up
 No data

About this map: Intervals for this map were selected based on the median population density of blacks across all U.S. counties, and the accompanying quartile boundaries. Colors were generated via colorbrewer2.

Credit: Susan E. McGregor, Tow Center for Digital Journalism.

Support for breastfeeding in all communities has increased dramatically during the administration of President Barack Obama.

Through a concerted effort of the former surgeon general, Regina M. Benjamin, and many others in the health community, U.S. breastfeeding rates have continued to rise. Between 2000 and 2010, the percentage of mothers who said they breastfed their babies in the early postpartum period increased to nearly 77 percent from 71 percent, according to an August report from the CDC.

The CDC also reported in August that black mothers nationwide lag behind other racial and ethnic groups when it comes to breastfeeding. In a , 54 percent of black mothers initiated breastfeeding compared with 74 percent of white mothers and 80 percent of Hispanic mothers. The CDC reports this gap persists regardless of income and educational attainment.

Rise in Baby-Friendly Hospitals

Meanwhile, the number of Baby-Friendly hospitals certified by Baby-Friendly USA has increased by 12 this year, for a total of 166. Of the 12, however, only two are located in a community with a large African American population: St. Mary's Hospital in Decatur, Ill., where the African American population is 23 percent, and Georgetown. S.C., with a 57 percent African American population.

The CDC has addressed the geography issue, said MacEnroe of Baby-Friendly USA, the organization that works with hospitals seeking the certification.

An initiative launched by the CDC, called Best Fed Beginnings, is working with 89 additional hospitals serving low-income patients that are willing to work toward becoming officially Baby-Friendly. Of those, two are in Houston, two are in Philadelphia and one is in Chicago. None are in New York City or Detroit, with a total of more than 3 million African American residents.

The CDC also reported this month an unprecedented decline in U.S. obesity rates, attributed in part to increased breastfeeding. The obesity rate for school-age, low-income children in the United States dropped by as much as 1 percent, in what the CDC hopes might be a trend. At the current time, 1-in-5 black children and 1-in-6 Hispanic children are obese, leading to lifetimes of poor health.

Increasing breastfeeding is seen as a major strategy on the national level for improving the health of African American mothers and their children. For women, breastfeeding reduces the risks for breast and ovarian cancer, as well as obesity, diabetes and heart disease.

For infants, the health benefits are also significant. Babies who are breastfed have lower risks of ear and gastrointestinal infections, diabetes and obesity. Breast milk also contains antibodies that help babies fight off viruses, bacteria, allergies and asthma.

"This persistent gap in breastfeeding rates between black women and women of other races and ethnicities might indicate that black women are more likely to encounter unsupportive cultural norms: perceptions that breastfeeding is inferior to formula feeding, lack of partner support and an unsupportive work environment," said a 2002 report published by the Journal of the Black Nurses Association.

Green, the breastfeeding activist in Detroit, said she also wants a closer look at the impact of Baby-Friendly hospitals on these breastfeeding rates. "It is my wish that there is an examination of how this initiative is positively impacting the breastfeeding disparity gap for black babies," she said.

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