(WOMENSENEWS)--Kathi Barber was the first to try.
"Before I nursed my son and daughter, none of the women in my family had ever breastfed before," says Barber. "But I decided change would start with me when I learned breastfeeding has health benefits for mothers and babies alike."
Barber had such a positive experience with nursing--feeling close to her children as they nuzzled her and feeling empowered when they had healthy checkups--that she went on to found the Baltimore-based African-American Breastfeeding Alliance in 2000 and to write the 2005 book "The Black Woman's Guide to Breastfeeding."
As an organizer of lactation seminars for other black women across the United States, Barber symbolizes and spearheads a growing movement to raise historically low breastfeeding rates in the black community.
An April report from the Centers for Disease Control and Prevention in Atlanta found that African American mothers, who are less likely than white or Latina women to breastfeed, are now doing so in record numbers. Sixty-five percent of black women have nursed their infants at some point, compared to 36 percent 14 years ago. But only 20 percent of black mothers reach the government's target goal of exclusively breastfeeding when their infants are six months old.
Through grassroots, hospital-based and government efforts, advocates are working to raise that number. They say that if more black women breastfed their children, it could address health problems that plague African American mothers and infants alike.
Breast Milk Reduces Risk
Last year, CDC researchers found black infants are twice as likely as white infants to be premature or underweight, or to die before their first birthdays.
Mother's milk improves those odds. Breastfed infants are seven times more likely to maintain a healthy weight than formula-fed infants, notes a 2003 study in the journal Pediatrics. Breastfeeding also reduces infants' risk of asthma, diabetes, infections and sudden infant death syndrome, all more common among African Americans.
Just as breastfeeding can help black infants, so too can it help their mothers. Research shows African American women are 70 percent more likely than other women to die of breast cancer and doubly likely to be overweight or have diabetes.
A woman's risk of developing breast cancer decreases by 4 percent for each year that she breastfeeds, according to a 2002 study in the journal Lancet. Breastfeeding burns up to 500 calories a day and can help women shed weight after pregnancy. It can also help ward off obesity and diabetes, for which African American women are at higher risk.
For women of all races, breastfeeding can lower the risk of osteoporosis and ovarian and uterine cancers. The health benefits continue through the next generation: Studies show breastfed daughters have lower rates of breast cancer when they grow up.
Though breastfeeding could help improve black women's health outcomes, they are 20 percent less likely to try it--and doubly likely to give it up before the six-month target--than their white and Latina peers.
Social and Economic Barriers
Advocates say historical, economic and cultural factors all account for this difference.
"The trend dates back to slavery, when black women were wet nurses but were not allowed to breastfeed their own children regularly," says Kiddada Ramey, president of the Detroit-based Black Mothers' Breastfeeding Association. "Black women disassociated themselves from breastfeeding and continued to do so through the generations."
Modern-day African American mothers are more likely than other women to give birth at cash-strapped hospitals that lack lactation consultants and often give away formula companies' free "welcome baby" packages to patients who take them home and get accustomed to using formula instead of breast milk.
Among some black women, formula is preferred because it has come to symbolize affluence, success and a special treat for babies.
"This is especially true of African immigrant women, who believe formula is more American than breastfeeding," says Dr. Edgar Mandeville, chief of obstetrics at Harlem Hospital Center in New York. "When we encourage African women to breastfeed as women do in their home countries, they sometimes react as if we're treating them like second-class citizens."
African American women are also three times more likely than other women to live below the federal poverty level and may face difficulty buying breast pumps. Or they may be unable to take time to pump breast milk if they hold low-paying jobs that lack workplace flexibility.
"Some black patients tell me their bosses just laugh at them when they ask for breaks to pump breast milk at work," says Dr. Bobbi Philipp, medical director of the Birth Place at Boston Medical Center.
Female relatives also may scoff. "For generations, infant formula has been the norm among black women," says Barber. "When a mother tells her daughter, 'I gave you formula and you turned out just fine,' that serves to continue the norm."
Across the nation, advocates are working to make nursing the norm among black women by offering wider education, tools and models for breastfeeding.
At the CDC, officials are promoting "Healthy People 2010" objectives that include having 75 percent of all mothers initiate breastfeeding and having 50 percent of all infants exclusively breastfeeding at six months.
The federal Office of Women's Health has made "An Easy Guide to Breastfeeding for African American Women" available online.
A total 65 U.S. hospitals and birthing centers have worked to earn "Baby-Friendly" status from the World Health Organization and the United Nations Children's Fund. This designation is awarded to facilities that offer "optimal" lactation support to patients.
At baby-friendly Harlem Hospital Center, breastfeeding videos play in the prenatal clinic's waiting room, and posters of African American women nursing their children line the walls. Staff members who interact with pregnant patients get 18 hours of training in breastfeeding basics and lactation consultants meet with every new mother.
At baby-friendly Boston Medical Center, infants have been moved out of the nursery and are rooming with their mothers shortly after birth, which helps the mother's body produce the optimum amount of milk. The hospital provides free breast pumps to patients who can't afford them, and pays $20,000 for formula annually instead of accepting free donations or gift bags from manufacturers.
At both these hospitals, most new mothers are black. And at both, breastfeeding initiation rates have spiked dramatically, now standing at 72 percent for Harlem Hospital Center and 91 percent for Boston Medical Center.
Regardless of authorities' efforts, health advocates say change depends on mothers, such as the 20 who attended a "Welcome Baby" party and breastfeeding seminar at New York City's Sydenham Health Center this month.
Surrounded by their partners, children and other relatives, pregnant women in head scarves, dreadlocks and braids watched with rapt attention as Harlem Hospital breastfeeding coordinator Alison Benjamin explained how a baby latches on to the breast.
No one reached for the pink and blue balloons, or for the white and yellow birthday cake. All eyes fixed on Benjamin, except for those of a woman who sat in the corner, quietly breastfeeding and cooing to her newborn.
Molly M. Ginty is a freelance writer based in New York City.
This series is supported by the W.K. Kellogg Foundation.