NEW YORK (WOMENSENEWS)–The breastfeeding coordinator at Lincoln Hospital in the Bronx likes to tell people this story.
An African American teen mother had a baby and said she wanted to breastfeed her child. But the father of her baby did not support nursing.
Coordinator Ilana Taubman showed the father a video produced by Women, Infant, and Children, which encourages black fathers to support breastfeeding.
The young man reacted in awe and asked: "Why didn’t we learn about this in school? Why didn’t anybody teach us of the importance of breastfeeding?"
While nationally, 74 percent of new mothers breastfeed at some point, at Lincoln Hospital that figure is more than 90 percent. Almost all of the mothers delivering babies here are black or Latina and work blue-collar jobs.
"Breastfeeding is not natural anymore to most people," said Dr. Ray Mercado, chairman of the department of obstetrics and gynecology at Lincoln Hospital. "We have to reverse that trend."
In an effort to do just that, Mercardo and staff make sure a healthy baby gets skin-to-skin contact with the mother and is latched onto her breast as quickly as possible after birth.
For the last three years, New York City’s Health and Hospitals Corporation, the country’s largest network of public hospitals, has been trying to gain "Baby Friendly" status for each of their 11 hospitals, including Lincoln. The World Health Organization certifies hospital and maternity centers as "Baby Friendly" only after they demonstrate they have taken the necessary steps to support breastfeeding, including buying formula rather than accepting gifts from formula manufacturers.
Eliminating Barriers for Black Women
If New York City’s public hospital’s leaders can attain Baby Friendly status, they can impact a huge number of women who are the least likely to gain the benefits of breastfeeding: black mothers. A third of the 23,000 mothers delivering babies in the network’s hospitals are African American, proving an opportunity to eliminate some of the barriers that make black women the least likely to breastfeed in the nation. This also puts New York City in a unique position to become the first major metropolitan area to reverse the nearly three decade-long trend of low breastfeeding rates among black women.
"We hope we’ll have the answers to promoting breastfeeding, especially among black women," said Dr. Susan Vierczhaleck, a pediatrician at Manhattan’s Bellevue Hospital and co-chair of the hospital network’s Baby Friendly steering committee. "There’s not one magic key but certainly I’m hopeful."
The fact that black women breastfeed less than white women and Latinas concerns some health leaders who say breastfeeding is the lynchpin of efforts to improve maternal health. Breastfeeding reduces a mother’s risk of cancer, diabetes and obesity over the course of her life.
"We need to normalize breastfeeding," Vierczhaleck said. "It should not be the Christmas of feeding a baby. If breastfeeding is the norm, then anything else is inferior."
In 2006, 60 percent of African American mothers breastfed at least once compared to 82 percent of Latina mothers and 76 of white mothers, according to the Atlanta-based Centers for Disease Control and Prevention or CDC.
The CDC recommends women breastfeed exclusively for six months. Roughly 30 percent of black mothers reached that goal in 2006 compared to an estimated 50 percent of Latina and white women.
Due to a bottle-feeding push in hospitals that began decades ago, a lack of education and cultural beliefs, black women across all socioeconomic categories breastfeed less than mothers with only a high school degree and mothers living below the poverty line.
More Women Dying During Pregnancy
At the same time, the number of women dying during pregnancy, a hallmark indicator of maternal health in a country, is bleak. While nationally the rate of maternal deaths is 13 per 100,000 live births, among black women in New York City in 2008 that rate was 78 maternal deaths per 100,000 live births, according to Vital Statistics data released in January. A federal goal to reduce maternal morality in the United States to 3.3 deaths per 100,000 live births is grossly missed.
Maternal mortality among black women in New York is quadruple the maternal death rate in California, which has gained a lot of press for its striking rise in Cesarean section-related maternal deaths.
A link between maternal mortality and breastfeeding may seem dubious, but it is not.
"Fifty percent of women who died in pregnancy had chronic problems, cardiac disease and hypertension," said Deborah Kaplan, New York City’s assistant commissioner of the Bureau of Maternal, Infant and Reproductive Health. "Breastfeeding can reduce the risks of some of these conditions later in life. The risk of high blood pressure and cardiovascular disease is higher among women who use bottle formula."
For the past several years, New York health department officials have actively promoted breastfeeding as a part of the mayor’s effort to support healthy lifestyles and prevent disease.
In 2007 and 2008, the city health department provided funding for its public hospitals to launch its effort to go Baby Friendly and to hire a breastfeeding coordinator at each acute care hospital. These coordinators promote breastfeeding in wards and measure program success. After 2008, the hospital network took on the funding of the Baby Friendly effort.
Busting the Myth
"New York will bust the myth that going Baby Friendly is an impossible task," said Trish MacEnroe, director of the Baby Friendly Hospital Initiative USA, based in East Sandwich, Mass. "If you can go Baby Friendly in New York, with different races, languages and cultures, and with hospitals being fiscally challenged, that sends a powerful message to all hospitals that breastfeeding is an achievement you can reach."
In the United States, 86 hospitals and birthing centers are officially Baby Friendly; many of the awarded facilities predominantly serve white women. California has the most awards with 25 Baby Friendly hospitals and centers. Now Los Angeles public hospitals, with their diverse racial cast of mothers, are on board to becoming Baby Friendly, MacEnroe said
New York’s public hospitals can boast that Harlem Hospital earned the Baby Friendly award in 2008, becoming the first in New York City and the second in the state to receive the designation. Lincoln Hospital is expected to join it soon.
Vierczhaleck says reducing the preference for bottle formula is the biggest challenge.
"Formula companies are really smart. Some mothers say they get cases of free formula delivered to their house," she said. "Where are they getting their names from? Probably baby registries."
Vierczhaleck helped write the hospital network’s breastfeeding policy that encourages nurses, doctors and breastfeeding coordinators to be sensitive to the varying beliefs mothers have about breastfeeding.
Mercardo, of Lincoln Hospital, says breastfeeding and nutrition was not an integral part of his medical training.
"That was a cultural change for our staff," said the Bronx-born doctor. "Some had children and were accustomed to bottle feeding."
Malena Amusa is a New York-based reporter completing a book about her adventures in Delhi.
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