Detroit Team Shrinks Breastfeeding Disparities

DETROIT (WOMENSENEWS)–She faced one of health care’s most persistent problems.

Eleven years ago, when Dr. Paula Schreck became director of breastfeeding support services at St. John Hospital and Medical Center here, she grew concerned about her black patients. Unlike the white and Latina women she was treating, they weren’t as readily initiating breastfeeding, which studies have proven to be healthier than using infant formula for mothers and babies alike.

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"Research showed that across the U.S., black women were only about two-thirds as likely as women of other ethnicities to start breastfeeding and to continue it for the six months that health authorities recommend," says Schreck. "It was a longstanding problem. And to change it, I knew my colleagues and I would have to get creative."

Determined to achieve healthier outcomes for her patients (90 percent of whom are black and 85 percent of whom receive Medicaid, the government-funded health insurance for low-income Americans), Schreck started reaching out to African American health activists for help and advice.

Together, they connected with community, corporate and government groups, forming innovative partnerships. They ferreted out money whenever they could find it, forming a patchwork of grant funding to launch, starting in 2011, a series of new breastfeeding programs that serve St. John’s patients.

After establishing those programs, they began addressing a racial disparity among health care providers that was contributing to the overall racial disparity in breastfeeding rates. They hired African American women to become breastfeeding peer counselors and started training them to become skilled lactation consultants.

As a result of this collaborative, out-of-the-box approach, Schreck, her colleagues–and their patients–have overcome the odds.

Today at St. John, 68 percent of black mothers now initiate breastfeeding. "That’s nearly double what the number was before we started," says Renee Pearson, one of three African American breastfeeding peer counselors now working at St. John.

Pearson is earning a bachelor’s degree in health services administration while her work at St. John helps her gain the skills and credits needed to become a certified lactation consultant. Thanks in large part to the support she has received at the hospital, she is among a small but growing number of black women who are seeking more advanced training in breastfeeding medicine.

Studying Other Successes

To drum up ideas that would create stronger support for breastfeeding among St. John’s patients, Schreck didn’t work in isolation, but instead studied the example of successful health care initiatives.

Some were small scale, local programs, such as the Mother’s Milk Club at Rush University Medical Center in Chicago, which offers breastfeeding support groups to women of color.

Other models were global endeavors, such as the Baby-Friendly Hospital Initiative, which was founded by the World Health Organization and the United Nations Children’s Fund and establishes stringent breastfeeding standards for hospitals across the globe.

Schreck consulted Detroit groups such as CareLink, the Parish Nurse Program, the Detroit Regional Infant Mortality Reduction Task Force and The Detroit Urban League. Many of these initiatives are staffed and headed by African Americans.

"Activists in this community told us that the biggest obstacle to black mothers breastfeeding was a lack of community support," says Schreck, a mother of two with bright hazel eyes and a trim white lab coat. "Black women weren’t breastfeeding because their friends and family members simply weren’t doing so themselves."

Scientific literature proved peer support was key: 2009 research in the Journal of Human Lactation showed black mothers who attended support groups were twice as likely to breastfeed as those who did not. Other studies showed people of different ethnicities were significantly more receptive to receiving health information when it was delivered by someone with whom they identified–someone who looked like them, talked like them, and was in their same peer group.

Part of the disparity in black women’s breastfeeding rates could also be attributed to inadequate maternity health care. Hospitals in areas where the percentage of black residents was above the national average of 12 percent were less likely to promote early initiation of breastfeeding, give obstetrics patients breastfeeding supplements and to have new babies "room in" with their mothers, found a 2014 report by the Centers for Disease Control and Prevention.

"There are racial disparities in access to maternity care practices known to support breastfeeding," noted the study’s authors; a determination also made by Women’s eNews in a 2013 report on the failure of hospitals in black neighborhoods to support breastfeeding.

Concluding that a stronger sense of community and improved hospital care were the keys to spurring change, Schreck and her colleagues at St. John moved to launch Mother Nurture, an innovative program pairing new mothers with black breastfeeding peer counselors who meet them one-on-one and in support groups.

Collaboration in Action

Since a collaborative effort led to its launch in 2011, Mother Nurture has served as an example of collaboration in action.

When it hired its breastfeeding peer counselors, Mother Nurture relied on partnership with the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, a government program that offered the initial, two-day training for Mother Nurture‘s peer counselors.

Next, Mother Nurture sought to give its breastfeeding peer counselors more in-depth training. For this, it collaborated with the Detroit-based Black Mother’s Breastfeeding Association, which helped Schreck and her colleagues launch the Mother Nurture Lactation College in 2013. Through this program, breastfeeding peer counselors can move on to become certified lactation consultants.

Both the peer counseling and lactation consultant programs involve further collaboration within their ranks. Here, black mothers brainstorm about how to address challenges: a baby who won’t latch on; a husband or boyfriend who is critical of breastfeeding in public; or a grocery store that tempts women away from breastfeeding by offering free bags of diapers with infant formula that is bought in bulk. Working together, women learn about breastfeeding’s benefits and spread the word to their wider communities.

Dalvery Blackwell, co-founder of the Milwaukee-based African American Breastfeeding Network, says community building like this may be the most effective way that health care providers can address racial disparities in nursing rates.

"To get black mothers to breastfeed, we need to work not just with them, but with their partners, grandmothers and best friends," she says. "We need to promote breastfeeding to everyone in black women’s support networks, too."

Collaboration is key, affirms Schreck. "We’re collaborating not just in terms of the way we design our programs, but in the way we fund them, too." In other words, funding comes from several sources at once.

Mother Nurture‘s first substantial grant came from a funder also in Michigan; the W.K. Kellogg Foundation, located in Battle Creek. It was for $1.2 million and helped sustain Mother Nurture from its launch in 2011 through the year 2014.

Funding from Kellogg–which also supports projects at Women’s eNews–continues today in the form of two grants (one for $500,000, one for $750,000, and both slated to continue through 2016).

Also lending support are the Ronald McDonald House of Charities, the Comerica Foundation, Blue Cross and Blue Shield, the National Association of County and City Health Officials and other funders that together offer grants totaling $100,000 and slated to last through 2017.

’19 Grants Keeping Us Afloat’

"We rely on a whole group of funders who appreciate the value of our work," says Schreck. "We’ve got 19 separate grants keeping us afloat. We have six full-time staff members, and one of them devotes almost all of her time to fundraising."

On top of private grants, an additional 20 percent of Mother Nurture‘s $500,000 annual budget comes from the state or federal governments, which work with Schreck and her team to help fill the remaining funding gaps.

Blackwell says that to create more programs like Mother Nurture, the biggest obstacle is funding. "Organizers need to look everywhere for support–and that financial model can be tough to sustain," she says. "In the future, as we spread the word about the need for programs like this, we hope more grant providers will take the initiative and throw their support behind this movement."

Four years since its launch, Mother Nurture has succeeded in better meeting its patients’ needs. It now has a "breastfeeding boutique" where patients can obtain nursing bras, breast pumps and other supplies; an obstetrics clinic staffed by lactation consultants; and a program that ensures breast milk is provided to infants who are treated in the neonatal intensive care unit. For these and other accomplishments, St. John was deemed a "Baby Friendly" hospital in 2014–a designation achieved by less than five percent of U.S. hospitals.

Thus far, Mother Nurture‘s lactation college has helped one African American woman become a full-fledged lactation consultant: Stacy Davis, who now works at Providence Hospital in Southfield, Mich. The program is currently training two other candidates, and hopes to welcome two more in late 2015.

Mother Nurture‘s policies are having an impact on the wider Detroit community because St. John is a large hospital that oversees 3,500 deliveries annually; because it lies within a system of five hospitals that oversee a total 9,000 deliveries per year; and because elements of Mother Nurture are being replicated system wide.

More Work Ahead

Still, health activists at the Mother Nurture program and elsewhere say that much more work still needs to be done to expand the kind of work Mother Nurture does and reach more women.

The most recent statistics indicate that in Michigan, only 16 percent of women exclusively breastfeed at the six-month mark, one of the lowest rates in the nation (Michigan ranks 33 out of 50 states in this regard).

Another concern is the still-pressing need for more lactation consultants who are African American.

Black breastfeeding peer counselors fill a vital need, say health advocates. But having more of them is no substitute for having more black women playing oversight roles as certified lactation consultants, managing maternity wards and shifting those institutions in a more culturally sensitive direction. "We need more women from the African American community put in more charge here," says Schreck.

In the entire state of Michigan, only six black women are certified lactation consultants. In Detroit itself–where there are more than 688,000 residents, 83 percent of whom are African American–the total number of black lactation consultants is just two.

"To really help mothers in the African American community, the health care system needs to train more of us," says Davis, a soft-spoken mother of four with a thoughtful, steady gaze. "But juggling lactation college coursework while raising a family and working to earn a living can really put the squeeze on black women who are on fixed budgets and who have to push themselves hard to reach this goal."

Valerie Rochester, director of programs for the Black Women’s Health Imperative in Washington, D.C., says health advocates need to drum up stronger community support and more generous scholarships for African American women who are seeking to become certified lactation consultants.

"Health problems are systemic problems, and they require systemic solutions," says Angela M. Johnson, a senior outreach specialist at the Program for Multicultural Health at the University of Michigan in Ann Arbor. "To overcome racial disparities in breastfeeding, we need grassroots organizations, hospitals and policymakers all working together to address this persistent problem. Partnership and collaboration on these fronts need to happen not just in Detroit, but across the entire nation."

This series was partially funded by the Solutions Journalism Network.