Breastfeeding among Low Income, African-American Women: Power, Beliefs and Decision Making

Abstract

Breastfeeding rates among African-American women lag behind all other ethnic groups. National data show that only 45% of African-American women reported ever breastfeeding compared to 66 and 68% of Hispanic and white women, respectively. Of African-American women who do choose to breastfeed, duration is short, with many discontinuing in the first days after birth. This report applies a social ecological framework to breastfeeding to investigate macrolevel-microlevel linkages. We posit that macrolevel factors, such as the media, aggressive marketing of breastmilk substitutes, welfare reform, hospital policy and breastfeeding legislation, interact with microlevel factors to influence a woman's decision to breastfeed. These microlevel factors include features of the community, neighborhoods, workplaces that support or discourage breastfeeding, social and personal networks and cultural norms and individual beliefs about breastfeeding. The report discusses how power operates at each level to influence women's choices and also emphasizes the value of ethnographic data in breastfeeding studies. Through a case study of a sample of low income, African-American women living in Baltimore, MD, where breastfeeding role models are few, beliefs that discourage breastfeeding are many, and where everyday life is full of danger and fear, it is understandable that breastfeeding is not considered practical. The narrative data provide important information that can be used to enhance intervention efforts. To reach the Surgeon General's Healthy People 2010 breastfeeding goals requires a shift in cultural norms and structures at all levels that will support breastfeeding for all women.

Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions

“…Finally, the inner, or individual, level is typically understood as the motherinfant dyad. 50,63 Although the social ecological framework shows the level that the intervention targets, the history of past and present racial discrimination presents the sociohistorical context in which the interventions operate, 26 thus functioning as a larger context in which all interventions operate (Fig. 1).…”

“…48,49 Additionally, low-income mothers often lack adequate levels of personal social support from family and friends as well as the flexibility within work environments that are associated with positive breastfeeding behavior. 45,50 Furthermore, negative life events, 51 chronic social and environmental stress, 52 and lack of models and resources 53,54 might all account for class differences in postpartum care practices like breastfeeding among lowincome African American women. Despite great need, African American mothers are less likely than other groups of women to receive support or treatment for their social, physical, or emotional needs.…”

Racial and Ethnic Differences in Breastfeeding

“…15 Health-related variables included 1 month postpartum depression, 16 according to the Edinburgh Postnatal Depression Scale 17 (scores ≥9 were categorized as depressed); smoking at 1 month 18 ; and infant preterm birth 19 (via medical records, gestation <37 weeks). We also collected maternal and paternal family history of breastfeeding 20 (determined by asking mothers and fathers "Did the woman who raised you breastfeed any children?") and the mother's belief 21 that "breast is best" (assessed by asking "Which of the following do you think is the best way to feed a baby-breastfeeding, a mix of breast milk and formula, only formula, or either breast milk or formula?").…”

The Effect of Maternity Leave Length and Time of Return to Work on Breastfeeding

“…18,40,41 Variables were classified as maternal (race/ethnicity, age, marital status, education, income status (Ͻ/Ն185% of federal poverty level [FPL]), smoking status in last 3 months of pregnancy, and country of birth); child/delivery (birth weight, mode of delivery, birth order, and health care professional advice about breastfeeding); interpersonal/family (separation from child and child care arrangements); and organizational/community (participation of the child or mother in the past 12 months in the All independent and control variables, except country of birth, were drawn from the 9-month interview data. Country of birth was ascertained at the 2-year interview; hence, we created a missing category for those lost to follow-up by the 2-year interview.…”