Social norms, lack of support may keep many African American moms from breastfeeding

August 29, 2017

URBANA, Ill. – While completing her Master of Public Health capstone project at the Champaign Urbana Public Health District (CUPHD) breastfeeding program, a University of Illinois researcher noticed a disparity: fewer African American women were asking for breastfeeding support.

Julia Kim, a doctoral student in the Division of Nutritional Sciences at U of I began to study previous research on the demographics of women who tend to breastfeed and the disparity was confirmed. Although breastfeeding rates have increased for African American women over the years, the literature shows that African American moms are less likely to start and continue breastfeeding than mothers of other ethnicities.

In a study published in the Journal of Nutrition Education and Behavior, Kim and other researchers explore possible barriers that keep African American mothers from choosing to breastfeed or to continue breastfeeding. For the women involved with the study, barriers were less about knowing the benefits of breastfeeding and more about the perceived social norms and limited social support for breastfeeding within their communities.

“It’s important to support African American moms in breastfeeding so their children, and all ethnicities of children, have that same nutritional advantage—to start on the same playing field, nutritionally speaking.

“Breastfed babies are less likely to get ear infections and they have fewer respiratory tract infections. Nutrition from the start is very important. For example, although not as strong, there is some research that shows that breastfeeding can reduce childhood obesity, and if you’re less likely to be obese as a child, you’re less likely to be obese as an adult.”

Sharon Donovan, a professor in the Department of Food Science and Human Nutrition at U of I says an important part of the study is that it highlights the significance of cultural norms as a barrier for African American moms when it comes to breastfeeding.

“This is also a broader problem when you have women kicked out of a store or business for breastfeeding, or when women are breastfeeding in the park and people confront them for exposing their breast or that they are doing something wrong. The United States, in general, is still not a very breastfeeding-supportive country compared to many other countries, such as in Europe, that have higher breastfeeding rates. It seems to be even more punctuated in the African American community.”

For the study, Kim interviewed and surveyed African American women in Champaign County who were first-time breast feeders and who were in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). She focused on women enrolled in WIC because, as she explains, research has shown WIC participants are less likely to breastfeed than mothers who qualify but do not receive WIC because the program provides infant formula to moms of infants. Kim hoped to hear about what made the choice to breastfeed difficult or easy for them.  

WIC does offer education and support for breastfeeding moms, Kim says, through programs such as support groups and hotlines for moms to ask questions. These types of programs were available in the WIC clinic at CUPHD she observed for the study.

From the interviews and surveys, several themes emerged, including beliefs about maternal nutrition while breastfeeding, time and costs related to breastfeeding, the need for social support and female role models, and suboptimal support from institutions (hospitals, schools, workplace, and the community).

Kim says what made it easier for moms to choose to breastfeed was that they knew of the health benefits for the baby and they liked providing for the baby. “Many moms liked that they were the sole source or provider for the baby,” she says. “They liked being depended on, they felt needed.”

But not having support from their social network or having it feel “abnormal” to breastfeed in their community was a common barrier cited by the moms.

One mom in the study had not breastfed her first two children, but was successful with her third.

“This was an interesting case because with her first two children she was opposed to breastfeeding because her surrounding environment that she lived in was very formula dominant. Nobody told her it was healthy for the baby, and even if they did, she said she just dismissed it because she was so adamant about formula feeding. She thought breastfeeding was awkward. She said, ‘My mom didn’t do that.’” But with her third child, she had support from the father and his family, which made it easier for her, Kim adds.

But some women reported that they did not have the support of their babies’ fathers.

“It can take a lot of the mom’s time to breastfeed, so maybe that’s part of the men’s perception,” Donovan says. “‘If she’s spending her time breastfeeding then she doesn’t have time for me.’”

Kim adds that for the women in the study, men and their mothers were their main support system. “Not only is it important to educate the mom who is breastfeeding, but educating their family members and cousins and sisters. There is a whole social network that we need to target.  I think men in this population are very important, whether they live together or not. Many times the men would say negative comments to the moms. Small negative comments can add up and make it harder for the moms to continue breastfeeding.”

Barbara Fiese, a professor in the Department of Human Development and Family Studies at U of I stresses the importance of support from family members. “Even if they don’t live in the same house, this can have a powerful effect on how long the mother continues to breastfeed beyond the first few weeks,” she says.

A misconception that came up in interviews was the moms’ belief that to breastfeed, women have to eat “healthy,” and that it is expensive to buy healthier foods. “That’s [needing to eat healthy to breastfeed] not necessarily true, though,” Kim says.

“Nutrition is important, but likely it’s these other immune components and other protective components that come from the mother that help to reduce some of the GI and ear infections, those types of things that you cannot really mimic with infant formula,” Donovan says. “We don’t want women to have this perception that they’re not eating healthy so they can’t make healthy milk for their infants.”

Donovan adds that to be successful in supporting all women who choose to breastfeed, there must be a reshaping of the whole culture to be more supportive of the practice. “We also need to identify populations that are at particular risk and design interventions and education that is culturally appropriate and age appropriate. It’s part of a bigger nut that we need to crack. Culture is definitely a part of it.”

The paper, “Breastfeeding is natural but not the cultural norm: A mixed-methods study of first-time breastfeeding, African American mothers participating in WIC,” is published in the Journal of Nutrition Education and Behavior. Co-authors are Julia H. Kim, Barbara H. Fiese and Sharon M. Donovan.

The study was funded by the Agricultural and Food Research Initiative (AFRI) and the U.S. Department of Agriculture’s National Institute of Food and Agriculture, as part of the AFRI Childhood Obesity Prevention Challenge.

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