African-Americans may be getting inferior breastfeeding advice

By Ronnie Cohen NEW YORK (Reuters Health) - Mothers who give birth in areas with higher concentrations of African-Americans are less likely to get breastfeeding support on maternity wards than mothers in other communities, a new study shows. Breastfeeding provides well-documented health benefits to infants and their mothers. But African-American women are about 16 percent less likely to nurse their newborns than white women, according to research from the Centers for Disease Control and Prevention (CDC). The study of 2,727 American hospitals and birth centers sought to uncover the reasons for the racial disparities. “What this study suggests is that hospital practices, not just women’s choices, beliefs or values, contribute to the observed racial disparities in infant feeding,” sociologist Elizabeth Armstrong told Reuters Health in an email. “Where a woman lives – and consequently gives birth – affects how her infant is nourished. Black babies and their mothers are less likely to start off in environments that support the optimal level of care for infant feeding and mother-baby bonding,” she said. Armstrong, a professor at Princeton University in New Jersey, was not involved in the current study. The CDC researchers gathered data on optimal maternity care from hospitals and birth centers across the U.S. and compared areas with a higher percentage of black residents to areas with a lower percentage. Facilities in zip codes with more black residents were more likely to give tests to their staff on breastfeeding support, the researchers wrote in the CDC’s Morbidity and Mortality Weekly Report. At the same time, maternity wards in areas with more African-Americans were less than half as likely to limit the use of breastfeeding supplements, such as formula. A 2006 report from the Government Accountability Office showed that when hospitals hand out free formula samples, mothers tend to breastfeed less. Hospitals in neighborhoods with more African-Americans were also 7 percent more likely to give newborns pacifiers, which can inhibit breastfeeding. And facilities in areas with higher concentrations of whites were nearly 14 percent more likely to promote early initiation of breastfeeding and nearly 12 percent more likely to work to keep newborns next to their mothers in the hospital. Both factors are known to promote breastfeeding. Hospitals in neighborhoods with more blacks were significantly less likely to offer breastfeeding support after mothers returned home. “This study shows the best support is not where it’s most needed,” Dr. Miriam Labbok told Reuters Health in a telephone interview. “If we could just change the hospital practices, I think we could have a lot more equity.” A pediatrician, Labbok is the founding director of the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill and was not involved in the current study. Lead author Jennifer Lind told Reuters Health that it’s too early to understand the reasons for the racial differences. “Because this is the first stab or look into the whole issue, we really don’t know why we’re seeing these disparities,” she said in a telephone interview. Lind is an epidemiologist with the CDC. “We found that hospital practices during childbirth have a major impact on whether a mother is able to start and continue breastfeeding,” she said. “We think it’s really important that all hospitals – regardless of where they’re located – apply policies and practices proven to be supportive of breastfeeding so that more babies are able to reap the numerous benefits.” Research has shown that breastfed babies, especially those fed just breast milk without any formula, are less likely to die of sudden infant death syndrome, or SIDS (see Reuters Health story of June 14, 2011 here: African-American babies are more likely to die from SIDS, also known as “crib death.” Breastfeeding also lowers babies’ risk of infection, childhood obesity, asthma and type 2 diabetes, Lind said. Mothers who nurse their babies cut their chances of being diagnosed with breast and ovarian cancer, she said. The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for another year while babies are introduced to complementary foods. In 2011, 79 percent of new American mothers started to breastfeed their infants, but fewer than half were still breastfeeding at six months, according to the CDC. Only 195 U.S. hospitals, accounting for 8 percent of all births, have earned the status of Baby Friendly, the gold standard for optimal maternity care established by the World Health Organization and UNICEF in 1991, Armstrong said. “I really think what we’re seeing here is very much due to the fact that hospitals put up barriers,” Labbok said. “I’d say this is a very good reflection of something that’s wrong, and it needs to be fixed.” She noted that African-American women continued to nurse their babies at higher rates than white women in the 1960s, when breastfeeding in the U.S. hit an all-time low. “In general, there has been this incorrect assumption that because you’re black, you don’t breastfeed, and that is just out and out wrong,” Labbok said. “We’ve really got to strive for equity. This study shows very clearly that we have some work to do.” SOURCE: Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, online August 22, 2014.