It can be difficult to find a healthcare approach based on strong, solid evidence that it helps with a persistent, complex condition.
That’s one reason why public health officials are working hard to get more women to adopt breastfeeding, which has been linked clearly to a decreased risk of childhood obesity.
This may be of even greater importance for African-American women and babies, who breastfeed at a much lower rate than white and Hispanic families. Nationally, roughly 46 percent of white and Hispanic babies do at least some breastfeeding at 6 months of age, compared to only 30 percent of black babies.
Cultural and economic factors contribute to disparities in breastfeeding rates. But efforts to reach out to reduce those disparities are finding success. A new guide issued by the state aims to boost breastfeeding rates at all hospitals in New Jersey, while some hospitals have formed peer-support groups that have been proven to raise breastfeeding rates.
The disparities in breastfeeding rates are tied to a variety of factors, including a comparative lack of social support, a lack of information about breastfeeding, and not having family members or peers who can be examples, according to Ryan Parker, the chief diversity and inclusion officer for Robert Wood Johnson University Hospital in New Brunswick.
“We must break the cycle and intervene all along the continuum if we hope to increase breastfeeding among African-American women,” Parker told a group of hospital workers at a recent conference sponsored by the state and hosted by the New Jersey Hospital Association.
Parker said this can be accomplished through culturally sensitive educational materials and peer-support groups geared toward black women. He added that these efforts are being supplemented by breastfeeding campaigns broadly targeted to reach women of all social and economic backgrounds.
Journalist Kimberly Seals Allers, who’s written extensively about African-American women and breastfeeding, said a variety of influences have contributed to their lower breastfeeding rates. This has created what she describes as “first food deserts” – entire communities where it becomes difficult to breastfeed.
She linked the effort to increase breastfeeding to the broader “food justice” movement to increase access to healthy food in urban areas.
“If you can’t get food justice for babies we can’t get food justice for anybody,” she said.
The absence of public breastfeeding in public in these neighborhoods becomes a self-perpetuating cycle.
“People just haven’t seen it … and that’s so dangerous because it perpetuates the stereotype” that breastfeeding doesn’t happen in that community, Allers said.
She said black women who learn more about the health benefits of breastfeeding, and see images of women who look like them who are breastfeeding, can be convinced to try it themselves. But this message also needs to reach their healthcare providers, family members and social groups.
“We want to return breastfeeding to a communal status,” Allers said.
Hospitals are taking the diversity of their patient populations into account in their prenatal educational programs. For example, University Hospital in Newark offers these programs in different languages, including Haitian Creole, and presents materials with photos reflecting the race of program participants.
Jersey Shore University Medical Center in Neptune offers peer support through its “centering” program, which brings healthcare workers and mothers together in small groups.
While statewide breastfeeding statistics broken down by race or ethnic background aren’t available, New Jersey is making statewide progress in encouraging breastfeeding. The number of all babies breastfeeding exclusively at 6 months of age increased from 14 percent in 2012 to 22.3 percent in 2014. This outpaced the national rate, which rose from 15.6 percent in 2012 to 18.8 percent in 2014.
Similar progress is occurring among low-income families, with breastfeeding babies eligible for assistance through the federal nutrition program for women, infants and children (WIC), increasing from 9 percent in 2010 to 11.3 percent in 2013.
State Health Commissioner Mary E. O’Dowd has made increasing breastfeeding rates a priority, pointing to the health benefits.
For example, a Centers for Disease Control and Prevention study published in 2011 found that babies who breastfed for nine months had a 30 percent lower rate of childhood obesity than other babies.
“This is one of the few areas where there’s evidence-based results on dealing with a really challenging issue – childhood obesity, and then lifelong obesity – from a prevention perspective,” O’Dowd said at the conference earlier this week. “So we have to take this on here in New Jersey, and take it on aggressively.”
O’Dowd added that some of the strongest incentives for breastfeeding are economic – families can save $1,200 to $1,500 on formula in a baby’s first year alone.
This year, the state Department of Health and New Jersey Hospital Association worked together on a guide, “Healthy Beginnings NJ,” which provides hospitals with strategies for encouraging mothers to breastfeed.
“This will really help our hospitals collectively as a group move forward,” O’Dowd said.
[related]The state has integrated information about breastfeeding into the information that families receive when they apply for a wide variety of social services, not just those that are health-related.
The health department also is using other toolsother tools to encourage breastfeeding, including encouraging employers through the Working Well in New Jersey toolkit to designate a private area for mothers to pump and store milk. It also is teaching low-income women about nutrition and providing healthy food through WIC.
In addition, the state encourages hospitals to make it as easy as possible for breastfeeding to begin as soon as babies are born, both through grants to hospitals and through regulations.
O’Dowd said the point of the regulations released last year was to make sure that “every single child born and every single mom having a baby in the state of New Jersey has the same standard of care” in receiving education and other support for breastfeeding both in the hospital and when they return home.
“When you’re being educated about breastfeeding, you’re being educated about so many other things,” which may lay the groundwork for future improved nutrition and reduced obesity, O’Dowd said.