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Continuing our series on the landscape of breastfeeding in the US, we’re shifting our focus westward to Oakland, California. We’ll quickly assess the challenges that exist, then highlight a lactation support group that is working to close gaps and reach families in innovative ways.

While it’s true that no other area is consistently underperforming as significantly as the South when compared to the CDC’s Breastfeeding Score Card, there is room for improvement in every direction. This is true even on the West coast, where state breastfeeding rates are excellent at a glance. Per the scorecard, California is outpacing the national average in nearly every measure. California has already reached the Healthy People 2020 goals, and is on a trajectory to continue to outpace most states in the coming years. The data highlights some of the many things that are working well in California, such as the high percentage of Baby Friendly Hospitals (which directly correlates to the percentage of babies who receive solely breastmilk during their first two days of life), and childcare regulations that support breastfeeding success in the long run. California gets it right in many ways. However, as much as it is an anomaly, some pockets of California are also plagued by the same obstacles to success that we saw in the deep South and in Appalachia. As we’ve seen, some key factors have a detrimental impact on whether babies get mother’s milk as early, as often, and for as long a duration as is ideal. These factors include race, economic status, and access to quality care. The scorecard shows a significant gap in the number of births to the number of lactation supporters statewide. For example, in terms of free or low cost support, there are only around 2 certified lactation counselors and less than one La Leche League leader per 1,000 live births. Both of these figures are lagging compared to national averages.

So what support is there for parents who need help breastfeeding but may not be in a position to hire an IBCLC? One such solution has been working well in Alameda County, and specifically East Oakland. We caught up with the renowned TaNefer Camara, to discuss her community support group, The Lactation Café (TLC).

California scored well on the last BFing ScoreCard. How does East Oakland compare?

Overall California's breastfeeding rates are impressive and in some areas exceed national averages. In East Oakland, breastfeeding rates do not reflect state averages. East Oakland is an area that is still very much segregated by ethnic and socioeconomic lines. Some areas - particularly the community where The Lactation Cafe is held - are largely Black and Hispanic. While there has been an increase in breastfeeding initiation and duration rates over the past 5 years in Alameda county, there remains pockets of community that could benefit from additional support. Many of the families are receiving the message that breastfeeding is important but they fall short of breastfeeding goals due to work conditions, lack of familial support, medical reasons or misinformation.

Can you tell us a little about the group’s inception and how it has grown/evolved since it began?

The Lactation Cafe began as a pilot program sponsored by First 5 Alameda County. We started off with maybe 4 participants and grew to serve 10-15 moms each group. We collaborated with local health programs, hospitals and clinics to engage new families. The next phase will focus on sustainability and community capacity building. We hope to develop group participants into leaders who will lead and facilitate future groups.

How is the community better off due to your presence?

The Lactation Cafe has been a safe place for families to receive concrete support in times of need, gain knowledge of child development, build social connections and get the support they need to meet their breastfeeding goals. Moms who attend TLC and other groups in our community are able to share what they learn with other mothers, they become advocates for themselves, their children and their community members and they support one another.

Could something like the The Lactation Cafe be duplicated elsewhere?

Absolutely! TLC can be duplicated. We used the Strengthening Families framework as our guide and in alignment with our breastfeeding curriculum. The key to a successful group is outreach, engagement and community partnership. Oh, and good food. Whole some food and nutrition was a major part of our group.

Wherever there are breastfeeding disparities, local activists like TaNefer Camara, Tiana Pyles, Jada Wright-Nichols and Ngozi Walker-Tibbs are rising up to meet the need. Their work is changing the landscape of breastfeeding throughout the United States in real and impactful ways. As a student or professional lactation supporter, you too, have an opportunity to make an impact and to reach communities that have a greater need or unique barriers. We’ll highlight one more group in the North to round out our four cities tour next month and to bring this series to a close. The conversation will continue in various ways as LER works to prepare the next generation of lactation supporters to be informed and equipped resources to all breastfeeding families.

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In the initial installment of this series, we discussed the swinging pendulum of breastfeeding rates across the nation, as highlighted by the CDC’s most recent Breastfeeding Report Card.  Among the data are outliers on both ends of the spectrum that warrant a closer look. Over the course of the next four installments, we’ll hear from lactation supporters who are in the trenches in four cities that are performing demonstrably different compared to the total US average and compared to the Healthy People 2020 benchmarks. We’ll discuss what is working to reach families in a unique way in each city, then at the end of the series, we’ll explore state and national efforts to increase accessibility to lactation support across the nation.

As we delve into the challenges and victories occurring in various areas, one factor that is hard to ignore is demographics. Do extenuating factors such as the mother’s sphere of influence or race or line of work directly impact breastfeeding? In short, absolutely! Income, age, education, race, and even language spoken impact healthcare experiences. This is consistent with breastfeeding and the types of support that are available in some communities as well. Breastfeeding success today requires a delicate balance of support and encouragement from many parts of a community; access to current, evidence-based information provided by relatable and available sources; and a work environment that supports pumping breaks and milk storage. The absence of any one of these factors can upset the entire system and almost certainly lead to failure.

The South

Without question, the worst performing area in this country in terms of breastfeeding initiation and duration is the deep south. With consistent averages of 10-20 points below the US average of 81.1% of babies ever breastfed, Georgia, Alabama, Louisiana, Mississippi and Tennessee together represent a cluster of states where unique challenges like those listed above create a dearth of support and a veritable first food desert. Take Mississippi, as an example.  The Breastfeeding Report Card assessed Mississippi as simultaneously having the lowest breastfeeding rates AND the lowest number of lactation support providers available (both free and paid). Success and support go hand in hand.

In the face of the lowest ratings in the nation, there are some methods that seem to be making progress. Taking a closer look at what is working allows for some insight into some of the tangible challenges, and allows for some exploration of replicating that success in further parts of this region. Looking at Tennessee specifically, we find that breastfeeding initiation rates are trending 10 points behind the national average. Not surprisingly, the data also shows a consistent lag across all the measured categories, including the number of lactation supporters per 1,000 live births. Per the TN.GOV site, some obstacles that exist within the state to prevent mothers who have the intention to breastfeed from achieving success are:

  • Lack of experience or understanding among family members of how best to support mothers and babies
  • Not enough opportunities to communicate with other breastfeeding mothers
  • Lack of up-to-date instruction and information from health care professionals
  • Hospital practices that make it difficult to get started with successful breastfeeding
  • Lack of accommodation to breastfeed or express milk at the workplace

How Does Race Factor In?

Sadly, breastfeeding trends are often illuminated when broken down by race. Using almost any breastfeeding metric in the US, White mothers outperform their Latina and Black counterparts. This is even more true in communities that are segregated, which often translates into differing levels and quality of care for those mothers in underserved groups. Latino breastfeeding rates lag White mothers, but the gap is narrowed or widened depending on their country of origin and level of assimilation. This layered and complicated phenomenon will be a focus when we turn our attention to the western region.

Black mothers lag behind the general US population, white mothers, and Latina mothers in every breastfeeding metric, from a national to a local level. This creates a dire situation in many majority-Black cities where ill newborns could be greatly helped by the benefit of mother’s milk, and Black mothers could also be helped by the benefits of breastfeeding. Efforts like Black Breastfeeding Week were created to overcome the obstacles that Black mothers face and to highlight breastfeeding within the Black community to normalize it. With a Black population of over 950,000, Tennessee has a need for year-round, focused breastfeeding support that gets to the heart of the Black community and its specific challenges. 

BSTARS: Memphis, TN

To gain a first-hand perspective of the impacts this type of focused programming and initiative could have on the lives of mothers at the local level, I had the opportunity to speak with Ms. Jada Wright Nichols, one of the founders of BSTARS in Memphis. She provided insights to better understand her program and the challenges that necessitated its inception. BSTARS’ mission is to support, protect, and promote Black women as they choose to breastfeed. Their work is impacting Black families in Memphis by combatting several of the listed obstacles to breastfeeding success in Tennessee. They are working to build a supportive community armed with confidence and solid information about breastfeeding. The template they have developed is tailor-made to fit the needs of mothers in Memphis, yet is flexible enough to plant elsewhere, and expect similar success.

Can you tell us about the inception of BSTARS?

Breastfeeding Sisters That Are Receiving Support (BSTARS) began in Memphis, TN out of the need to address the low breastfeeding rates amongst mothers of color in the city, while also highlighting those who do breastfeed, but often go unnoticed. Memphis has some of the lowest breastfeeding rates, highest infant mortality rates, highest breast cancer (and diabetes, and obesity) rates, highest poverty rates, and highest segregation rates in the country. We hope that helping to improve breastfeeding rates through consistent and accessible education and support, will also help to bring some of these other social and health issues into balance. We were created through the generous cooperation of the Shelby County Department of Health, Shelby County Breastfeeding Coalition, and Atlanta-based Reaching Our Sisters Everywhere (ROSE).

How has the organization grown/evolved since it began?

We began with a hearty level of interest. At our first official meeting, we had certified lactation counselors, WIC peer counselors, lactation consultants, nurses, and physicians of color all eager to support pregnant and nursing moms.


At each meeting, we discuss a health topic and how it relates to breastfeeding, while also offering skilled breastfeeding support. We have had speakers from the community to address nutrition, exercise, postpartum mood disorders, smoking, birth control, safe sleeping, and family support. We have a solid group of attendees, but as the topics change, so does the make-up of each month's group, depending on the needs and interests of the families. We love being able to support the entire family. We regularly have partners, sisters, mothers, and grandmothers present to hear the same information as the mothers. We always have a lite meal, and an area for children to play or do homework. We are in our second year and growing strong, heading toward becoming our own 501c3 organization.

How is the community better off due to your presence?

Thanks to several of our signature events, Memphis has a greater awareness and appreciation of breastfeeding moms within the city. We have a community baby shower where we distribute pack-n-plays, car seats, nursing pillows, and pumps to 30 families. We have an annual walk along Historic Beale Street and throughout downtown Memphis to promote breastfeeding, health, and sisterhood. We have many community sponsors for this event, including Hooters - our favorite. Perhaps most impactful, we organized a one day breastfeeding symposium, which attracted healthcare providers from 4 states to gather to hear about current research and initiatives in breastfeeding. We were greeted by city officials excited about supporting breastfeeding, and we heard from some of the top voices in the field of lactation. We also have an intimate Facebook group, wherein moms of color ask questions and document, with pride, their breastfeeding journeys.

Could something like BSTARS be duplicated elsewhere?

Absolutely! We are already discussing its replication in a few communities and we are happy to help any others who are interested.

 

It’s a little too soon to see empirical data on the effectiveness of BSTARS. However, historically, the type of focused attention that BSTARS provides yields notable increases in mother confidence, breastfeeding initiation, and duration. Anecdotally, Memphis physicians have already noted that Black mothers seem to be inquiring more about breastfeeding, and breastfeeding for longer periods since BSTARS launched. There is great promise and potential at the local level for closing gaps in breastfeeding and BSTARS is one shining example of how it can be done. Next up, we’ll look at trends in the Western US and explore a program that is focused on groups that are still challenged, even amid high breastfeeding rates in their state.

 

If you would like more information about BSTARS, please contact founder and director, Tiana Pyles at This email address is being protected from spambots. You need JavaScript enabled to view it. or Memphis BSTARS on Facebook.  

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What an exciting time to be a part of breastfeeding education! The marked shift back toward the breast - after a generation of mothers turned to bottles and formula - is nothing short of amazing. From wide-scale national public health efforts to the tireless determination of grassroots community educators, there is plenty of credit to spread around for the wins that we are seeing. And everyone who has had a hand in this work should be proud of the clear success of the movement. That is not to say, of course, that our work is done. Hardly so. For every hospital that has become Baby Friendly and placed breastfeeding education and support at the forefront of their pre and post-natal offerings, there are several more who still have yet to prioritize increasing their breastfeeding rates. For every pediatrician and obstetrician who advises an expecting parent to consider breastfeeding, there are several more who never mention it or maintain outdated perspectives. And the truth is, for every state that is meeting and surpassing the Healthy People 2020 goals for breastfeeding initiation and duration, there are states that are not even close. While there is cause for celebration, it’s too soon to rest on our laurels.  This post is the first in a series that will dig into the current state of breastfeeding in the US, examine the outliers on both ends of the data, and consider how we can continue the work to increase equity in lactation across the country.

According to the CDC’s latest Breastfeeding Report Card, the number of babies who were put to the breast at least once in 2013 is 81.1%. That number is an average across 50 states, plus Washington DC and Puerto Rico. This means there are states faring way better (I’m looking at you, Utah, with 94.4%), and there are those who fared far less (O-Mississippi-G with 52%) being factored in. Once you start to explore the data at a state level, glaring differences like this emerge again and again. How could Utah’s breastfeeding initiation rates be 20-40 percentage points higher than every state in the deep south? Why does every state west of Texas tout initiation rates above the Healthy People 2020 goal of 81.9%, but so few on the east coast have even come close to that benchmark? What is happening differently across the country? How can we help to close to gaps?

The good news is that in most states, there are innovative programs aimed at addressing local challenges to breastfeeding. The services range from grassroots community organizations to statewide coalitions, and everything in between. They provide catered solutions to the specific challenges of the families in those areas. And they are making steady progress. However, huge extenuating factors like economics and race play a particularly significant role in breastfeeding in many of the states that are the most challenged. That means the incredibly important and delicate work of dismantling barriers and mindsets is needed to reverse some of the trends that are being seen. So there is no easy or quick fix. But there are strategies and solutions and communities who are committed to progress.

Helping to remove barriers to breastfeeding in the states where the least number of mothers are putting babies to the breast (and subsequently keeping them at the breast) is a worthy focus because it has the potential to save lives in areas where infant mortality rates are frighteningly high. And it’s where we will pay particular attention as this series progresses. We hope you’ll tune in as we start to look a bit closer at the data and also at the national, state and local efforts that are working to turn some of the statistics around. We’ll also discuss how you can become involved in fostering change to bring about lactation equity in those areas where it’s most needed, and help to push more states across the line from promise to progress.

Next up: North, South, East, West: A Breastfeeding Tale of Four cities

Nikki Killings MPH, IBCLC, CLC, LLLL lives and works in California with her husband and children. She spends her time writing, reading and supporting families in underserved communities.

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