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Nekisha Killings

Nekisha Killings

Nekisha Killings MPH IBCLC RLC.  This is part of a continuing series on diversity. Nikki is a lactation consultant in private practice in Lompoc, California and is LER's diversity consultant.

Rounding out our series on the landscape of breastfeeding in the US, we’re shifting our focus northward to Milwaukee, Wisconsin. 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.


According to the CDC’s Breastfeeding Scorecard, northern states are trending remarkably well in the measures that are tracked. With the exception of Wisconsin and Michigan, all northern states are outpacing total US are on pace to continue doing so. Overall, Wisconsin is very close to hitting the HP markers, and is on pace to do so by 2020. The state is outpacing total US in every breastfeeding measure except initiation, where it is within 1 percentage point of total US and within 2 points of the Healthy People 2020 goal. The clearer picture emerges as we look at the breastfeeding support measure. Wisconsin lags significantly in almost every measure of support. As we’ve noted in earlier segments of this series, one of the major contributors to a state’s success or lack of success lies within its underrepresented communities and the efforts to close gaps in breastfeeding initiation, duration, education and support within specific swaths of residents. In the case of Wisconsin, we can find exactly that in the efforts of Dalvery Blackwell and the African American Breastfeeding Network (AABN).


Based in Milwaukee, the AABN has enjoyed some tremendous wins in closing the disparity gaps among African Americans, and making lasting change in a community that desperately needs focused support.

Please share a little about AABN’s inception.

The African American Breastfeeding Network was formed in 2008 to (1) address breastfeeding disparities (2) increase awareness of the benefits and value of mother’s milk, (3) build community allies, and (4) de-normalize formula use. Our mission is to promote breastfeeding as the natural and the best way to provide optimal nourishment to babies and young children. Our vision is to live in a world where breastfeeding is the norm within the African American community.

How has the organization grown/evolved since it began?

Next year AABN will be celebrating 10 years!  We are very excited about our journey, proud of our accomplishments and are eagerly looking forward to another 10 years of serving families. Our work together with our partners moves the entire state of Wisconsin closer to achieving the 2020 breastfeeding recommendations.  Our accomplishments include…

  • January 2017: Front Page Feature in the Milwaukee Community Journal
  • April 2015: Quoted in Essence Magazine, “10 Things People Are Talking About”
  • January 2015: Associated Press news article, photos and video
  • August 2014: Featured in CDC Breastfeeding Report Card
  • October 2014: Featured in Black Child Development Institute’s Wisconsin report Being Black Is Not a Risk Factor
  • February 2012: Featured in Milwaukee Journal Sentinel breastfeeding video
  • February 2011: Featured in Milwaukee Journal Sentinel series on infant mortality, Empty Cradles

How is the community better off due to your presence?

The awareness and breastfeeding rates have increased because of our efforts. For the last 9 years AABN has been working diligently to eradicate inequities and disparities though our program hallmark, Community Breastfeeding Gatherings (CBGs).  Taking place at two local YMCA sites-- Parklawn and Northside-- CBGs are designed to: 1) increase breastfeeding rates, especially duration and exclusivity, 2) enhance father engagement, 3) increase access to trained lactation support persons of color, 4) provide lactation support services in hospital, home and CBG settings, and 5) enhance referral networks with health care provider systems. By incorporating community-based, culturally tailored health education, leveraging peer support, and engaging the entire support system including fathers, AABN positively impacts breastfeeding rates Clinic. Prenatal and postpartum support is provided by a Father Peer Advocate (FPA) and Community Breastfeeding Peer Counselors (CBPCs). Mothers experiencing lactation challenges are referred to AABN’s International Board Certified Lactation Consultant. Mothers receive support as long as they are breastfeeding. We estimate that at least 500 pregnant and/or breastfeeding mothers have benefited and countless support persons attended through the years, and last year we reached 120 pregnant women!  Data collected in partnership with the Center for Urban Population Health reveals the following data:

  • 91% initiation
  • 30% exclusive breastfeeding at 3 months
  • average attendance at the Northside YMCA is 15 families/Average attendance at the Parklawn YMCA is 8 families
  • mean age for women is 23 years old
  • 76% of pregnant and breastfeeding women attending CBGs live in zip codes of greatest need and having a huge inequality hole in health care access
  • 93% of post-CBG survey respondents reported that they were more likely to breastfed or continue breastfeeding after attending a CBG

Could something like the AABN be duplicated elsewhere?

Yes!  I believe our model could be duplicated elsewhere. Anyone who is interested, please email aabn@ymail.com

AABN’s motto is “together we are building a breastfeeding movement”. As a student or professional lactation supporter, you have an opportunity to make an impact and to reach communities that have a greater need or unique barriers to success. LER is inviting you to join the movement alongside Dalvery Blackwell, TaNefer Camara, Tiana Pyles, Jada Wright-Nichols, Ngozi Walker-Tibbs and all of the dedicated lactivists who are working within their communities to change the face of breastfeeding and to reach those who need it most.
While this series has come to a close, the conversation will continue in various ways as LER will work to prepare the next generation of lactation supporters to be informed and equipped resources to all breastfeeding families. Stay tuned for future blog posts, course additions, and advocacy opportunities as we do our part to impact the landscape of breastfeeding in the US and beyond.

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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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Continuing our series on the landscape of breastfeeding in the US, we’re shifting our focus Eastward to Pittsburgh, Pennsylvania. 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. At a glance, the US Eastern seaboard is packed with major metropolitan cities with large hospitals and no shortage of outpatient lactation support. Once you zoom in a bit inland or into more urban or rural areas, a different story begins to emerge. Many of the same challenges we encountered in the South exist in the East, including lack of access to support, lack of breastfeeding education among parents, and lack of breastfeeding supportive healthcare providers. Adding other factors such as demographics only compounds the issues.

For example, states in the Appalachian Region are woefully underperforming compared to their neighbors. Why? We know that socioeconomic levels directly impact quality of care. Breastfeeding disparities are, therefore, not surprisingly lower in areas that are economically depressed. We also know that race is a further compounding factor that drives breastfeeding disparities. Using almost any breastfeeding metric in the US, White mothers outperform their Latinx and Black counterparts. This is even truer in communities that are segregated, which often translates into differing levels and quality of care for those mothers in underserved groups. Black mothers lag the general US population, white mothers, and Latinx mothers, no matter how you slice the data. This creates a dire situation in cities with large Black populations 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. For more on this, see our previous installments in this series.

Having relatable, culturally competent support is a major key to closing the disparity gaps in areas where breastfeeding is not the norm. What does success look like in a major eastern city? Is anyone reaching the families who are doubly hit with economics and race?

Yes. We had the opportunity to speak with Ngozi Walker-Tibbs, co-founder of the Pittsburgh Black Breastfeeding Circle (PBBC) which provides a safe space for encouragement, community and breastfeeding support. In our discussion, she illuminated the breastfeeding support needs in Pittsburgh, and detailed her journey to craft a suitable solution.

Can you tell us a bit about how PBBC was started?

The PBBC began in August 2014 during Black Breastfeeding Week. I had just finished graduate school in May of that year and this vision had been on my heart for many years but I wasn't sure where to start. I was overwhelmed with ideas and vision but lacked insight into how to make it work. As one of only 2 black LC's in the entire city; I was well aware of the lower rates of breastfeeding amongst women of color. I wanted to make a difference. A sister who is an activist in the community approached me and asked me to speak for the BBW 2014. I spoke from my heart as to why breastfeeding matters to us and how we can support each other as a community. After this event, the organizers and I discussed how to keep this momentum going. We had no money but wanted to feed the families. For the most part, we went into our pockets and found a spot, purchased food, and had our meetings. We are so grateful for some food donations that we received early on. We began to meet 1x per month at local libraries and women began to come. We discussed lots of topics including how to practice skin to skin after delivery, avoiding and resolving nipple pain, working and pumping, nursing toddlers and many more. We got our first grant in 2015.

How has PBBC grown or evolved since it first began?

We now meet two times per month and we are bursting at the seams! We have discussed meeting 3x per month and looking for a larger venue. Its a beautiful challenge to have.

How is the Pittsburgh community better off due to PBBC’s presence?

We have been featured twice this year in our local newspapers and the community is responding so positively. Physicians, Midwives, Nurses, LC's and other providers are recommending our circle to mothers in the community. They understand that we are an evidence based organization and mothers are learning about breastfeeding, parenting and bonding with their babies. Mothers in the circle have said they would have stopped nursing if it were not for the support of the PBBC. We know we are making a difference; one mother and baby at a time.

Can something like PBBC be duplicated elsewhere? How?

A black breastfeeding circle can be duplicated anywhere where there is an established need. First, the potential organizer should find what groups are already in operation in town, who do they reach, are there underserved communities? Find providers who are willing to partner with you to make a difference. Be prepared to share data and research. Find a spot, look for other likeminded organizations, talk with them, seek donations for food and space, develop and agenda based on the health needs of the community. 

Wherever there are breastfeeding disparities, local activists and parents are rising up to meet the need. Solutions come in various forms, from cafes to library meet ups to online support. We’ll highlight other such groups as this series continues in the coming months.

Meanwhile, PBBC is growing by leaps and bounds, and even supports their group mothers via Facebook in a closed support group that has blossomed to over 300 members. For more information about PBBC, Ngozi can be reached at 412-638-1580.

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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 tpyles@bstars.org 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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