PEDIATRICS Vol. 118 No. 4 October 2006, pp. 1742-1743 (doi:10.1542/peds.2006-2161)
COMMENTARY |
Race, Ethnicity, and Breastfeeding
Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts
Breastfeeding is an ancient art courted by young science. Until the mid-1980s, breastfeeding research was in its infancy, limited by low numbers of women who breastfed, especially exclusively, and especially in nations active in research. Consequently, we must interpret data from a legacy of inconsistent, older studies that measured health outcomes but did not or could not control for even basic variables such as amount of breast milk consumed. As we move forward and correct for such issues (eg, by clearly defining breastfeeding), we should guard against new generalizations in the area of breastfeeding, race, and ethnicity.
One emergent myth that needs to be weeded before it roots is that breastfeeding rates are lowest in minority women. In fact, per national data, annual US breastfeeding-initiation rates are usually highest among Asian and Hispanic women.1,2 Further complicating the picture, and of essence when considering a culturally mediated behavior such as breastfeeding, are maternal birthplace and our 1-size-fits-all design of our racial/ethnic terminology. Terms like "Hispanic" and "black" are, at best, unhelpful and, at worst, confounding when working with patients, designing research, and allocating resources.
In our study3 (in this month’s Pediatrics Electronic Pages), premature infants had lower breastfeeding initiation rates than term infants, and women on public insurance were one third as likely as privately insured women to breastfeed. We traditionally ascribe such outcomes to practical and economic problems: transportation to the NICU and the need for a pump, for example, undoubtedly make breastfeeding a premature infant more difficult, especially for those with few resources. Nonetheless, non–US-born mothers (many of whom face tremendous practical and financial barriers) were far more likely than US-born women to breastfeed, in or out of the NICU.
If non–US-born mothers are overcoming the odds to breastfeed in difficult circumstances, we might deduce, sadly, that something about US culture deters women from nursing their infants. Even US acculturation reduces the odds of breastfeeding.4,5 According to a recent study by Gibson-Davis and Brooks-Gunn, "each additional year of US residency decreased the odds of breastfeeding by 4%."5 Apparently, our society is not simply apathetic but actually counterproductive to the infant’s chance of receiving the protection developed by evolution, the gold standard of outcome-based research.
How can we resolve this problem? Increased knowledge on determinants, gained from more careful examination of race/ethnicity data, should guide us to collect more sensitive, meaningful breastfeeding data and to avoid broad strokes of black and white. At the very least, we can report maternal birth place, control for relevant confounders, and aim to refine or eliminate banal, generic classifications such as "Hispanic"—terms which bound our own study because of reliance on race/ethnicity data from the birth certificate.
More subtle insights on breastfeeding patterns also raise an uncomfortable question: What about the United States discourages breastfeeding? We have no shortage of suspects: decades of low initiation and the loss of a "breastfeeding generation"; marginalization of breastfeeding in medicine, with poor research funding and uneducated providers; industry influence; lack of workplace support; and a tremulous approach to breastfeeding promotion.
Asking one mother’s opinion, I received the response, "In Cambodia, you breastfeed. On the bus, in the fields, at the market. Here, infants are big and healthy with the bottle milk." If that is the message US culture sends, we must replace the myth with good science and proactive public policy.
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FOOTNOTES |
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Address correspondence to Anne Merewood, MPH, IBCLC, Division of General Pediatrics, Maternity Building, 4th Floor, 91 E Concord St, Boston Medical Center, Boston, MA 02118. E-mail: anne.merewood{at}bmc.org
The author has indicated she has no financial relationships relevant to this article to disclose.
Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.
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REFERENCES |
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 TOP REFERENCES |
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1. Department of Health and Human Services, Centers for Disease Control. Breastfeeding: data and statistics: breastfeeding practices—results from the 2005 National Immunization Survey. Available at: www.cdc.gov/breastfeeding/data/NIS_data/data_2005.htm. Accessed August 15, 2006
2. Ross Products Division. Ross Mothers Survey. Cleveland, OH: Abbot Laboratories; 2003
3. Merewood A, Brooks D, Bauchner H, MacAuley L, Mehta SD. Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts. Pediatrics. 2006;118(4). Available at: www.pediatrics.org/cgi/content/full/118/4/e1048
4. Byrd TL, Balcazar H, Hummer RA. Acculturation and breast-feeding intention and practice in Hispanic women on the US-Mexico border. Ethn Dis. 2001;11 :72 –79[Medline]
5. Gibson-Davis CM, Brooks-Gunn J. Couples’ immigration status and ethnicity as determinants of breastfeeding.
Am J Public Health. 2006;96
:641
–646
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
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