By Barbara Brotman
Tribune staff reporter

Published September 25, 2002


Erika Scott and Charlotte Johnson walked into a room at Cook County Hospital, 
and into their kind of challenge.Rashida Collins was there with her newborn 
baby, her mind set on feeding her formula."All my friends bottle-feed," said 
Collins, 20, of the West Side, who also has a year-old son. She would be 
putting her baby in day care in about a month to return to school, and didn't 
see how breast-feeding would work, she said. Besides, she thought feeding by 
breast would be embarrassing. "You can't just whip it out; everyone doesn't 
feel comfortable like that," she said.But it's hard to feel uncomfortable 
with Johnson, breast-feeding coordinator at the hospital, and Scott, a 
breast-feeding peer counselor, both of whom speak so gently that you almost 
don't hear the determination.They are among the front-line troops in the 
local battle to change national statistics: Only 51 percent of black women 
start breast-feeding after giving birth, compared with 72 percent of whites 
and 71 percent of Hispanics. Six months later, only 21 percent of black women 
are breast-feeding, compared with 34 percent of white women and 28 percent of 
Hispanics, according to the 2000 Ross Mothers Survey conducted by Abbott 
Laboratories, which manufactures infant formula through its Ross Products 
Division.Former U.S. Surgeon General David Satcher called the breast-feeding 
rates among African-American women "alarmingly low," and characterized them 
as a serious public health problem.Scott and Johnson took aim at the problem 
by taking an affectionate look at newborn Tyre'l, who was sleeping."Have you 
tried to put the baby to the breast?" Scott asked."I don't know how," Collins 
said. "Someone's going to have to show me."Scott and Johnson didn't have to 
be asked twice."She should be in the crook of your arms," Scott instructed. 
"Now hold your breast like this--four fingers underneath, thumb on top.""Like 
this?" Collins said."Now tickle her chin; wait till she opens up really big . 
. . ""No biting, now," Collins said, looking down uncertainly.Tyre'l opened 
her mouth, latched on and methodically began sucking."She did it!" Scott 
said."Wow! Great job," Johnson told Collins.Despite that successful 
beginning, Collins was uncertain whether she would continue. "It feels funny; 
but it doesn't feel bad," she concluded. "We'll see how it goes."The Cook 
County Hospital Breastfeeding Program, run jointly by the hospital and 
Chicago Health Connection, serves patients of all races and has developed 
expertise in a variety of cultural attitudes toward breast-feeding. Sixty one 
percent of women who deliver babies at the hospital are black. The program's 
peer counselors are generally current or former nursing mothers and are 
chosen partly to reflect the patient population."The mothers are able to 
relate," said breast-feeding clinician Bertha Condes.They speak frankly to 
counselors about why they are reluctant to breast-feed.Beyond the myths"In 
the African-American population, they hear a lot of myths," said Scott. 
"`Breast-feeding hurts.' `Your baby will be spoiled.' `You can't do anything 
else but breast-feed.' We've heard it all."They heard more of it a few 
minutes later in the neonatal intensive care unit, where 19-year-old Crystal 
Ware, of Harvey, was visiting her newborn, Keyon, who was recovering from a 
fever."I don't want to get my baby spoiled; I've got to go to work, to 
school," she said. "I don't want him to get too attached."But after a few 
minutes with Scott and Johnson, Ware was willing to try pumping her breast 
milk while Keyon was in the hospital.Johnson assures mothers that nursing 
babies will not spoil them."We tell them that babies learn to trust in those 
early months," she said. "The only way they learn to trust is when we meet 
their needs."The hospital walls are papered at regular intervals with posters 
and fliers about breast-feeding. Staffers and peer counselors extol the 
benefits of breast-feeding at the prenatal clinic, in the hospital--"in the 
elevators, walking through the halls, walking down the street--any 
opportunity," said Johnson, who is also a member of the Chicago Region 
Breastfeeding Task Force."I breathe breast-feeding," joked Condes.Medical 
complications do not dissuade the breast-feeding team; a sick or low 
birth-weight baby, staffers say, is in even more urgent need of the 
protections provided by breast milk. Some 80 to 85 percent of mothers of low 
birth-weight babies in the hospital's neonatal intensive care unit pump their 
milk.One of the hospital's successful breast-feeding mothers is Angelique 
McKinney, whose baby was delivered by emergency C-section in May after both 
she and the 7-month-old fetus were shot on a South Side street.Adriel was 
born without a heart rate, but doctors resuscitated her. McKinney underwent 
surgery, but a few days later, under the breast-feeding team's guidance, 
started pumping her breast milk. It was given to Adriel, who was too 
undeveloped to suck, through a feeding tube. Adriel is now doing well and 
nursing conventionally."I'll breast-feed, I hope, up to a year," said 
McKinney.The percentage of women who start breast-feeding in Cook County 
Hospital has increased from 23 percent in 1987, when the program began, to 
between 50 and 55 percent today.Nationwide, the trend is improving, too. 
Between 1990 and 2000, black women showed the greatest increase in initiating 
breast-feeding, the Ross Mothers Survey found. While only 23 percent of black 
women were breast-feeding immediately after birth in 1990, nearly 51 percent 
were doing so in 2000.Taking on the causeIn the Chicago area, the cause has 
been taken on by a growing cadre of peer counselors, staffers from the Women, 
Infants and Children special supplemental nutrition program and 
African-American nursing mothers themselves."I have approached young pregnant 
women in the grocery store. I'll say, `When are you due? How are you going to 
feed? Have you ever breast-fed?'" said Marilyn Markham, 35, of North Chicago. 
A WIC recipient, Markham nursed all six of her children and last year 
received a "Loving Support Award" from the Illinois Department of Human 
Services for promoting breast-feeding among African-Americans.The WIC program 
provides infant formula for low-income women, but increasingly encourages new 
mothers to breast-feed. Jessica Carpenter, breast-feeding coordinator for the 
Chicago Department of Health's WIC program, regularly sends staffers to be 
trained as certified lactation counselors."What works the best is expecting 
[black women] to breast-feed," Carpenter said.She tells staffers not to ask 
whether their clients plan to breast-feed, but to ask how long they plan to 
do so."That makes breast-feeding the norm," she said.It once was the norm, 
said Mishawn Purnell-O'Neal, a public health consultant who last year founded 
the Chicago chapter of the African-American Breastfeeding Alliance."At one 
time, African-Americans exclusively breast-fed," said Purnell-O'Neal, 33, of 
Forest Park. She nursed her now 3-year-old son and is breast-feeding her 
6-week-old son, and attributes her success partly to her husband's 
support."But when formula became available, [black women] wanted to embrace 
that; it seemed like a step up as opposed to being stuck breast-feeding. 
Breast-feeding seemed something you did out of necessity," she said.There is 
also a lingering distaste for breast-feeding because black women once served 
as wet nurses for other people's children, she said. It adds up to a 
devastating health problem in the black community, said Purnell-O'Neal, who 
has self-published a book titled, "Breastfeeding Facts Over Fiction: The 
Health Implications on the African-American Community.""In the city of 
Chicago, African-American communities have the highest infant mortality rate, 
and the lowest breast-feeding rate; there's a correlation," she 
said.Breast-feeding reduces the chances and severity of several illnesses 
that contribute to infant mortality, said Rachel Abramson, executive director 
of Chicago Health Connection, including sudden infant death syndrome, 
necrotizing enterocolitis and gastrointestinal and respiratory 
infections.Breast-fed infants experience fewer infections and non-infectious 
diseases, and less severe cases of diarrhea, respiratory infections and ear 
infections. Studies have suggested that they are also at less risk for 
chronic diseases including diabetes, celiac disease, inflammatory bowel 
disease and childhood cancer. For mothers, breast-feeding makes it easier to 
lose pregnancy weight, minimizes postpartum blood loss and may reduce breast 
and ovarian cancer.Breast-fed babies have been shown to be less likely to 
suffer childhood obesity, a greater problem among African-Americans than 
whites. Breast milk is particularly important for low birth-weight babies, 
also a more common health issue among African-Americans.And studies have 
shown that breast-feeding reduces the chances a child will develop asthma, 
which is also more prevalent among blacks than whites. However, a study 
published last week in The Lancet found that breast-fed children are actually 
twice as likely to develop asthma and allergies as those who are not 
breast-fed.But these benefits have to battle unfamiliarity. Many 
African-Americans have never seen a black woman nursing a baby, Markham 
said."I have had many children come up to me and say, `What is your baby 
doing under there? That is disgusting.' That is a horrifying thing in our 
community," she said. "Black women need to see black women 
breast-feeding."CindyMarkham does her best to show them. A trained 
breast-feeding peer counselor, she speaks to classes at Lake County WIC sites 
and to women in her church, where her husband is pastor. She has tried to get 
other black women to join her La Leche League International group in Lake 
County, where she has been the lone black member for seven years, but in 
vain. "I've taken them [to meetings], but they feel very threatened by these 
white women who can afford to stay at home when a lot of the black women I 
deal with are single moms," she said.Targeting teenage mothers.Teenage 
mothers are among the least likely to breast-feed."It's peer pressure," said 
Rosie Moreno, a peer counselor at Cook County Hospital. "They don't want to 
feel different. And they want to go out shopping and partying; you can't be 
away for 2 1/2 hours" while breast-feeding.Johnson tells teens that 
breast-feeding gives them a powerful bond with their babies even if their own 
mothers do most of the child care.Bottle-feeding insulates young mothers from 
the demanding nature of good parenting, Markham said."It's convenient; they 
can get [the] grandmothers to keep their baby," she said. "But what does that 
do? ... They don't feel like mothers."And they may be more likely to have 
additional children, she said, because it seems relatively easy.At Cook 
County Hospital, the breast-feeding program keeps a watch out for anything 
that might make breast-feeding hard. As they left the postpartum ward, Scott 
and Johnson noticed an infant sucking on a nipple from a bottle. Artificial 
nipples can lead to confusion when a baby tries to latch on to the real 
thing, the breast-feeding team says. They were given out by a baby 
photographer who wanted to keep the newborns quiet."Oooh," said Johnson 
softly. "We're going to have to talk to somebody."----------For more 
information, contact the African-American Breastfeeding Alliance at 
877-532-8535; the Chicago chapter by e-mail at [log in to unmask]; or the 
La Leche League at 800-LA-LECHE.
Copyright © 2002, Chicago Tribune


Cindy Fagiano
Peer breastfeeding Counselor

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