Thought the listserv would find this article interesting.
Margaret Farrell MPH RD
-----Original Message-----
From: Vicky Getty [SMTP:[log in to unmask]]
Sent: Thursday, July 16, 1998 5:58 PM
To: [log in to unmask]
Subject: EFR 8(27): Ethnic breastfeeding rates
Subject: Ethnic breastfeeding rates - EFR 8-27
ELECTRONIC FOOD RAP
VOL. 8 NO. 27
Vicky Getty, MEd, RD and Bill Evers, PhD, RD
Cooperative Extension Foods and Nutrition Specialists
Purdue University School of Consumer and Family Sciences
Department of Foods and Nutrition
Back in March Vicky wrote an Electronic Food Rap summarizing a WIC
(Special Supplemental Nutrition Program for Women, Infants, and Children)
Infant Feeding Practices Study, which examined how WIC-participating
mothers choose to feed their children through the first year of life. In
that study, only white, Hispanic, and African-American ethnic groups were
reported on separately. As a follow-up, this EFR summarizes findings from
the California Department of Health Services Breastfeeding Promotion
Committee Report, which includes data on the breastfeeding decisions made
by ethnically diverse populations in California.
Source: Statewide Committee on Breastfeeding Promotion. "Breastfeeding:
Investing in California's Future," California Department of Health
Services, November 15, 1996.
BREASTFEEDING PRACTICES AMONG ETHNIC GROUPS
Background
----------
The U.S. national health objective for breastfeeding is "to increase to at
least 75% the proportion of mothers who initiate breastfeeding and to
increase to at least 50% the proportion who continue to breastfeed until
their infants are 6 months old" (p. xi). In California, the vision of the
Statewide Committee on Breastfeeding Promotion is that "breastfeeding will
be the norm in California for at least the first year of life and
preferably longer" (p. viii).
The report released by the committee in 1996 provides 17 recommendations
to improve breastfeeding initiation and duration rates in California,
recommendations which cover six major areas: Health Care Systems, Public
Education, Professional Education, Workplace and Educational Centers,
Mother-to-Mother Support, and Research. Three other recommendations were
designated as overall priorities. The first is an administrative
suggestion specific to California. The other two are as follows:
"II. All breastfeeding promotion activities at all levels must be
culturally relevant to the diverse populations in California and must be
implemented by individuals who are culturally competent.
"III. No money or goods should be accepted from the manufacturers of
artificial baby milk for the implementation of the recommendations of this
report. Gifts from manufacturers of other infant feeding and lactation
products should be used only with great caution and should be
progressively eliminated" (p. xvi).
Breastfeeding rates in general
------------------------------
In the United States as a whole, breastfeeding reached an all-time low in
1971, with only about one-quarter of American mothers initiating the
practice at all and merely 5% continuing to breastfeed through 6 months.
There was then a sharp reversal that peaked in 1982 with 62% of American
mothers initiating the practice. By 1994, 57.4% of American mothers
initiated breastfeeding. A rise since 1990 was almost certainly aided by
extra funds provided to the WIC program to promote breastfeeding. However,
only 19% of infants were still being breastfed at 5-6 months, and only
half of those exclusively so. This is obviously below the national
objective of at least 50% continuing through 6 months.
According to the report, the status of breastfeeding in California is
generally positive, yet there is room for improvement. Based on
in-hospital data for 1993, 74% of California mothers did breastfeed their
babies while in the hospital, but only 43% did so exclusively. The 31% who
supplemented breastfeeding with formula were more likely to stop
breastfeeding early. Still, the initiation rates compare favorably to the
75% initiation goal.
Breastfeeding initiation/duration among California ethnic groups
----------------------------------------------------------------
In addition to differences according to mother's education, socioeconomic
status, and age (teen mothers generally breastfeed less than than adult
mothers), rates of breastfeeding vary greatly by ethnic group. The
California Breastfeeding Promotion Committee gathered data on the
breastfeeding initiation choices of WIC mothers; the results follow.
In-Hospital Breastfeeding Rates
California, by Ethnicity, 1993-94
Ethnic group Supplemented [sic]* Breast Only
------------ ------------ -----------
White 80% 60%
Asian 75% 40%
Hispanic 75% 30%
Native American 65% 45%
African American 55% 30%
Southeast Asian 35% 15%
*[EFR note] This column in the original table is labeled "Supplemented."
Logically, however, these numbers refer to the total percentage of
in-hospital mothers who breastfeed their children with or without
supplementation.
**Percentages are rounded to the nearest 5%.
Clearly, Southeast Asian mothers have the lowest incidence of
breastfeeding. African American mothers have the second lowest rate, but
according to the text, the "rate for African American women in Califonia
is 81 percent higher than that for all African Americans" in the U.S.;
rates for white and Hispanic women in California are 32% and 34% higher
than for those same groups in the U.S. in general (p. 20).
"In general, adolescent mothers have a lower rate of breastfeeding and a
higher rate of supplementation than older mothers. However, the difference
in breastfeeding rates between younger and older mothers varies by
ethnicity. The breastfeeding rates for non-Hispanic white and Asian teens
are considerably lower than those for older women of the same ethnic
group. In contrast, adolescents of Hispanic and Native American ethnicity
have breastfeeding patterns very similar to older mothers of the same
ethnicity" (p. 20).
In-Hospital Breastfeeding Rates
California Teens, by Ethnicity, 1993-94
Ethnic group Supplemented [sic]* Breast Only
------------ ------------ -----------
White 65% 45%
Asian 65% 35%
Hispanic 70% 30%
Native American 65% 45%
African American 45% 25%
Southeast Asian 30% 10%
*[EFR note] This column in the original table is labeled "Supplemented."
Logically, however, these numbers refer to the total percentage of
in-hospital teens who breastfeed their children with or without
supplementation.
**Percentages are rounded to the nearest 5%.
The report notes that, at the time, there were "no accessible sources of
data on duration of breastfeeding in California" statewide (p. 21).
Indications are that few California women of any ethnicity breastfeed
beyond the first few weeks.
Conclusions
-----------
Available data suggest that "breastfeeding initiation rates in California
are higher than in the nation as a whole. However, among certain ethnic
groups and in particular regions, initiation rates lag far behind national
objectives. There is also a very high rate of supplementation, which often
leads to early termination of breastfeeding" (p. 24). The patterns
observed suggest that many women initiate breastfeeding with the belief
that it is the preferable way to feed their infants, but do not receive
the necessary support to continue for the recommended minimum of 5-6
months.
What the California data also illustrate clearly is that breastfeeding
patterns differ significantly among various ethnic groups. Therefore
nutrition education aimed at increasing breastfeeding initiation and
duration must address the specific needs of different groups. As noted
earlier, a fundamental recommendation delineated in this report is that
"All breastfeeding promotion activities at all levels must be culturally
relevant to the diverse populations in California and must be implemented
by individuals who are culturally competent." The concepts of cultural
relevancy and cultural competency were defined as follows:
Cultural relevancy "is defined as the use of acceptable cultural practices
that will avoid major taboos and offenses to the members of a defined
culture, and will address issues of common concern in a way that will be
viewed as respectful by members of that culture. Cultural competency is
defined as a set of academic and interpersonal skills that allows
individuals to increase their understanding and appreciation of cultural
differences and similarities within and among groups. These skills include
but are not limited to expanding awareness, acceptance, valuing and
utilization of, and an openness to learn from, general and health-related
beliefs, practices, traditions, languages, religions, histories, and
current needs of individuals and the cultural groups to which they
belong...Essential to cultural competency is the ability to listen to,
learn from, and work with knowledgeable community members when developing
targeted interventions" (p. 27-28).
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Vicky Getty, M.Ed., R.D.
Extension Specialist
Purdue University
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