I would like to respond to the issue of promotion of breastfeeding among
Black women. Black, non-Hispanic women have the lowest rates for bf and
almost three times higher rates than White babies for infant mortality. There
are regional differences in these statistics and I think that we need more
research to get a better handle on the beliefs and experiences of  infant
feeding decisions among Black women. The women have a lot to tell us and we
need to work with them in devising culturally sensitive programs that meet
their needs.
For the past 18 mos I have been conducting an ethnographic study of the
infant feeding decisions among Black women enrolled in WIC. I have followed
11 women on a regular basis (at least 12- 24 data points each) from pregnancy
until up to a year postpartum. In addition I have informally
interviewed/observed over 158 Black women and their families and friends in
the WIC clinic, their homes, hospitals, NICU, McDonald's etc. As a middle
class white woman with a strong commitment to breastfeeding, I have been
humbled by the strength and endurance of the mothers who have talked with me.
I sincerely believe that we have to understand the everyday lives of the
people that we deal with as professionals. Most of the women were struggling
mightily to survive very serious crises in their lives. Infant feeding
decisions were not uppermost in their priorities. Most  only had exposure to
bottle feeding experiences among their families and friends. All of them were
committed to becoming "good mothers" according to their criteria. There was a
history of loss and abandonment among many. One woman blatantly said to me,
"Why are you asking me such STUPID questions? Who cares how you feed your
baby? You give them a bottle, put them on the rug and they drink." She had
been abandoned by her mother at age eight, was expecting twins and her
boyfriend had walked out on her when she told him that she was pregnant. She
had no money and was living in a different place almost every time that I
talked with her. It took a long time to develop any trust with her. Another
woman told me that she heard that breastfeeding makes you fall IN LOVE with
your baby and although she intended to love her baby to the fullest she never
wanted to be IN LOVE with her baby. She said, "Okay, it's one thing to be
close to somebody and love them  and know when to let them go, but to be IN
LOVE with them, especially if it's your child.... I mean to look at this
person like they were God... What if something happens to the baby or
something like that and you IN LOVE with this child? Like that's I think what
happened to my mother; when my brother died, I think she was IN LOVE with him
and she died of depression. That's what happened." This woman had been
tormented by others as a child because of a cleft defect and had lost her
father, mother and brother at an early age. Loss loomed large in her mind.
She chose to bottle feed like the woman before her.
Lest you think that all the women bottle fed, I have also had a number of
women who  breastfed despite many stumbling blocks. One in particular,
tenderly breastfeeds and nurtures a baby with a fatal brain defect. Another
takes three buses every morning to get to work to barely make ends meet but
sits down to bf her baby every evening when she gets home. WIC has been a
trusted source of knowledge and encouragement for many of the women in my
study. The first time that some of the women ever heard about the benefits of
bf was at the WIC clinic. My research has been exploratory in nature but I
think that it has had a therapeutic outcome indirectly. Many of these women
do not have the luxury of having someone listen to their concerns. The very
nature of the interview process provided an outlet and a validation of these
new mothers. Listening is so important.
There are many ways to raise children and different cultures devise their own
solutions for the problems that they know. I have also encountered a strong
belief among these women about the value of independence and the importance
of raising children that are not "spoiled." The women from my study live in
environments of poverty, drugs, and violence. They have had to be strong
"soldiers" in order to survive hardship. They recognize that they have
limited ability to protect their children and feel strongly that they have to
inculcate independence from an early age. Interestingly, the women who did
breastfeed did not necessarily find it to be a problem with independence. One
woman told me that she thought that independence would be facilitated by bf
because her child would be healthier and smarter.
Anyway, I think that the issue of breastfeeding is a loaded topic for women
of any culture. Infant feeding beliefs and experiences vary greatly and need
to be considered. Women have valuable information to teach us.
Roberta Cricco-Lizza RN MPH MS
PhD Candidate NYU

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