Head Start

Historical, Cultural and Social Factors Impacting Breastfeeding Choices and Options
The Numbers
Common Cultural and Family Norms around Breastfeeding
The Response
African-American Mothers and Families
American Indian and Alaska Native Mothers and Families
Quick Tips for Parents
Resources
Web-based Resources
Websites
EHS NRC Resousrces

Part I of our Breastfeeding Series focused on the benefits of breastfeeding for babies, mothers and families. In Part II, we outline important historical, cultural and social factors that have influenced breastfeeding decisions and options for families.

Historical, Cultural and Social Factors Impacting Breastfeeding Choices and Options

While many believe that, "breastfeeding is the most natural process in the world" (Evans and Danda, 2000, p.1)," the current number of women from all backgrounds who breastfeed and the length of time they nurse suggest a different picture (see chart below). During the first part of the 20th century in the United States, many women breastfed their babies because it was natural, less expensive and part of family tradition.

The 1950's brought changing roles for women, and media advertising of infant formula as the "feeding method of choice" for infants (Jones, 2003, p. 2). The infant formula campaign (actually launched in the 1800's) provided clear messages about infant feeding options to women who were entering the workforce and searching for ways to feed their babies when they needed to be away from them for extended periods of time. Women with very young infants entered a workforce that was not conducive to breastfeeding. At that time, there were few private, quiet places outside the home for women to nurse their babies, and even fewer situations in which nursing in public felt comfortable for mothers and acceptable to others. Many new mothers worked long hours in huge, industrial factories -- hardly a place to promote breastfeeding or the special bonding that occurs between mothers and infants during this time.

American women and families felt good about formula for their infants because it was convenient, free (in some cases), and had many of the nutrients found in breast milk. The use of formula also allowed fathers to take part in feeding their babies. However, now we know that there are certain nutrients in breast milk that formula cannot duplicate; and these very nutrients provide infants with increased health benefits and protection from diseases often found in very young children (Dermer & Montgomery, 1997; Agency for Healthcare Research and Quality, 2007). EHS staff have the opportunity to share the health benefits of breastfeeding with parents and families, understand cultural and social factors impacting breastfeeding choices and options, and make certain that all families receive this information in the most useful way for their particular situation.

Most families are greatly influenced by societal cues (e.g. available places to breastfeed in public) and family cultural norms (e.g. whether a family has traditionally breastfed or formula fed infants; and opinions about the preferred infant feeding choice in that family) around breastfeeding. These cues and cultural norms effect and impact breastfeeding choices and options for many new mothers and families. Although the statistics on breastfeeding rates shed light on only part of the story, the numbers can be useful for EHS staff working with families who receive and use infant feeding information in different ways based on the family situation. Let's start with the numbers.

The Numbers

In 2005, the Centers for Disease Control's (CDC) National Immunization Data on Breastfeeding revealed the following:

The chart above shows that Asian women breastfed more than any other ethnic/racial group. On the other hand, American Indian and Alaska Native (AIAN) women and African-American women are below the national average and are breastfeeding for shorter periods.[1] This means that mothers and babies from these two cultural groups are receiving less of the preventive health benefits of breastfeeding (outlined in Part I of this series) than mothers and babies from the other groups. However, when we look more closely we can find similarities between AIAN and African-American mothers in terms of cultural and family norms that might also affect breastfeeding rates and duration in both communities.

Common Cultural and Family Norms around Breastfeeding

• Family habits, beliefs, and oral histories are all highly honored and respected traditions in AIAN and African-American communities. New mothers who have seen their mothers breastfeed will be more likely to breastfeed their children. Likewise, new mothers whose families formula feed their infants are more likely to carry on that tradition (L.Whitehair, personal communication, July, 2007). In the African-American community, grandmothers' and infants' fathers' opinions about breastfeeding greatly influence the mother's decision about breastfeeding choices and options, and fathers' opinions have the greatest impact (Bentley, Dee, and Jensen, 2003).
• Family opinions about breastfeeding choices and options are as powerful in AIAN and African-American communities as is current evidence about breastfeeding benefits for babies and mothers. For example, mothers who are interested in learning about recommended feeding practices for very young infants are equally influenced by their own family practices and beliefs. Understanding and respecting these traditions is important when working with families from these cultural backgrounds.

The Response

The federal government, African American breastfeeding coalitions, Women Infants and Children (WIC), Indian Health Service (IHS) and other organizations have worked together to create culturally sensitive information for African-American and AIAN mothers and families regarding breastfeeding options and resources. Programs and resource materials developed in response to the needs of mothers and families from both of these cultural groups can be of particular help to EHS program staff. All web-based materials with active links are listed in the resources section.

African-American Mothers and Families

• In many communities across the country, African-American breastfeeding coalitions have been established to offer African-American families information and support in breastfeeding. Families with Internet access can place "African-American Breastfeeding Coalitions" in their web browsers for more information and locations. Families can also check with local WIC offices for local coalitions.
• The United States Department of Health and Human Services/Office on Women's Health (USDHHS/OWH), the AABA and others have developed written products and materials to address the unique social concerns and needs of African-American women. These tools were designed to help support and encourage breastfeeding. Some of these products are user-friendly for Early Head Start (EHS) staff working with nursing and/or pregnant mothers. Other products provide more specific information on breastfeeding for parents and the benefits for infants, mothers and fathers.
• Fathers Supporting Breastfeeding is a WIC Food & Nutrition Service project geared towards African-American fathers. The project encourages and supports fathers so that they, in turn, can positively influence African-American mothers in their decision to breastfeed. This project is part of an ongoing effort to increase breastfeeding initiation and duration rates in the African-American community.

American Indian/Alaska Native Mothers and Families

• The USDHHS/OWH, the Breastfeeding Promotion Group of Arizona and others have developed written and audiovisual materials to encourage, promote and support breastfeeding in AIAN communities. The materials are EHS staff-friendly, highlight breastfeeding benefits for babies and mothers, and provide options and strategies for moms returning to work or school after a baby's birth. More information is included and listed in the resources section.
• In AIAN communities, many families struggle with serious health problems such as obesity and diabetes. The Gila River Indian Community in Arizona worked closely with scientists from the National Institutes of Health (NIH) and found that breastfeeding lowers the risk of infants becoming overweight and developing diabetes later in life (USDHHS, 2006, pg. 4). Curricula on nutrition, diabetes, pregnancy and other resources are easily accessed from the IHS website.
• American Indian tribes with significant increases in breastfeeding rates and duration have strong WIC peer counseling support in place. The Loving Support Makes Breastfeeding Work campaign combines peer counseling with WIC's current breastfeeding promotion project. Additionally, WIC clinics located near or within medical centers, make it more convenient for nursing mothers to complete their medical and WIC appointments on the same day in one location (L.Whitehair, personal communication, July, 2007). Click on the link for more information on the Loving Support Makes Breastfeeding Work campaign: http://www.nal.usda.gov/wicworks/Learning_Center/support_peer.html
• Quick Tips for Program Staff: Breastfeeding Education and Support for African-American and American Indian and Alaska Native Families.
• Have information and materials about breastfeeding readily available in centers and during home visits for parents and families. Invite representatives from WIC, and your local African-American breastfeeding coalition to a parent meeting/gathering or Socialization to talk informally with parents about breastfeeding options and resources.
• Connect with fathers of young infants to discuss breastfeeding benefits and making the best choices for their families. The benefits are two-fold. Not only do fathers have significant influence with new mothers in making the decision to breastfeed, their involvement also helps them to become more a part of the breastfeeding process.
• Encourage new mothers to keep all medical appointments for themselves and for well-baby check-ups. If available in your community, locate medical clinics with WIC offices either attached to the medical facility or nearby. This will make it more convenient and likely for new mothers to receive valuable information, resources and support from WIC, and attend to any medical needs of the baby -- all in one location.
• Remember that every family has different needs and concerns regarding breastfeeding choices and options. Encourage and support all parents, whether breastfeeding or not, to make the decisions that feel best for the family. These opportunities can occur during one-on-one informal conversations or during more structured parent gatherings or meetings.
• Have discussions with parents and families that include benefits of breastfeeding, as well as encouraging families to share and honor their own traditions. Talk with them about their feeding choices and the reasons behind those choices . These types of discussions can happen during home visits, parent gatherings or Socializations. Parents can also be encouraged to connect and share with each other for ongoing support.

Quick Tips for Parents

• Reflect on your own family traditions regarding breastfeeding. Make choices based on your family's needs and be well informed about breastfeeding. If necessary, modify your practices based on what feels most comfortable for your family.
• Ask your EHS program to help you find a support group of other parents and families who are deciding about breastfeeding.
• Remember the health benefits of breastfeeding for babies and mothers (News You Can Use, Breastfeeding News and Research, Part I, July, 2007) as you consider your own needs and those of your family.
• Check with your local WIC agency for any information, breastfeeding support, and breastfeeding equipment (e.g. breast pumps) they may provide.

Resources

Barber, K. (2005). The Black Woman's Guide to Breastfeeding: The Definitive Guide to Nursing for African American Mothers. Naperville, IL: Sourcebooks, Inc. ($11.00-available at www.amazon.com).

Bentley, M.E., Dee, D.L., Jensen, J.L. (2003). Breastfeeding among low income African- American women: Power, beliefs and decision-making. The Journal of Nutrition. 133(1), 305S-309S. http://jn.nutrition.org/cgi/reprint/133/1/305S.

Dermer, A. & Montgomery, A. (1997). Breastfeeding: Good for babies, Mothers and the Planet. Retrieved June 2007.

Evans, G.D. & Danda, C.E. (2000). Emotional and Physical Preparation for Breast Feeding. University of Florida, Institute of Food and Agricultural Sciences, Gainesville, FL, 1-8. Retrieved August 2007. http://edis.ifas.ufl.edu/FY004.

Jones, F. (2003). The History of Milk Banking. Human Milk Banking Association of North America, 1-3. Retrieved July 2007. http://www.hmbana.org/index.php?mode=history.

Web-based Resources

An Easy Guide to Breastfeeding for African-American Women and Their Families
This online guide was developed by the USDHHS/OWH and the AABA to support and encourage breastfeeding in African-American women. The tool is user-friendly for EHS staff in working with nursing mothers.
http://www.womenshealth.gov/publications/our-publications/breastfeeding-guide/BreastfeedingGuide-AfricanAmerican-English.pdf

An Easy Guide to Breastfeeding for American Indian and Alaska Native Families
This online guide developed by the USDHHS/OWH and the Breastfeeding Promotion Group of Arizona was designed to support and encourage breastfeeding in AIAN women. EHS staff can also use this tool for this purpose.
http://www.womenshealth.gov/publications/our-publications/breastfeeding-guide/BreastfeedingGuide-NativeAmerican-English.pdf

Close to the Heart: Breastfeeding our Children, Honoring our Values
This videotape promotes breastfeeding for Native American women, highlights benefits for babies and mothers, and provides options for moms returning to work or school after a baby's birth.

For more information contact:
Phoenix Indian Medical Center, IHS, Diabetes Center of Excellence Breastfeeding Helpline at: 1-877-868-9473.
http://diabetes.niddk.nih.gov/dm/pubs/breastfeeding/Breastfeeding.pdf

Websites

Centers for Disease Control
CDC's Breastfeeding National Immunization Data: Socio-demographic: 2005
http://www.cdc.gov/breastfeeding/data/NIS_data/2005/socio-demographic.htm

United States Department of Agriculture, Food and Nutrition Service Women Infants and Children (WIC)
http://www.fns.usda.gov/wic/

United States Department of Health and Human Services Agency for Healthcare Research and Quality Evidence Report/Technology Assessment
Number 153
http://www.ahrq.gov/

United States Department of Health and Human Services Indian Health Service, Breastfeeding Promotion and Support
http://www.ihs.gov/babyfriendly/

United States Department of Health and Human Services Pediatric Nutrition Surveillance
http://www.cdc.gov/pednss/pdfs/PedNSS_2003_summary.pdf

EHS NRC Resousrces: Fall 2007

Mother's Milk: Welcoming and Supporting Breastfeeding in Your Program
This audio conference aired on May 23, 2007 from 2-3:30 pm (EST) and was designed to provide Head Start, Early Head Start and Migrant and Seasonal Head Start programs with information to support families in making the choice to breastfeed. Faculty for the audio conference talked about the reasons to breastfeed, and shared their experiences in establishing breastfeeding-friendly programs. A brief question and answer period followed.

Missed the audio conference? Click on the link below to listen to the broadcast in its entirety in the fall of 2007: http://www.ehsnrc.org

Quality Practices for Babies and Toddlers: Systems and Services that Work
The 11th Annual Birth To Three Institute was held from June 25-29, 2007 at the Marriott Wardman Park in Washington, DC. Sponsored by the Office of Head Start, this institute provided the opportunity for participants to learn about cutting-edge research and practical uses for the infant and family field.

Weren't able to attend? Be sure to log onto http://www.ehsnrc.org through October 2007 to view the plenary sessions via web cast.

Get ready for Birth To Three 2008! The Call For Proposals will be issued in early October 2007.

It's Good for Them! Promoting Physical and Social-Emotional Development at Snacks and Mealtimes
This audio conference aired on August 1, 2007 from 2-3:30 pm (EST). Snacks and mealtimes are an important part of the day. In working through Head Start Program Performance Standards, your program partners with families in providing not only healthy nutrition to children, but also healthy interactions as they eat. Snacks and mealtimes provide rich opportunities to teach children important cultural and social-emotional skills. This audio conference examined the requirements for food and feeding in the Head Start Program Performance Standards, and the many ways staff and families can use these important routines to support development and learning in infants and toddlers.

Missed the audio conference? Click on the link below to listen to the broadcast in its entirety in the fall of 2007: http://www.ehsnrc.org.

Helping Children HEAR and NOW: How to Update Hearing Screening Practices for Children Birth to Three
The National Center for Hearing Assessment and Management (NCHAM), in collaboration with the EHS NRC @ ZERO TO THREE sponsored this audio conference/ webinar on August 8, 2007. Key steps for implementing up-to-date hearing/screening practices were reviewed. Two more audio conferences are being offered, both at 2:00 pm (EDT). On September 26, 2007, an advanced audio conference/webinar will happen for programs that have OAE screening equipment. For programs that do not have OAE screening equipment but are interested in updating their hearing/screening practices the August 8 audio conference/webinar will re-air on October 3, 2007.

For more information and registration details please contact Nicole Bellamy at: nbellamy@zerotothree.org.