Confronting Cultural Barriers to Breastfeeding

Q&A with Advocate and NICHQ Faculty Kimarie Bugg

July 12, 2013
By Kristina Grifantini

Kimarie Bugg, MSN, MPH
Kimarie Bugg, MSN, MPH

Supporting a mother’s choice to breastfeed has become a national priority.External Link  NICHQ (the National Initiative of Children’s Healthcare Quality is using quality improvement methods to help hospitals make systematic changes to support breastfeeding in the national Best Fed Beginnings initiative. The work involves educating staff on supportive breastfeeding environments, providing support to moms before and after birth, and allowing mothers and babies to spend the most time together as soon as possible after birth.

Kimarie Bugg, MSN, MPH, a nurse practitioner who specializes in breastfeeding, works with Best Fed Beginnings hospitals in the southern US, an area of the country that has traditionally had lower breastfeeding rates.External Link Bugg is also a co-founder and the current President and CEO of Reaching Our Sisters Everywhere (ROSE),External Link an organization that helps healthcare practitioners to support breastfeeding in underserved populations. She recently talked with NICHQ about the cultural barriers to breastfeeding many families face.

Why do breastfeeding rates tend to be lower in the southern US?

There are lots of cultural barriers and, just like most health disparities in this country, they include access to and quality of care. One barrier is the cost. If moms struggle with breastfeeding they can go to a counselor but it costs $150 or so and generally that’s not something that women of color can always afford. African-American women also typically go back to work sooner than Caucasian moms. Another barrier is images: you don’t see a lot of images of African-American women breastfeeding in the community.

What we know is that only around half of African-Americans initiate breastfeeding because the barriers seem insurmountable. Our concern is getting more women to initiate breastfeeding and to make the benefits outweigh the barriers. Aside from a lack of access to proper care, quality of care and cost, the workplace is also a major concern: when people work in service industries it’s difficult to take a multi-month maternity leave. I know people who go back to work in a couple of weeks so that makes it difficult to continue to breastfeed. A lot of times, people don’t even start because they know those barriers exist.

As far as education is concerned, just like everybody else, African-American women do know the benefits of breastfeeding but that hasn’t been a big enough motivator to change it. Our thought at ROSE is that it’s not just the educating, peer support and relationships tend to make a difference. It’s the message as well as the messenger. It also has to do with the fact that there are fewer African-American healthcare providers. Increasing ethnic racial diversity in healthcare would make a major difference.

How has the Best Fed Beginnings program improved barriers for different ethnic groups?

Because of the policy and system changes that Best Fed Beginnings encourages, the changes will increase breastfeeding across the board. Breastfeeding improves when the policies change, for example, when all moms get the same breastfeeding message. Getting that pre-natal education from the healthcare provider is going to make a major difference not only for the African-American community but also the Asian and Pacific communities where breastfeeding rates are dropping.

Have you seen specific improvements in the hospitals since the initiative began?

We do see improvements. Moms tell me they’re keeping the babies with them and doing the skin-to-skin contact right after birth, which has been shown to improve breastfeeding. Things have definitely gotten noticeably better in the seven hospitals that are here in Georgia and the other ones I’m working with in the South, especially with moms who are having a second child in the same hospital. For example, my friend’s daughter had a C-section recently and got her baby within the first hour, which is really pretty amazing since before at this particular hospital it probably would have been a few hours delay.

What are the challenges the hospitals still face?

Some of the hospitals still have a long way to go. For example, last week I had a mom deliver twins and the hospital sent her home with a pump, nipple shield and other supplies because the babies weren’t nursing well. One of her sorority sisters reached out to us at ROSE eight days postpartum because breastfeeding still wasn’t going well and the mom had been pretty miserable.

Working with the babies we discovered one wasn’t suckling well so we referred him to his primary care physician. The doctor tested him and found he had thyroid problems. So this really shows the importance of proper care and follow-up to better support breastfeeding moms.

Are there any barriers or solutions particular in the South that you’ve noticed?

One of the things we’re working on a lot in the southeast is engaging the faith-based communities. We’re currently working on a toolkit to help churches support and spread breastfeeding, because the black church is pretty influential in the South. The toolkit helps churches establish lactation rooms in the church, provide lactation education and information, and encourage senior citizens and grandparents to get onboard.

Grandparents are a barrier to breastfeeding?

Sometimes—we lost out on a generation of breastfeeding in African-American communities. In the 1970s breastfeeding rates were extremely low in the country overall. After that the rates did not go up dramatically in the African-American community because of being disenfranchised in general and all of these social obstacles that have not been completely overcome but have gotten much better.

What tips would you give places trying to reduce cultural barriers in breastfeeding?

Hospitals can make sure brochures and handouts are culturally appropriate and use multicultural images and language. On a deeper level, you have to really care. Like Teddy Roosevelt said, “Nobody cares how much you know, until they know how much you care.” With African-American moms, that’s particularly important especially when you get down to something as intimate as feeding. Unless someone knows you really care, it’s difficult to listen. And to my moms, I tell them: you don’t have to start out an expert, you just need to start.


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