infant mortality

Mamas on Bedrest: Why there is a need for “Black Breastfeeding Week

August 18th, 2016

Hello Mamas,

Black Breastfeeding Week is August 25-31, 2016. Many may be asking, if August is Breastfeeding Awareness Month and August 1-6 was World Breastfeeding Week, why is there a need for a Black Breastfeeding Week???

According to organizers Kimberly Seals Allers, Kiddada Green and Anayah Sangodele-Ayoka,

Black Breastfeeding Week was created because for over 40 years there has been a gaping racial disparity in breastfeeding rates. The most recent CDC data show that 75% of white women have ever breastfed versus 58.9% of black women. The fact that racial disparity in initiation and an even bigger one for duration has lingered for so long is reason enough to take 7 days to focus on the issue.”

And the organizers cite 5 specific reasons a Black Breastfeeding week is essential:

  1. The High Black Infant Mortality Rate
  2. High Rates of Diet Related Disease in African Americans
  3. Lack of diversity in the lactation field
  4. Unique cultural barriers among black women
  5. Desert-like conditions in our communities

If you ask any black breastfeeding expert what are the top barriers to breastfeeding for black women, they will reply:

  1. The historical role of black women as “wet nurses” to white (slave owner’s) children
  2. The perception by many black people that breastfeeding is “dirty” or “nasty” (the result of #1)
  3. The aggressive campaign by formula companies who capitalized on the notion that “poorer women” breastfeed and modern women of means used formula.
  4. Hospitals that serve primarily black patients have been shown not to offer the same level of support and education for breastfeeding initiation to black women
  5. Few professional black lactation consultants
  6. The lack of support from family members for breastfeeding

It has to be recognized that breastfeeding has very different implications for black women than for white women and lactation consultants trying to counsel black women to breastfeed must be aware of the cultural history of breastfeeding for black women. They need to be aware of the fact that many black women have no breastfeeding role models as their mothers, grandmothers, sisters and aunts may not have breastfed their babies. Without the family tradition of breastfeeding, and the history of the “mammy” wet nurse, many black women lack breastfeeding support and encouragement from their families and are not eager to breastfeed themselves. Many black women work at jobs where they may not be able to take time to nurse or pump, nor do they have a private place to nurse or pump at work. For these reasons in particular and many others, it is imperative that more black women become trained as lactation consultants. Certification to become an Internationally Board Certified Lactation Consultant (IBCLC), the top credential for lactation consultants, is such a rigorous and expensive endeavor, and many black women who want to become certified state they cannot afford to undertake the process.

So while there are many challenges that face black women who choose to breastfeed and Sellers, Greene and Sangodele-Ayoka-like many other black women who are well versed in the benefits of breastfeeding for back women-have taken it upon themselves to create an organization that promotes breastfeeding and where they can provide information, education, support and resources for black women who want to breastfeed.  

In counseling black women to breastfeed, highlighting the benefits of breastfeeding is a potent motivator. Breastfed babies are:

  • Less likely to have allergies and asthma
  • Less likely to have upper respiratory and ear infections
  • Less likely to have weight problems as adults
  • Less likely to develop Type 2 Diabetes
  • Able to self soothe/are less fussy
  • Have less stomach upset (and less incidence of Necrotizing Enterocolitis)
  • May have increased intelligence
  • Less likely to die from Sudden Infant Death Syndrome (SIDS)

And breastfeeding greatly benefits Mamas, Too!

  • Mamas who breastfeed tend to return to their pre-pregnancy weight sooner
  • Mamas who breastfeed experience decreased incidences of breast and ovarian cancers
  • Mamas who breastfeed experience decreased incidences of Type 2 diabetes

Before being brought to this country as slaves, black women successfully breastfed their babies. Unfortunately, the legacy of slavery and many current socioeconomic and cultural barriers have made breastfeeding a difficult process for many mamas. It is imperative that these barriers be eliminated and that the education, support and resources be made available so that black mamas and their babies can reap the many life enhancing benefits of breastfeeding.

My Breastfed babies then…..

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My kids just days after the birth of my son.

And Now!!

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References:

http://blackbreastfeedingweek.org/

https://historyengine.richmond.edu/epsiodes/view/2901

www.bbc.com/news/blogs-magazine-monitor-27744391

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a1.htm

http://www.webmd.com/women/news/20140821/racial-disparities-in-breast-feeding-may-start-with-hospitals-study-suggests

www.huffingtonpost.com/2014/08/27/black-mothers-breastfeedi_n_5721316.html

http://www.ncbi.nlm.nih.gov/books/NBK52688/

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6333a2.htm?s_cid=mm6333a2_w

http://womenshealth.gov/publications/our-publications/breastfeeding-guide/breastfeedingguide-africanamerican-english.pdf

http://www.wakawfarmersmarket.org/0-3771-poor-mothers-enticed-to-bottle-feed.html

http://www.womenshealth.gov/breastfeeding/breastfeeding-benefits.html

 

 

 

 

 

Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”

January 14th, 2016

Hello Mamas,

As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release: 

“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”

 “Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”

 The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).

  • Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
  • The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
  • State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
  • The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
  • Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
  • State legislatures should mandate private insurance coverage of doula services.

Read the entire Issue Brief Here. For more information, visit Choices in Childbirth or Childbirth Connection.

 

 

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Mamas on Bedrest: September is Infant Mortality Awareness Month!

September 8th, 2015
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Photo by Racha Tahani Lawler, Los Angeles, CA

Mamas,

Did you know that September is Infant Mortality Awareness Month?

Globally, The United States spends more on healthcare than any other country. Yet, it has worse birth outcomes than many other countries globally. Despite recent declines in infant mortality, the United States ranked 26th among the 29 Organization for Economic Co-operation and Development (OECD) countries in 2010, behind most European countries as well as Japan, Korea, Israel, Australia, and New Zealand (1). The U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births was more than twice that for Japan and Finland (both 2.3), the countries with the lowest rates. Twenty-one of the 26 OECD countries studied had infant mortality rates below 5.0.

Overall in the United States, white infants die at a rate of 5-6/1000 births and Hispanic infants have a similar infant mortality rate. African American Infants die at a rate of approximately 11.4/1000 births. I’m here in Texas and our infant mortality rate for white and hispanic infants is 5.5/1000 births while it is 11.4/1000 for African American Infants. In Travis County (the Greater Austin Area where I live), African American Infants have an infant mortality rate of 11.5/1000 births, whereas white infants have an infant mortality rate of 3.7/1000 births and Hispanic infants 6/1000 births.(2) What is the cause of this disparity?

Researchers and public health officials have numerous speculations as to why the IMR for African American infants is so poor,

  • Delayed initiation of prenatal care among African American women
  • Lack of access to quality prenatal care
  • Lack of insurance
  • Poverty
  • Preterm labor/Prematurity
  • Low birth weight
  • Birth Defect
  • SIDS
  • Maternal health complications

However Dr. Michael Lu, an obstetrician and gynecologist at the David Geffen School of Medicine at UCLA and a professor in the Department of Community Health Sciences and the Center for Healthier Children, Families and Communities at UCLA School of Public Health has proposed other reasons for the birth outcome disparities. In his groundbreaking  research paper “Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach (3) Dr Lu and his colleagues point to systemic racism in American culture as the underlying cause of the birth outcome disparities. Lu and his colleagues point out that racism passed down through generations, as well as repeated racial slights in the daily lives of African American women has created an allostatic load of stress on African American women that is affecting their overall health, but in particular, their reproductive health and causing the negative birth outcomes we see in African American women and infants. To address these social determinants of health, Lu and his colleagues propose a 12 point Life-Course approach to closing the racial gap in birth outcomes.

  1. Provide Inter-conception care for women with prior adverse pregnancy outcomes
  2. Increase access to preconception care for African American women
  3. Improve the quality of prenatal care for African American women
  4. Expand healthcare access over the life course for African American women
  5. Strengthen father involvement in African American families
  6. Enhance systems coordination and integration for family support services
  7. Create reproductive social capital in African American communities
  8. Invest in community building and urban renewal
  9. Close the education gap
  10. Reduce poverty among African American families
  11. Support working mothers and families
  12. Undo Racism

Lu and his colleagues have presented an approach that not only address issues surrounding pregnancy and childbearing, but also addresses the social issues affecting African American families and communities. Lu makes some very bold statements, ones that some people may be loathe to accept and even less likely to act upon. But as Lu says in his publication,

“We will not close the Black-White gap in birth outcomes without political will to do so. Political will is the ability to command resources to make things happen (i.e. implement the 12 points).”

As the saying goes, “Where there is a will, there is a way!” The question now becomes do we the American people have the will, the actual desire to close this gap?

 

References

MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; vol 63 no 5. Hyattsville, MD: National Center for Health Statistics. 2014.

Austin Travis County Health and Human Services Department. Infant Mortality Rate Causes of Death for Travis County, 2000-2011. Data Source, Center for Health Statistics, Texas Department of State Health Services. Texas Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012

Lu, M.C., MD, MPH, Kotelchuck, M., PhD, MPH, Hogan, V., DrPH, Jones, L., MA, Wright, K., PhD, MPH, Halfon, N., MD, MPH. “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach” Ethnicity and Disease, Volume 20, Winter 2010.