A culture which prevailed in the mid-20th century America viewed breastfeeding as outside the norm, as “the special way,” became entrenched in Puerto Rico because of its close relationship with the United States. The prevalence of formula-feeding continues to be reflected today among low-income Puerto Rican women living in Hartford who tend to breastfeed less than other Latinas.
The desire to change this culture, to normalize and increase the use of a practice that most pediatricians and health care advocates endorse as the best way to nourish newborns and infants, inspired a peer counseling program. Breastfeeding: Heritage and Pride was developed by the Hispanic Health Council and has run in collaboration with Hartford Hospital over the past decade.
Recently, this “one woman helping another” approach, which had primarily centered in the heavily Hispanic neighborhoods near Hartford Hospital, has been able to increase its outreach to other parts of the city, particularly to the low-income communities north of Interstate 84 that mostly rely on St. Francis Hospital and Medical Center and its women’s center for health care. This population is heavily African-American but also has a large number of Spanish-speaking women.
The game changer is a $498,980 grant that Saint Francis received last December from the W.K. Kellogg Foundation that has enabled the Saint Francis Center for Women’s Health to tap into HHC’s established breastfeeding program, as well as to hire a lactation consultant and peer counselors.
“This grant will help us change the culture of formula-feeding the babies of the women who use our center,” said Walter Trymbulak, M.D., Ph.D, director of the Center for Women’s Health.
Heritage and Pride relies heavily on community health care workers, counselors enlisted from women who have successfully breastfed for at least six months and share the economic and cultural background of the women they are helping, as well as speak their language.
These women, who are paid, undergo rigorous training to prepare them to become breastfeeding peer counselors. The focus is on having counselors who, because of their similar background, can develop what Trymbulak described as a trust relationship.
St. Francis and HHC have invested several months in making sure everything was in place before recently rolling out Heritage and Pride. “We got the grant a year ago and spent time establishing the program parameters, developing job descriptions, interviewing and hiring and then training the right people,” said Fiona Phelan, media manager at Saint Francis.
The Center for Women’s Health and its satellite office in the Burgdorf Health Center care for more than 600 pregnant women each year, most from the neighborhoods north of Interstate-84 and some nearby communities.
Based on the demographics of its community, Saint Francis currently employs two peer counselors, one is African-American and the other fluent in Spanish, said Julie-Ann Toalston, the women’s center lactation consultant. The Hartford Hospital side of the program has five counselors.
The use of community health care workers is the wave of the future, said Dr. Trymbulak, who added that Connecticut has a chance to lead in this movement. What is needed, the doctor said, is for the state to allow Medicaid funds to be used toward compensating these workers.
While the vast majority of American women, including Hispanics, have embraced breastfeeding in the last 25 years, the prevalence for formula feeding has contributed to Hartford’s inner city ethnic population having what is considered the lowest rate of breastfeeding in the state.
The reason attention was focused on Puerto Rican women is that they have much lower rate of breastfeeding than other Latino women in the city, observed Toalston. “If you subtract out the Puerto Ricans, there is a higher rate of breastfeeding in the low-income population.
Breastfeeding practices among Puerto Ricans differ from those of other Latinas, particularly those from Mexico, Peru and Colombia, according to 2012 Yale School of Public Health report focusing on Hartford. This study underscored earlier research by a team from the University of Connecticut, HHC and Hartford Hospital that found that “many Puerto Rican women in Hartford do not see breastfeeding as a social norm” and introduced formula within the first week after delivery of a child.
Nationally, Latinas have a high rate of breastfeeding, similar to non-Hispanic whites and higher than non-Hispanic blacks, according to Centers for Disease Control study of children born in 2012. The percentage of U.S. children who are breast fed has increased from 71.4 percent among those born in 2002 to 80 percent for those born in 2012, and also has progressed significantly for children breastfed at 6 months as well as those exclusively breast fed through three and six months.
However, while breastfeeding may be the norm in many Latin American countries, its use tends to decline when they move to this country, Trymbulak observed. This cultural change, he said, is due in part to the message they have received which was “come to the United States, the land of plenty, and get free formula from WIC.”
Meanwhile, breastfeeding advocates also have to contend with the pharmaceutical companies’ ongoing efforts to extol the value of the formulas they sold, which are not entirely the same as breast milk, Trymbulak said.
The benefits of breastfeeding, according to the center director and other health care specialists, include a positive impact on growth and development, as well as reducing the risk of Sudden Infant Death Syndrome, childhood obesity, asthma, respiratory infections, allergies, and eczema. Breast feeding also reinforces a strong emotional bond with the mother.
A key ingredient in normalizing breastfeeding, said Toalston, is there needs to be a buy-in from all health care providers. “Unity has to be there,” the lactation consultant said.
Heritage and Pride’s 360-degree approach begins with Health and Pride coaches meeting with the pregnant women at the hospital to explain the health benefits of breastfeeding. After the baby arrives, the counselors work with the hospital’s lactation consultants help the new mother initiate breastfeeding. This support continues with the peer counselors making home visits to make sure the breastfeeding is going well. The first visit comes within 24-48 hours after the discharge, and is also available over the phone.
Pediatricians and the World Health Organization recommend that mothers exclusively breastfeed during a child’s first month and continue this practice to compliment other nourishment up to 12 months.
Studies have shown that intensive peer counseling increases the initiation and duration of breastfeeding, and is successful in populations that have historically low rates of 6-month and 12-month breastfeeding, according to St. Francis and HHC.
While breastfeeding has not been normalized yet among many low-income Latinas and African-Americans in Hartford, Toalston said, “We are getting there.”