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Why black mothers are falling behind in breast-feeding: surgeon general David Satcher sounds the alarm.

ONE of the strangest and most puzzling of all health indicators is that Black women, who have nursed children for generations, are now at the bottom in breast-feeding rates among American mothers. According to the 1998 data compiled by the surgeon general's office, only 45 percent of Black mothers breast-feed their children immediately after birth, compared to 68 percent of Whites and 66 percent of Hispanics. Another steep drop occurs at 6 months after birth when only 19 percent of Black mothers continue breast-feeding, compared to 29 percent of mothers overall.

There are many theories on why Black mothers have fallen behind on the breast-feeding front. Some experts say the basic problem is class, and that many low-income women lacking extended maternity leaves are forced to return to work earlier, and therefore view breast-feeding as cumbersome. Others blame the association of breast-feeding with the slavery practice of wet-nursing.

The reasons for the disparity are complex, but health experts are taking proactive measures to reverse the trend. Surgeon General David Satcher has made it his personal mission to address the racial disparity in breast-feeding as well as to increase breast-feeding among women of all races. "Healthy People 2010" is the cornerstone of Satcher's health initiative for the nation during the next decade. It's designed to improve future lives by increased breast-feeding of babies.

"As we close the disparity gap [in breast-feeding], we will also be impacting `Healthy People 2010's' other goal of increasing the years and quality of healthy life," Dr. Satcher says. "We cannot afford to wait until a person is in [her] senior years to focus in on increasing quality and longevity. We have to begin our emphases as early in the life span as possible, which is why breast-feeding is so important."

The advantages of breast-feeding are clear, he says. "Breast-feeding protects infants from a wide array of infectious and noninfectious diseases, including diarrhea, respiratory tract infection, otitis media [ear infections], pneumonia, urinary infection ... and invasive bacterial infection," Dr. Satcher says. "When compared with formula-fed infants, breast-fed infants produce enhanced immune response to polio, tetanus, diphtheria, and haemophilus influenzae immunizations and to respiratory syncitial virus infection."

There are other benefits, too. Breast-fed children generally have lower rates of chronic childhood diseases, including cancer, asthma and diabetes.

Breast-feeding mothers also benefit from nursing. Studies have proven that mothers who breast-feed have less bleeding, return to their normal weight quicker and may have less risk of breast and ovarian cancer when compared to those who do not breast-feed.

A number of organizations, public and private, have launched national efforts to disseminate this information. The surgeon general's Blueprint for Action On Breast--Feeding contains guidelines, benefits, and other critical information about breast-feeding for mothers. The Baltimore-based African-American Breast-feeding Alliance, established in February 2000, educates Black mothers, fathers and families on breast-feeding through home and hospital visits.

"Right now, we're concerned that not enough [education] is going on," Dr. Satcher says, "so one of the things we do in the report is encourage physicians and other public health officials to become much more active in encouraging their patients to breast-feed."

Among the Black mothers taking the lead is Imani Barberousse of Chicago. Like most couples, Imani Barberousse, a former education director at the Boys & Girls Club and now a homemaker, and her husband, Dr. Lionel Barberousse, weighed the merits of breast milk and formula before having their first child more than nine years ago. The Barberousses say the overwhelming evidence supporting natural milk convinced them. Since then, all of the couple's children--Nia, 9; Nzinga, 5; Menelik, 2; and Talha, 3 months--have been nursed.

The basic factor for the Barberousses, Lionel Barberousse says, was determining what was best for the child. "The difference between formula and breast milk was that breast milk was the best choice and that was the choice she made, no matter what sacrifice, commitment or anything went along with that."

Imani Barberousse, who was bottle-fed by her mother, says she wasn't sure about breast-feeding at first. Nia came into this world at a hefty 9 pounds, and Imani was tempted to try formula. But her husband's support, and stories about friends who breast-fed their children, kept Barberousse on course. "It's a wonderful commitment that you make in the same way that you make a commitment to your career and educating your child," Imani Barberousse says. "It lets you know just how strong you are as a human being and what wonderful ties you have to your children, family and community."

To fully grasp the importance of breast-feeding, it is necessary to understand its key component, breast milk. During pregnancy, the breast physically prepares itself to release milk, and complete milk production begins within 72 hours of delivery.

In the first days of feeding, the breast produces colostrum, a creamy substance full of protein, minerals and antibodies, and low in fat. The milk changes form a few days later and becomes a mixture of water, fat, carbohydrates, protein, amino acids, and vitamins and minerals. Over the course of a feeding, the milk changes consistency. It starts out as foremilk, full of water and lactose, and transforms into hindmilk, which includes fat and calories. Breast milk contains more than 200 components.

"Many women just do not know that breast milk is a human tissue very specific to each mother," says Dr. Yvonne Bronner, professor and director of the public health program at Morgan State University in Baltimore. "The composition literally is going to be different for every single mother who you measure. That's amazing, that the breast milk is so suited for this particular infant."

Breast milk may come naturally, but feeding must be learned. Getting the baby to accept the breast may take some time, but help is available. Many hospitals provide lactation consultants who show mothers how to position the baby properly, how to get the milk to "let down" or release, and how to use breast pumps.

Still, breast-feeding may not be for everyone. Women with certain conditions, such as hepatitis C, substance-abuse problems and breast implants should consult a doctor before breast-feeding. A mother who is HIV-positive should not breast-feed.

Mothers who have received the green light to breast-feed advance the health of themselves and their children, and bolster their wallet at the same time. Breast milk is obviously free of charge, and healthier babies and mothers mean fewer prescriptions, hospitalizations and lower medical costs overall. Healthier children miss fewer days from school and their parents use fewer sick-leave days from work. Aside from the obvious factors, breast-feeding bonds the mother and child at this crucial stage. Not only is milk being delivered, but love is flowing from the mother to the baby.

"Not only am I nourishing her, but this is her time to be with me," Imani Barberousse says about breast-feeding her youngest child, 3-month-old Talha. "When you breast-feed, there is an endorphin [hormone] released that helps you relax, so I focus on that."

Fathers have an active role in the breast-feeding process as well. The mental support a father gives to the mother of his child dining breast-feeding strengthens the bond between the couple. Also, the father can provide a major service by performing other household duties or keeping the other children busy, which allows the mother to relax when feeding.

A remaining problem is to destroy harmful myths about breast-feeding in the Black and White communities. One of the major problems in Black America, some experts say, is the idea that breast-feeding is connected somehow to the subservient roles Black women were forced to play during slavery and segregation.

"Some people connect it to that negative time of slavery, [when] we nursed many White children as well as our own," says Katherine Barber, the founder and executive director of the African-American Breast-feeding Alliance. "I have begun to think of it as not attaching to slavery, but attaching to us as African-American women giving life and nourishment to humans, and regardless of the circumstances we were in, we were lifegivers."

Parents who may have been bottle-fed as infants are being advised to reconsider that notion for their own children. Breast-feeding could be the first major action a mother makes toward raising a healthy child.
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Author:Roquemore, Bobbi
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Dec 1, 2001
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