As a Latina, I know all too well
how stereotypes and bias can impact the care we receive. When I was delivering
my first child, I was subjected to all sorts of assumptions about my marital
status, income, education and breastfeeding knowledge. And we don’t need to go
far into current events to be awakened to the realities of the strong
undercurrents of racism and biased thinking that still permeates America. It’s
also a mindset that permeates health professionals, from physicians to nurses,
at times unintentionally impacting the care they give and, at other times,
their best intentions block our efforts to support our families.
What we also know is that my
experience is not unique. In fact, far too many Latinas report that they
experienced a form of racism or bias during birth or with breastfeeding
support. Our recent landmark findings in our Latino Best Start program,
surveying almost 800 Latina mothers, found far too many participants reporting
unjust treatment from health care personnel. Often that includes a dangerous
thinking that all Latinos are the same, assumptions about education and English
proficiency, and use of language such as “them/us” —all of which shows the
subtleties of how bias impacts Latinas. We cannot shift Latino health outcomes
until there is broad recognition among health care professionals that Latinos
are not a homogenous group. Recognizing differences among Latino subgroups is
important to understanding their unique health characteristics and developing
programs that address their health needs.
When it comes to breastfeeding,
Latinas have one of the highest initiation rates in the U.S. Yet, while over
80% of Latinas initiate breastfeeding, only 16% continue to exclusively
breastfeed for 6 months. That’s a tremendous drop off. Among Latino groups,
breastfeeding initiation and duration rates are lower among Puerto Rican
mothers living in the United States in comparison with other U.S. Latina
mothers. Puerto Ricans have a 6-month exclusivity rate of 14.4%. As our
research showed, Latinas know that breastfeeding is the healthiest food for
their babies—but something gets in the way to stunt that commitment. Our report
found racism and discrimination around health care to be significant obstacles.
Lack of community support and lack of employer support were also reported as
In addition, the “Las Dos Cosas” (both things)
phenomenon—Latina women feeding both breastmilk and using formula— is also
important. The reasons behind “Las dos”
are not fully understood but includes a thinking that formula has additional
vitamins that will add to a chubbier baby, which is desirable. However, the “Las dos” trend causes many health care
professionals to assume Latina moms will not exclusively breastfeed and
therefore they may not receive the information or support resources to
exclusively breastfeed longer, which turns “las dos” into a self-fulfilling
prophecy - a very dangerous one. Latino infants who experience suboptimal
breastfeeding are twice as likely to experience necrotizing enterocolitis, 1.4
times as likely to die from SIDS and 1.4 times as likely to suffer a
gastrointestinal infection that leads to hospitalization.
More Latinas won’t exclusively
breastfeed if we don’t learn more to address the root causes instead of viewing
it as a fait accompli. More Latinas
won’t exclusively breastfeed if we don’t build more culturally sensitive
lactation support that allows women to explore the cultural nuances of infant
feeding decision-making in safe environments. Perpetuating the belief of mixed
feeding only benefits the multibillion dollar infant formula industry, who
would love to ensure that the fast-growing Latino consumer base become loyal
customers. As a community and family we
need to support mothers where they are.
Mothers want the best for their babies and we should provide positive,
assuring reinforcement and not guilt and condemnation.
As Breastfeeding Awareness Month
comes to a close with the celebration of Black Breastfeeding Week, this August
25-31, we stand with our black sisters to end stereotyping and bias in
maternity care and breastfeeding support practices.
To help build agency among black
and brown women, we created Latino Best Start as culturally relevant, grounded
in the core values of Latino families and designed to create and amplify local
champions. We know this can be a model for all communities of color.
the anticipated continued rapid growth of the U.S.
Latino population, the younger than national average age of the population,
and the high birth rate among Latinas, it is clear that the health trajectory
of Latinas are inextricably linked to the health trajectory of the United
States at large. As Latinas spend more time in the United States and experience
increased and prolonged exposure to chronic stress in the form of racism, both
interpersonal and structural, their birth outcomes and those of their offspring
could be even more negatively impacted.
We can’t afford to allow racism and bias to continue its brutal attack
on the health of women of color and their infants, which is an attack on all
feel free to continue the conversation and share your thoughts and
breastfeeding stories with us at our Facebook page https://www.facebook.com/urbstrategies/
Diana N. Derige,
DrPH National Director of Health Initiatives
leads Urban Strategies’ national health strategy development, program
implementation and evaluation of the organization’s broad health equity
agenda. She is also co-director of the Center for Latina Maternal and
Family Health Research at the University of Houston. Dr. Derige is responsible
for leadership and vision in program conceptualization, design, planning,
management, coordination, communication, evaluation, policy and learning of
Urban Strategies’ national health portfolio.
She is the proud mother of four girls and one fur baby with her partner
Luis. With two toddlers at home she continues to learn about the joys and
challenges of being a working mother.