By Sara Brown
Breastfeeding may seem natural and uncomplicated to some mothers, but for many new mothers, establishment of breastfeeding may seem quite difficult. The low rate of breastfeeding among African American women in the U.S. continues to be a persistent health disparity and an imperative public health focus. This issue is a disparate health issue, thread with social and cultural implications, making it a complex problem, requiring an intricate solution from a collaborative effort.
Douglas County and the state of Nebraska has long identified an underserved population in our North Omaha community, which has a sizeable African American population of families. It was apparent that the breastfeeding rates were low and the infants were at higher risk for poorer outcomes in North Omaha. Given these issues and the known implications of social support being the provision for these resources (instrumental, informational, emotional and appraisal support), a multifaceted breastfeeding support collaboration was proposed. As a solution to these issues, the North Omaha Community Breastfeeding Advisory Team was formed, consisting of voluntary members from the community bringing a diverse discussion and thought to monthly meetings.
Even with all of the major national and world health organizations supporting breastfeeding and making a call for prolonged breastfeeding, African American families face the same barriers to successful breastfeeding that all families do, as well as others. Many families encounter barriers such as potential pain, inconvenience, a lack of education on breastfeeding benefits and a lack of support around breastfeeding behaviors. African American families may face an even greater lack of support, may be more likely to be in a position of early return to work/school, potentially impacting breastfeeding continuation and most strikingly, have cultural threads with breastfeeding dating back to slavery when they were expected to breastfeed their slave owners’ babies before their own.
The state of Nebraska’s Health and Human Services Systems Division of Public Health supported the formation of the North Omaha Breastfeeding Advisory Team. We then turned to the Nebraska Breastfeeding Coalition to help us work with Partnership for a Healthy Lincoln (PHL) and to learn from their collective impact approaches to form broader community partnerships. We brought together local hospitals, WIC agencies, physician offices, businesses, non-profits, child care centers, community members, and breastfeeding advocates to form the North Omaha Breastfeeding Advisory Team. We then worked to create unified, consistent messaging related to breastfeeding, opened the community discussion around breastfeeding and offered the first North Omaha training on Community Breastfeeding Educators (CBEs). We are now working to establish a system of measuring progress.
Based on the Surgeon General’s Call to Action to Support Breastfeeding, the following steps were designed to support mothers and families in the community to be able to breastfeed their babies and close the disparity gap.
- Establish a community breastfeeding advisory board focused on commitment to community support of breastfeeding.
- Host a community forum around breastfeeding.
- Create a program to build on support received in the hospital by identifying women in the community to be trained as CBEs.
- Strengthen mother-to-mother support by connecting new moms to CBEs for peer support and maintenance of breastfeeding.
- Manage sustainability of community commitment through the formed advisory board
Each of these steps taken by this collaborative team, are essential in building breastfeeding awareness, receptiveness and increasing the capacity of our coalition.
Future collaborative efforts include another free community event in the Spring to promote open dialogue on current national and state legislation around breastfeeding. It is open to all community members and will focus on what an employer is required to provide for a breastfeeding mother returning to work or school and how breastfeeding families can be advocates for themselves by knowing their rights.
We also plan to start tracking some specific health outcomes related to breastfeeding within this community, as well as, use of a county-wide service that will enable structural support and the ability for the community to decide the next steps, future directions and specific mission of the advisory team. This will allow for continued visibility in the community, potentially support further funding, give the team direction for further community needs and provide discrete confirmation of successes.
The North Omaha Advisory Team has used a collective impact framework to which is impacting health. This has and continues to be a multi-collaborative effort to achieve significant and ongoing social change. This has allowed a multi-partnership of community members, health care partners, businesses, non-profits, schools and early childhood centers to take the lead and initiate a unified change in their own community. It has become a powerful reminder of the importance of community empowerment and including those at the table who are impacted by the decisions.
Sara Brown, EdD, RN is an Assistant Professor in the College of Nursing at the University of Nebraska.