Running head: BREASTFEEDING AND LOW BIRTHWEIGHTS 1

Reviewing Breastfeeding Outcomes and Low Birthweights in African American Infants

Katlyn Carter

Midwives College of Utah

BREASTFEEDING AND LOW BIRTHWEIGHTS 2

In preparing to write a paper requiring use of one identity category and two distinct

markers of maternal-child health, I thought about what numbers have been most surprising to me

thus far in my journey into cultural competency. First, and foremost, I have been surprised and

horrified to look at the data surrounding the data involving black infant mortality, specifically in

the article written by Fleda Mask Jackson (2007) titled Race, Stress, and Social Support:

Addressing the Crisis in Black Infant Mortality. Choosing to look further into whats going on

with African American babies was an easy choice.

When choosing the two markers of maternal-child health, I found myself curious about

how the stress that Ms. Jackson (2007) describes is effecting African American infants

birthweights. In thinking about birthweights, I began wondering how breastfeeding was going in

the lives of African American babies.

In my review of McKinney, et al. (2016) article titled Racial and Ethnic Differences in

Breastfeeding, I wasnt surprised at what I found. Data was collected from 3 different locations

in the USA: Baltimore, Maryland, Washington D.C., and Lake County, Illinois. This specific

study looked at the breastfeeding outcomes in white, black, Spanish, and English speaking

Hispanic women of low socio-economic status. The data (from 2012) found the initiation rates

of breastfeeding in black women were 66.4% compared to 83% in white women (McKinney, et

al. 2016). The black women in this study had the lowest rates of intention to breastfeed and the

lowest rates of initiation. McKinney, et al.s study explained the rates by increased poverty,

reduced educational attainment, and low marital status. I feel it is important to add the highly
BREASTFEEDING AND LOW BIRTHWEIGHTS 3

varying rates of introduction of infant formula to black mothers (76%) compared to that of white

mothers (39%) (McKinney, et al. 2016).

To look at the birthweight aspect of my research, I turned to an article written by Collins,

David, Handler, Wall, and Andes titled Very Low Birthweight in African American Infants: The

Role of Maternal Exposure to Interpersonal Racial Discrimination (2004). The researchers

performed a study including 104 African American women who delivered very low birthweight

infants (less than 1500 grams or 3.31 lbs.) preterm and 208 African American who delivered

non-low birthweight infants (greater than 2500 grams or 5.51 lbs.) in Chicago, Illinois (Collins,

et al., 2004). They concluded that, The lifetime accumulated experiences of racial

discrimination by African American women constitute an independent risk factor for preterm

delivery (Collins, et al., 2004). African American babies can be very low birthweight because

they are born prematurely which can be influenced by stress. Infant birthweight is a main

determining factor of infant mortality risk (Collins, et al., 2004). Something else I found very

interesting was that in the US, foreign-born black women have considerably lower preterm birth

risk than native-born black women (McKinnon 2016).

One of our class readings titled Reducing Health Disparities by the American College of

Nurse Midwives, discusses the disparities in infant mortalities between privileged and deprived

communities. The American College of Nurse Midwives go on to say, For African American

women, the lifetime of and generational exposure to institutional and interpersonal racism have

been shown to affect pregnancy outcomes such as birth weight, as well as other health conditions

(2007). There is a low birthweight gap that ranges from 13.4% in African American infants to

6.9% in Non-Hispanic Whites (American College of Nurse Midwives, 2007).

BREASTFEEDING AND LOW BIRTHWEIGHTS 4

We have a long way to go in closing the massive gap in outcome among communities

and improving the health of women and their families. I believe we have organizations in place

who are working in the right direction. In the preface to Ms. Jacksons 2007 article, Ralph B.

Everett talks about the work of the Courage to Love: Infant Mortality Commission (part of the

larger effort by the Joint Center Health Policy Institute), whose mission is to ignite a Fair

Health movement that gives people of color the inalienable right to equal opportunity for

healthy lives. The American College of Midwives whole-heartedly endorses efforts to improve

the health of women and most especially of those women at greatest risk for poor health

outcomes (2007). These groups and their missions (and many others!) give me hope that we

can close these gaps and improve outcomes.

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References

American College of Nurse Midwives. (2007) Issue Brief: Reducing Health Disparities. Silver

Springs, MD: American College of Nurse Midwives.

Collins, J. W., David, R. J., Handler, A., Wall, S., & Andes, S. (2004). Very Low Birthweight in

African American Infants: The Role of Maternal Exposure to Interpersonal Racial

Discrimination. American Journal of Public Health, 94(12), 21322138.

Jackson, F. M. (2007). Race, stress, and social support: Addressing the crisis in black infant

mortality.

McKinney, C. O., Hahn-Holbrook, J., Chase-Lansdale, P. L., Ramey, S. L., Krohn, J., Reed-

Vance, M., . . . Shalowitz, M. U. (2016). Racial and ethnic differences in breastfeeding.

MIDIRS Midwifery Digest,138(2), 511-514.

McKinnon, B., Yang, S., Kramer, M. S., Bushnik, T., Sheppard, A. J., & Kaufman, J. S. (2016).

Comparison of blackwhite disparities in preterm birth between Canada and the United

States. CMAJ: Canadian Medical Association Journal, 188(1), E19E26.

http://doi.org/10.1503/cmaj.150464