The Breast Milk Gap

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Shaeriah Fox, 19, struggled to learn to breastfeed while raising two young children in Tulsa, Okla.Credit Cassidy McDonald
Each year, Nicholas Kristof holds a Win-A-Trip contest for college students to accompany him on a reporting trip to the developing world. This year’s winner, Cassidy McDonald, will likely travel to Papua New Guinea with Nicholas in the fall. This spring, they traveled to Tulsa, Okla., where Cassidy reported on low breastfeeding rates among the poorest women in the United States.

 

America is startlingly inferior to five of the world’s poorest countries — at least by one metric.

When it comes to a crucial health behavior, Malawi, Burundi, the Central African Republic, the Democratic Republic of the Congo and Niger are among the most advanced; America lags far behind. Why?

We don’t breastfeed.

That’s right. America: the land of the free and the home of the formula fed.

“The norm has really shifted,” said Ellen Piwoz, senior program officer of the Bill and Melinda Gates Foundation nutrition team.

For many mothers — particularly those who are young, black, poor or who have less than a college education — nursing is not an obvious option.

That’s a shame, because breast milk has a wealth of natural health benefits. Evidence suggests that nursing can protect against obesity, infant ear infections and even breast and ovarian cancer in the mother. Multiple studies found a consistent increase of about 3 I.Q. points in children who were breastfed.

An important note: experts agree on the benefits of breastfeeding babies in low-income countries, but the evidence is sparser in wealthy nations like America, where confounding factors muddy the data. (A mother who breastfeeds is more likely to have other healthy habits as well.)

Still, Piwoz said, “The benefits are obvious in poor countries, so it’s likely American kids would get this benefit as well.”

Affluent moms in America breastfeed, but there’s a class and a race gap. Because fewer young, black, poor and uneducated mothers nurse, a subset of American babies fall behind with their first bottle, compounding other kinds of disadvantage. According to the Centers for Disease Control and Prevention, 58.9 percent of black infants have ever breastfed, compared to 75.2 percent of whites and 80 percent of Hispanics.

This isn’t a chance to cast blame on formula-feeding moms — just the opposite. We need to acknowledge the barriers to breastfeeding and support moms who try.

In Tulsa, Oklahoma, I met a single mother named Shaeriah Fox when she visited Emergency Infant Services, a non-profit organization that gives out diapers, car seats, formula and other necessities to families in crisis.

At just 19 years old, Fox has survived more misfortune than most. She grew up with heroin-addicted parents, dropped out of school after eighth grade and landed in a gang at age 13. A few years ago, she escaped the gang, got pregnant and has raised her two children — a 2-year-old girl and an 8-month-old boy — with help from her grandmother.

Fox had come to Emergency Infant Services because she ran out of food and diapers.

When she gave birth to her daughter, she tried breastfeeding for a night. “It felt weird and I didn’t like it,” Fox said.

Faced with raising her daughter alone, she had more pressing concerns than learning to nurse comfortably. She opted out.

Formula was easily available through the Women, Infants, and Children nutrition program and Emergency Infant Services. Both programs encourage breastfeeding, but allow moms to decide for themselves.

And here, we meet the confusing incentives that drive formula feeding. Social programs should provide formula to babies who need it, but in doing so, do they inadvertently promote bottle feeding for mothers who could nurse? Couple that with aggressive marketing by the $3 billion formula industry, the challenges of pumping and refrigerating milk and a lack of knowledge about the biology of breastfeeding. Why should a young mother believe the effort to nurse is worthwhile?

“There is a commercial and promotional aspect to it, that — not meaning to be a pun — feeds in to this,” Piwoz said. “The free supplies, the direct, indirect messages that formula is as good as or just like breast milk, messages that get conveyed either directly or indirectly that your milk isn’t good enough.”

But in upper- and middle-class communities, a new, trendy industry cheers on moms who choose to breastfeed. Nursing boutiques like “The Upper Breast Side” and “Yummy Mummy” offer nursing bras, pump consultations and “lactation cookies,” with oats, brewer’s yeast and flax seed to boost milk production.

Let’s build on that momentum and cast some love (not judgment) toward the moms who can barely afford food and diapers — much less automatic breast pumps or lactation cookies. If you’re a healthy, young mother whose milk runneth over, you can donate to a local milk bank. Or look into an organization called La Leche League International, which provides breastfeeding support, and perhaps most crucially, education.

While we fight against the income gap and the education gap, let’s not forget the milk gap.