Breast-feeding her newborn seemed the right choice for ReaShondra Walker two years ago, but she got little support from those closest to her. Her sister said it would be painful. Her mother "didn't talk about such things." The baby's father resisted sharing her breasts with an infant.
Cases such as hers illustrate the challenges state health officials are confronting as they begin a campaign to get more Minnesota mothers to nurse their babies. Even though the practice has proven health benefits for infants and backing from the U.S. surgeon general, advocates have discovered pockets of skepticism and outright resistance in Minnesota's increasingly diverse population.
Some immigrants, they say, view baby formula as medicine or a symbol of the American ideal. Some African-Americans, scholars say, associate breast-feeding with slavery and black women who were forced to nurse their masters' children.
"We have been working on this a long time," said Linda Dech at Minnesota's Women, Infants and Children program (WIC). "Many of us in the breast-feeding world have felt like we have been spinning our wheels endlessly."
Since 2000, breast-feeding rates have increased nationally, according to a federal report released Wednesday in conjunction with World Breastfeeding Week. Minnesota remains below average, and behind other states in the number of hospitals that use practices such as "rooming-in" to help mothers adjust to their babies' feeding cycles.
Few public health issues in Minnesota break as distinctly along racial and ethnic lines as breast-feeding — or require solutions that are so tailored to diverse communities. About 81 percent of Minnesota's Hispanic mothers breast-fed for at least one month, compared to 76 percent of white mothers and 53.1 percent of American Indians.
Minnesota has the nation's highest rate of black mothers who try breast-feeding, but that reflects the influx of Somali immigrants. Some 90 percent of foreign-born black mothers breast-fed at least one month, while only 57 percent of American-born black mothers such as Walker lasted that long. The survey figures come from the state Pregnancy Risk Assessment Monitoring System for 2010.
Walker, 22, said her doctor assumed she wouldn't even want to try nursing her baby. Over time, she said, she was discouraged by friends who said formula was healthier or that breast-feeding coddled babies too much. The baby's father even suggested that she was disrupting his relationship with his daughter.
"'The only reason why she doesn't like me right now is because you breast-feed her,'" he once told her.
But Walker persisted. Her daughter, Genevieve, now 2, breast-fed for 14 months. Her story has become something of a folk tale advocates use to show that disparities can be overcome.
Backlash against formula
Formula feeding gained popularity in the 1970s and 1980s, as more mothers joined the full-time workforce and faced hassles in the workplace.
That trend halted with a wave of research showing that breast-fed babies had healthier immune systems and lower rates of asthma, respiratory problems and obesity, and that breast-feeding could save the United States billions of dollars in medical expenses.
In 2011, the U.S. surgeon general promoted workplace changes to increase breast-feeding. Minnesota law already requires employers to try to provide locations "other than a toilet stall" where working mothers could pump milk.
Yet disparities persist, partly because minority mothers are more likely to work in low-wage or service jobs, and often fear reprisals if they take breaks to pump, said Mary Johnson, breast-feeding coordinator for the state WIC program, which provides nutritional support to low-income mothers with young children.
"A lot of times women don't want to rock the boat," she said, "because they need that job."
Still, economic and employment barriers can't explain breast-feeding disparities entirely. Poverty rates are similar in Minnesota for African-Americans and Hispanics — but the breast-feeding rates differ dramatically. Success, advocates say, requires doctors, nurses and clinics to understand patients' perspectives on breast-feeding.
Now, state health leaders are encouraging hospitals to stop giving parents free formula samples and gift bags from formula companies, and reduce supplementary formula feedings to newborns. That could have a particular effect on immigrants, because foreign-born parents often view formula as something endorsed by hospitals, said Dr. Dana Barr, a staff physician for Hennepin County Medical Center.
"If they were in their own country, they would breast-feed," she said. "When they're in the United States, formula is like a land-of-opportunity product. Because it exists, it must be better."
In American Indian communities, where breast-feeding rates declined between 2005 and 2010, the dilemma is that public health messages from external sources are sometimes met with skepticism. State leaders believe changes will have to come from within the tribes — as happened in the Fond du Lac tribe when a public-health nurse convinced tribal leaders to embrace and promote breast-feeding.
Regardless of whether the legacy of slavery lingers today, there are generations of black women who haven't tried breast-feeding or stuck with it for very long. That has a strong influence on today's mothers, who look to their parents for guidance, Dech said. "If they don't have people around them who have successfully breast-fed, it makes a difference."
Lakeile Jones, 20, said the support of her baby's grandmother was critical as she adjusted to the awkwardness of breast-feeding and later tangled with a manager at her restaurant job over when she could pump milk. She is still breast-feeding her son, who is approaching his first birthday. The cuteness has worn off a bit, though.
"When he was a baby, he used to look in my eyes" when I fed him, she said. "Now he just puts his feet in my mouth.''
ReaShondra Walker was uncertain about breast-feeding until she encountered Everyday Miracles, a north Minneapolis nonprofit that provides doula services to low-income women. A supportive doula there helped her overcome the resistance from her family and some practical difficulties as she struggled to get her daughter to latch onto her breast.
"I thought hard about [quitting] in those first couple of days," Walker said.
Everyday Miracles, which employs doulas who are Somali, Latino, and Hmong, seems to have solved the ethnic challenges: Almost all of its clients at least try breast-feeding, according to a recent University of Minnesota study.
Co-founder Mary Williams also believes the organization puts women at ease, because mothers of all races breast-feed at its center.
"We've got boobs out all of the time around here," she said.