Brooklyn Initiative Addresses Economic, Racial Inequalities in Breastfeeding

For many women in Brooklyn, New York, the ability to breastfeed doesn't seem like a reality, according to Francesca Stephen-Alexis, a 37-year-old mother of two.

"I think a lot of women, especially in my area, see breastfeeding as a luxury that middle class housewives get to have. It's not seen as a reality for us," Stephen-Alexis says.

She adds that a lot of women in her community don't have the luxury of maternity leave and need to keep working to pay for housing and food, making it difficult to commit the time to breastfeeding.

At 22.7 percent, Brooklyn's poverty rate is nearly double the national average of 12.7 percent. The borough also has a large minority population, with nearly two-thirds of residents identifying as a race other than "white alone, not Hispanic or Latino," according to the U.S. Census Bureau. That figure includes Stephen-Alexis, who identifies as Afro-Latino. Nationally, 40 percent of the population identifies as a race other than "white alone, not Hispanic or Latino."

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Research shows that women in high-poverty neighborhoods and women of color face more barriers to breastfeeding than other women. Not only are low-income women more likely to return to work quickly, but they often do not have the flexibility to breastfeed at work; they are less likely to be educated about the benefits of breastfeeding; and they tend to lack social support from family and friends.

In terms of race, African-American mothers – who also are more likely than white mothers to live in poverty – face racially biased health care, meaning they are less likely to receive support or treatment for their health-related needs, according to a 2015 report published in the journal Breastfeeding Medicine.

This inequality is clear in New York City, where 40 percent of white non-Latina women breastfed for eight weeks or more in 2012. That percentage dropped to 25 percent for both black non-Latina women and Latina women.

An initiative (which began in 2014) in Brooklyn called the Breastfeeding Empowerment Zone (BEZ) aims to change this trend and break down barriers to provide community members with the resources to breastfeed.

Part of eliminating these barriers includes educating the community about breastfeeding through state programs and community partners.

Funded by the W.K. Kellogg Foundation, BFEZ focuses on two Brooklyn neighborhoods (Bedford-Stuyvesant and Brownsville) with low breastfeeding rates.

A 2014 NYC Health Department study looking at mothers in these neighborhoods revealed that most Brooklyn mothers do want to breastfeed. They viewed breast milk as nutrient-rich, among other health benefits, and saw breastfeeding as a chance to bond with their baby. Yet, very few – 1 percent in Brownsville and 3 percent in Bedford-Stuyvesant – exclusively breastfed for the recommended six months in 2011.

A major aspect of BFEZ is community involvement, according to Dr. Torian Easterling, assistant commissioner of the NYC Health Department's Brooklyn Neighborhood Health Action Centers, which administers the project.

One of BFEZ's programs, Brooklyn Daddy Iron Chef, teaches fathers about breastfeeding and other skills, including how to perform the Heimlich maneuver on infants and how to cook nutritious meals.

"(BFEZ supports) male involvement and really engaging men and fathers in their role in becoming better breastfeeding advocates," Easterling says.

Stephen-Alexis' husband, David Alexis, joined Brooklyn Daddy Iron Chef when she was pregnant with her first child, who is now 2. Alexis, who identifies as Afro-Haitian, learned about the program at a community event, where he was motivated by other fathers to participate. "These were men in the community who wanted to acknowledge that the preeminent narrative that men, especially men in some of the lower income predominantly black Hispanic communities, are not a part of or were not interested (in parenting involvement) was not as true or not as prevalent as was previously indicated," he says.

Francesca Stephen-Alexis, David Alexis and their daughter Davina pose in December of 2016 at a "fatherhood town hall." The event, convened by the New York City Health Department, celebrates fathers who demonstrate excellence in their community. (KEMPE HOPE/BROOKDALE HEALTHY FAMILIES)

Alexis identifies as Haitian-American and Stephen-Alexis identifies as Afro-Latino.

Alexis, 29, was so inspired by Brooklyn Daddy Iron Chef that he participated in trainings for fathers coordinated by New York City's health department. The classes focused on breastfeeding, including legislation and social issues regarding breastfeeding, in addition to other parenting skills.

He earned a certification from New York City's health department and now serves as a peer educator for other fathers in his community.

Stephen-Alexis says she thinks this male involvement is especially important because there are so many single fathers who lack parenting (including breastfeeding) resources.

"Single fathers in our neighborhood are not given resources single mothers would be given in a heartbeat," she says.

Another aspect of BFEZ is talking with owners of local businesses and encouraging them to become breastfeeding-friendly spaces, Easterling says.

Though businesses are legally required to allow mothers to breastfeed, they can still make women feel more comfortable by displaying decals that identify the facility as being breastfeeding friendly. Business owners can also make breastfeeding easier for women by providing chairs and proper breastfeeding spaces for nursing mothers.