Susan Bodnar-Deren

The Impact of Race and Nativity on Breastfeeding

VCU Sociologist Susan Bodnar-Deren works with local non-profit on programs to encourage breastfeeding.

Breastfeeding, despite its name, is about much more than the transfer of nutrients from mother to child. It’s a symbiotic period in the maternal relationship that benefits the health of both mothers and their  babies for the rest of their lives.

The cells, hormones and antibodies in breastmilk help protect newborns from illness and can help a mother’s health and healing after childbirth, according to the U.S. Department of Health and Human Services. Research shows that breastfed babies have lower risks of asthma, leukemia, ear infections, lower respiratory infections, and sudden infant death syndrome. Because breast milk is perfectly mapped to meet a baby’s nutrition, children who were breastfed also experience lower rates of diabetes and obesity. Additionally, mothers who breastfeed have lower rates of certain types of breast cancers, ovarian cancer, and Type 2 diabetes.  

“The research shows that breastfeeding sets this foundational stage for all of us that were breastfed – we have these protections as we grow older. People think these protections are just in the first few months of life, but they’re lifelong advantages,” said Susan Bodnar-Deren, Ph.D.

Bodnar-Deren is a medical sociologist and assistant professor in the Department of Sociology, whose research focuses on the social determinants of health, specifically during maternal reproductive years and older age. When she came to VCU, funded by a Council for Community of Engagement Research grant, Bodnar-Deren partnered with the university’s Institute for Women’s Health and a Richmond nonprofit called Healthy Hearts Plus II, which provides nutritional and educational services to disadvantaged communities. They are working together to implement a community-based participatory research evaluation of Healthy Heart Plus II’s educational program for mothers on the advantages of breastfeeding their children.

DiapersThe program, called the ABC’s of Breastfeeding, targets low-income African American women in the Richmond area because of their historically low rates of breastfeeding, and provided them with peer-to-peer support groups. Members come to these group discussions,  called “Sister-Circles,” to share their experiences as pregnant women and mothers in addition to getting access to expert advice on all aspects of pregnancy from the center’s staff.  

“They gave us tips on daily life experiences throughout your pregnancy,” said Alexus Banks, a US-born African American mother who has been going to Healthy Heart Plus II for the last three years. “It gives you a little strength, knowing you’re not the only one going through it and you don’t have to go through it by yourself.”  

Banks originally planned to supplement her breastmilk with formula, but said she changed her mind after the experts and fellow mothers at Healthy Hearts +2 gave her recipes for baked goods designed to increase her lactation.

The program is hugely successful in promoting breastfeeding among its participants.  97 percent are African American, and 65 percent of its members breastfeed to six months – almost four times the national average for black mothers.

Bodnar-Deren first became interested in maternal health during her postdoctoral training at Mt. Sinai School of Medicine, when she was part of the MADE IT (Mothers Improving Depression Through Empowerment) study, a randomized control trial funded by the National Institute of Mental Health, which was aimed at reducing depression symptoms in new mothers.

The study, which compared the experiences of 540 minority black and Latina women to 540 majority white women during the first six months of motherhood, was successful in enhancing the self-efficacy and self-esteem of its participants. They were able to do this by administering an intervention to half of the new mothers in each group which was aimed at decreasing postpartum depressive symptoms and educating new mothers on what to expect in the first months of motherhood.

“Motherhood a life-changing experience. Everything is different and change is stress, so it shouldn’t be surprising that we see spikes in depression,” Bodnar-Deren said.

The MADE-IT study also resulted in an increase across all racialized social groups in breastfeeding duration, but most dramatically among Latina and black moms.

breastfeedingDespite overall increases in breastfeeding rates for black and white infants over the last decade, racial disparities persist, according to a 2017 CDC study. This was consistent with the breastfeeding rates that Bodnar-Deren found among the women in the MADE-IT sample, where 64 percent of white moms breastfed for six months, compared to the 27 percent of African American and 37 percent of Latina moms.

According to the CDC, the racial gap for six-month breastfeeding duration rates in the U.S. has been narrowing, and decreased by 3 percentage points between 2000 and 2008. However, Bodnar-Deren says those statistics may be masking a larger problem.

“If you look at the overall rates of breastfeeding for black women and Latina women in the U.S., it seems like they’re going up. But if you take out the non-US born women they actually haven’t moved that much, and that’s really concerning,” said Bodnar-Deren. “Among the black women in our sample, 70 percent of foreign-born black women were breastfeeding at 6 months postpartum, compared to about 19 percent of the US-born black women. We see the same thing with Latina women where we have about 70 percent of foreign-born Latina women breastfeeding at 6 months, and just about 18 percent breastfeeding at 6 months for US-born Latina women.”  

Using data from the MADE-IT study, Bodnar-Deren discovered that the longer a mother had been acculturated into U.S. ways of life, the less likely they were to breastfeed. Because the health advantages of breastfeeding for both mothers and babies are so beneficial and long-lasting, correcting this racial disparity is a priority for her community engagement and research efforts .

Bodnar-Deren plans to present the success of her ABC’s of Breastfeeding project in a report to the Richmond City government, in hopes of securing additional funding for the promotion of breastfeeding among minority women. The full team, consisting of researchers from VCU and Healthy Hearts Plus II, has presented the program at a number of national conferences already, and will be disseminating their findings in academic journals.

Bodnar-Deren also spent the summer in South Africa, co-leading a VCU study abroad program.  This is the third year she spent in South Africa and she has begun examining the possibility of working with Healthy Hearts Plus II, and other local organizations in Kwa ZuluNatal, to adapt a similar breastfeeding duration model to help townships and rural communities across South Africa, which has one of the lowest rates of exclusive breastfeeding in the world.

Written by Megan Schiffres