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April 15, 2022
3 min read
Researchers found that breastfeeding rates were higher among Black immigrants compared with African Americans, a difference that would otherwise be hidden by standard reporting of demographics.
According to a press release, the CDC has made it a goal to increase the rate of breastfeeding among African Americans because low rates of breastfeeding have been linked to disproportionate incidence of medical ailments such as asthma and obesity in this population. However, people who self-report African American race come from varied backgrounds that may influence their behaviors.
To evaluate potential differences, researchers assessed breastfeeding initiation among Black immigrants — defined as people identifying as African American, non-Hispanic and speaking a language other than English — and African Americans — defined as people identifying as non-Hispanic African Americans speaking English only. They found that 69.6% of Black immigrants started breastfeeding, compared with 39.9% of African Americans.
Healio spoke with Amira A. Roess, PhD, MPH, a professor in George Mason University’s department of global and community health, to learn more about the disparities.
Healio: What prompted this study?
Roess: From our team’s fieldwork, clinical care provision and other activities, we observed that there quite a few subgroups captured by the commonly used “African American” categorization. We observed in our clinical care and program work that there are significant differences in health care access, health behavior and other important characteristics between people who are African American (second generation or later) and African or Black immigrants. One source of frustration is that often we are forced to categorize ourselves using very limited race/ethnicity constructs. By doing so, we water down important differences. Identifying differences in health behavior could help us better tailor and deliver health care, health education and related programs. It also helps us accurately assess the impact of various policies and interventions. Our team decided to attempt to describe the differences in health behavior among subgroups of “African Americans,” and we started off by examining breastfeeding behavior.
Healio: What is the take home message?
Roess: There are significant differences in health behavior among Black immigrants and African Americans, with Black immigrants having higher breastfeeding rates. Combining Black immigrants and African Americans makes it difficult to accurately assess differences in health indicators. If you do that, you miss the differences and the opportunity to better tailor health education campaigns, interventions or policies.
We also see that there is potential to analyze existing data in a nuanced way to help us more accurately describe what is happening in a population. This was not an easy study to do because there was no grant support for it, as is unfortunately commonplace for studies that attempt to disentangle race/ethnicity constructs and their implications for health, development and education in the United States. Hopefully, our experience with the pandemic will start to change that. There does seem to be at least more of a recognition of the importance of this type of work.
Healio: Were any of the findings surprising?
Roess: That there was a difference was not surprising. The extent of the differences was surprising and disheartening. The good news is that despite continuing to have much lower breastfeeding rates compared with other groups, there was a steady increase in breastfeeding rates among African Americans over time.
Healio: What are the clinical implications of your findings?
Roess: We absolutely need to delve into race/ethnicity constructs to describe health and other behaviors and outcomes more fully. Doing so will ultimately allow us to better serve populations. From a health care perspective, we’ve known for a while that the assumptions of health care and other providers about the populations they serve greatly impacts the type and quality of care provided. Providers need to be reminded of the significant biases introduced by using current race/ethnicity classifications. There also needs to be an understanding that the data reported using the current race/ethnicity buries important differences between patients.
Healio: What research on this topic would you like to conduct/see next?
Roess: A logical next step is to support programs at every level of society — private, public, academic — to more fully analyze the data that they already have so that they can better understand the challenges facing the populations they serve. We also need to collect more inclusive race/ethnicity data that are readily available for analysis by health care and other providers. Doing so can lead to accurate assessments of disparities and more tailored interventions.
Reference:
Race and Medicine
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