Perspectives on Breastfeeding in New Mexico among Spanish-speaking Hispanics and Native Americans Maria D. Otero

The mission of Nuestra Salud is to reduce health disparities affecting Hispanic communities in New Mexico and the nation through research, training, and outreach. The mission of the University of New Mexico, Envision New Mexico is to envision what can be, and to create the highest quality healthcare for children in New Mexico Supported by W.K. Kellogg Foundation, Administered through the University of New Mexico Envision New Mexico

Purpose and Aims Explore the issues surrounding breastfeeding, specifically New Mexico population groups Focus group discussions used to explore knowledge and perceptions about breastfeeding Utility of peer-support Health-system support acceptability of various interventions that with potential to increase breastfeeding in selected populations Aimed to utilize findings to examine breastfeeding support among selected groups Potentially aid in the design of efforts to promote breastfeeding in ways likely acceptable to these populations

Focus Groups: Description Total of 8 focus groups Bernalillo County (2), Doña Ana County (2), Native American Communities (4) Small, homogeneous, informal group Discussion of specific topic led by trained moderator Typically between 6-12 people Participants selected based on specific characteristics Self-identified Native Americans or Spanish-speaking Hispanic women Between ages 18-45 Considering breastfeeding

Perception of Community Support Varied between Native American and Spanish- speaking Hispanic groups Native American participants expressed their belief that breastfeeding is important in their communities Themes: Natural, traditional Spanish-speaking Hispanic participants expressed that while it is important, breastfeeding is not widely viewed important by their community

Key Factors Encouraging Breast Feeding Both groups found key factors that support and encourage breast feeding including: Family support Supportive partner Having mother who breastfed General community support Maternal age Lack of these was often cited as reason that breastfeeding was difficult to maintain or did not occur

How should breastfeeding be encouraged? Differences in responses from the two population groups Native American groups consistently and strongly supported idea that breastfeeding should be encouraged Very positive comments about WIC, CHRs Repeatedly suggested as way to encourage Role of community members in encouraging and supporting Spanish-speaking Hispanic groups recommended strategies that directly support mothers and educate community about importance Peer-to-peer education In-person education Encouraged as first choice for new mothers by healthcare providers, WIC staff and others

How healthcare providers can support breastfeeding Women in both population groups discussed importance of providers encouraging mothers Nurses and midwives mentioned as source of breastfeeding information, but participants still found it important to hear from physicians as well Address inconsistencies in provision of support depending on hospital and staff Breastfeeding needs to be discussed with husbands and partners to help develop support

Conclusions Several shared concerns that may limit breastfeeding Lack of support when returning to work Limited support from hospital staff at the time of birth Hispanic, Spanish-speaking women identified lack of community understanding and importance of breastfeeding as major barrier Manifests as shaming of breastfeeding by community Actively discourages from breastfeeding in public places The Doña Ana County groups especially concerned that Las Cruces was not ready to be baby-friendly city

Recommendations Implement linguistically and culturally appropriate mass media campaigns designed to reach Spanish-speaking Hispanics and focused on normalizing breastfeeding, removing stigma associated with breastfeeding and encouraging community support of breastfeeding. Work with insurance companies to ensure that enrollees are familiar with benefits that support and encourage breastfeeding. Support WIC in Bernalillo and Doña Ana counties to find innovative ways of encouraging breast feeding over formula use, of providing one-on- one support and/or peer support to encourage breastfeeding.

Recommendations cont’d… Increase community awareness of the laws supporting breastfeeding, including in the workplace; On non-tribal lands, work to enforce statewide breastfeeding-friendly workplace law, especially for workplaces that employ Spanish-speaking Hispanics, including child care, schools, and agriculture. Educate employers about the law and the importance of providing flexible break time, and a clean, private space that is not a bathroom for women who are breastfeeding. On tribal lands, work with employers to provide a clean, private space that is not a bathroom for women who are breastfeeding.