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Public Health in Oregon
Lillian Shirley, Public Health Director
Former WIC participant, now peer counselor, encourages breastfeeding among African American families
Shantae Johnson says WIC is not "the formula place" of yore, but a place of education and support.
 
Anything that has to do with supporting other women has always been a passion for Shantae Johnson of Portland. She became a participant in Oregon’s Women, Infants and Children (WIC) program 13 years ago after the birth of her first child. After she witnessed firsthand the support WIC provides to breastfeeding women through its Peer Counseling program, she knew she had to be more involved. She eventually became a WIC breastfeeding peer counselor for the Multnomah County Health Department.
 
“I had really wanted to work with people a lot more. I saw the opportunity to be able to do that,” says Johnson, who became a peer counselor three years ago after previously working as an office assistant for the county’s Corrections Health program. “I had been involved with the International Center for Traditional Childbearing for three years as a doula, helping moms with labor, so it was just a natural fit for me. It was really great because I got a lot more breastfeeding education and training.”
 
As an African American woman, Johnson’s work is especially important. While the percentages of African American infants who were ever breastfed and were still being breastfed at 6 months old increased faster than among Caucasian and Hispanic infants between 2000 and 2008, the gap between African American and Caucasian breastfeeding initiation narrowed. African American infants still had the lowest rate of breastfeeding initiation and duration, according to the Centers for Disease Control and Prevention (CDC).
 
African American moms, for the most part, are being lost in the shuffle,” Johnson says. “Not to say that African American women haven’t been breastfeeding. They have. We just don’t see a high percentage of African Americans who are breastfeeding.”
 
During August, WIC is celebrating National Breastfeeding Month by recognizing the long-term positive effects of breastfeeding on the health of Oregonians, and showing that high breastfeeding rates in Oregon help protect infants and mothers from many chronic and acute diseases and conditions. It’s also a chance to highlight Oregon's laws supporting breastfeeding, which are vital for helping mothers breastfeed exclusively for six months and continue breastfeeding for a year or longer, as recommended by health organizations worldwide.
 
This year also marks WIC’s 40th year of providing nutritious food and education, breastfeeding support, and referrals to health and social services for thousands of young Oregon families. In 1972, Congress passed a bill sponsored by Sen. Hubert Humphrey to create the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Two years later, WIC opened five clinics in Oregon and began serving 2,500 mothers and babies. Today, WIC has more than 100 clinics and serves more than 167,000 women, infants and children statewide. The program has evolved from an underfunded hunger relief effort into the nation’s premier public health nutrition program, serving about half of Oregon’s women and infants.
 
In February 2012, Oregon WIC received a $2.5 million grant from the U.S. Department of Agriculture for achieving the highest breastfeeding rate in the country. At the time, more than 90 percent of Oregon women reported having ever breastfed their babies, and that rate still stands today, according to the latest figures from the CDC’s National Center for Chronic Disease Prevention and Health Promotion. In addition to offering more farmers' market vouchers for fresh fruit and vegetables, the grant allowed WIC to create partnerships with community-based organizations such as Portland-based Native American Youth Association (NAYA) and International Center for Traditional Childbearing (ICTC) to examine health disparities in communities of color around breastfeeding.
 
In mid-2012, ICTC launched a series of focus group sessions aimed at finding out more about African Americans’ opinions about breastfeeding and barriers that may prevent African American women from initiating and continuing breastfeeding. The resulting report found:
 
  • while both women and men believed the African American community understands breastfeeding is better for babies and wants to improve rates, more breastfeeding role models are needed;
  • a lack of African American health care providers who can help with breastfeeding are creating cultural competency issues; and
  • health care institutions seem to discourage African American women from breastfeeding and deter African American men from helping their mates successfully breastfeed.
 
“Dads are wanting to feel more welcome with clinicians and health care providers,” Johnson says. “Sometimes dads are feeling left out of the picture.”
 
The ICTC’s findings inspired WIC to create an African American Breastfeeding group that is offered once a month in Northeast Portland and open to all clients of WIC and Multnomah County’s Health Birth Initiative, as well as community members. Monthly prenatal and postpartum groups also are available.
 
ICTC’s report also led to the organization of a Breastfeeding Black Babies summit in Portland in September 2012. ICTC, WIC, Healthy Birth Initiative, Urban League and other community partners supported the event. “People from all over came,” Johnson recalls. “From that, we formed the African American Breastfeeding Coalition, so I got to be a part of that as well.”
 
Although groups like the coalition, ICTC, Healthy Birth Initiative and the community breastfeeding groups are making strides in boosting breastfeeding rates among African Americans, challenges remain. “For a lot of moms, (a challenge) is returning to school or work and finding time in the day to pump milk,” Johnson explains. “The other part of that is who is taking care of baby? A caretaker might not know how to care for a baby who breastfeeding. Other barriers for moms might be that they have multiple children they’re caring for, so figuring out how to negotiate caring for baby and feeding the other children.”
 
Johnson’s personal breastfeeding experience alone makes her well qualified as a role model for other African American women working to overcome such challenges. She now has four children, all of whom she breastfed with support from WIC (she also has two stepchildren). And she has seen the positive changes that WIC has undergone over the years, from its reputation as “the formula place” where new moms could simply pick up free supplemental formula, to a place where breastfeeding is supported and encouraged as an essential component of child development.
 
Nutrition education remains the cornerstone of WIC, which is designed to improve health outcomes and influence lifetime nutrition and health behaviors in a targeted, at-risk population. WIC “isn’t just about giving food. It’s about giving nutritional education to folks when they need it,” Johnson says. “In the future, I see the African American breastfeeding groups growing. I’d like to be able to offer them at different clinics, and not just to African American clients, but to those with substance abuse issues and in places where women are having the toughest time.”