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"Systemic changes are crucial for improving breastfeeding rates in this country," Afulani says.

When she enrolled at UCLA School of Public Health, Schweitzer Fellow Patience Afulani—a native of Ghana, where breastfeeding, she says, is “the norm”—was surprised to discover that here in the U.S., it wasn’t.

After all, the health benefits of breastfeeding have been well-documented—and several weeks ago, an Institute for Social and Economic Research study found that breastfeeding has cognitive benefits as well.

But myths about breastfeeding persist: according to a just-released study in Personality and Social Psychology Bulletin, women who breastfeed in the U.S. face a social stigma and are often perceived as “less competent” than their peers. And, as Afulani soon realized, wide disparities exist when it comes to breastfeeding: in Los Angeles, rates are much lower among women who are young, low-income, low-educated, and African American.

So as a Schweitzer Fellow, Afulani partnered with the South Los Angeles Health Projects LA Biomed Women, Infants, and Children (WIC) program to promote breastfeeding among low income women, with particular focus on African American women at two WIC sites: Figueroa and Florence. Read on to learn more.

Why did you decide to develop your particular project?

Coming from a country where almost every child is breastfed for some period of time (98% according to the 2008 Ghana Demographic Health Survey (GHDS), with median duration of breastfeeding at 20 months), I was surprised at the low breastfeeding rates in the United States—especially in light of our increasing knowledge of the numerous short- and long-term benefits of breastfeeding to infants, mothers, families, and society as a whole.

In my home country, Ghana, breastfeeding is the norm. Formula is not even an option for most women. As a mother myself I don’t remember thinking about feeding options for my baby when I was pregnant or discussing it with anyone, because the normal thing to do was to breastfeed. As a clinician, I had no problem getting women to breastfeed. The issue I had to deal with was getting women to exclusively breastfeed in the first 6 months (median duration of exclusive breastfeeding in Ghana is 3 months, with 63 percent of children under 6 months being exclusively breastfed, GDHS 2008).

When I started my studies at UCLA, I learned about the low breastfeeding rates and very wide disparities in Los Angeles, where the lowest breastfeeding rates are among young, low-income, low-educated, and African American women. In short, the groups that stand to benefit most from breastfeeding have the lowest rates.

This got me interested in promoting breastfeeding among low-income women. So when I learned of the Schweitzer Fellowship, I felt this was an opportunity for me to get involved in community service once again. With my clinical background and personal experience of breastfeeding, I decided to develop a project that would counsel and educate prenatal and early postnatal women on breastfeeding and help address their related concerns.

What do you hope will be the lasting impact of your project on the community it serves?

An increase in the number of WIC program participants who initiate breastfeeding, and continue for at least one year.

In my interaction with the women, I realized lack of knowledge on breastfeeding was an issue. There seem to be many myths surrounding breastfeeding, and many women were surprised at all the benefits of breastfeeding to them and their babies. However, I also came to realize that lack of knowledge was just one of the reasons why women do not breastfeed. The bigger structural factors are even more important, and increasing breastfeeding rates requires efforts at various levels—including making changes to hospital policies, as well as school and worksite policies. When the system supports breastfeeding, many women would breastfeed even without knowing of the specific benefits to them.

I believe I have planted a seed about breastfeeding in these women—and hopefully some of the determined ones have gone on to breastfeed—but systemic changes are crucial for improving breastfeeding rates in this country.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?

I think there are a number of competing issues depending on where you are and how you think about it. However, access to health care globally is one of the most pressing issues.

Coming from a developing country with limited health care resources, I had very high expectations of the health care system in the United States. But after only a year’s experience, I feel differently. It is true that health care services are limited in developing countries with inadequate health workers and low medical technology, but from what I have heard, read, and personally experienced, I dare to say that navigating the health care system in this country is much more difficult than it is in some parts of the developing world.

This makes me wonder how people—especially immigrants with limited knowledge of the U.S. health system—access health services. With the caliber of trained personnel and medical technology available, it is unfortunate that a significant proportion of the population does not have access to good medical care, both curative and preventive. Access to health care is not just a problem of poor or rich countries, because even as developing countries are struggling with limited health care resources, people in areas with highly developed medical systems are still unable to access care.

I am not sure I have a good answer but I think it is important to emphasize that health care is a fundamental human right, and authorities ought to put in place measures to ensure that this right is protected. Access to health care should not be the preserve of the privileged. And the big question remains: should health care be the business of government or the business of business?

What has been the most surprising element of your experience as a Schweitzer Fellow so far?

My experience as a Schweitzer Fellow has exposed me to other groups working towards improving breastfeeding. I have been surprised but excited about the passion with which these groups are devoted to promoting breastfeeding in LA county and the country at large.

What does being a Schweitzer Fellow (and, ultimately, Fellow for Life) mean to you?

The opportunity to implement my project under this fellowship has increased my confidence in the fact that I can make a difference in whatever part of the world I find myself. Implementing my project was not just about making a difference in the lives of these women; it has also made a difference in my life. It has been a very good learning experience for me.

Being a Schweitzer Fellow for me means having the honor of being united with a group of people dedicated to serving the underprivileged and making a difference in this world.

Patience Afulani is a Schweitzer Fellow in Los Angeles, CA. Click here to read more about the Los Angeles Schweitzer Fellows Program and the Fellows like Afulani it supports in creating and carrying out yearlong direct service projects. To make a gift to The Albert Schweitzer Fellowship in honor of Afulani’s efforts to promote breastfeeding among low-income mothers, click here.

Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.

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