Breastfeeding MedicineVol. 18, No. 2 EditorialFree AccessCultural Variations in the Care and Support of BreastfeedingArthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding MedicineSearch for more papers by this authorPublished Online:15 Feb 2023https://doi.org/10.1089/bfm.2023.29234.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month's issue of Breastfeeding Medicine highlights two disparate articles that on first reading seemingly have absolutely nothing to do with each other. In one, in a comment in the Perspective Section, Segev and colleagues discuss the “unique” problem of which oral contraceptives should be recommend to Orthodox Jewish breastfeeding mothers. In the Clinical Research section Cordova Ramos and colleagues report on their study of the association of the mother's primary language and subsequent breastfeeding rates.As Segev notes, traditionally, estrogen-only medications have been the recommended oral contraceptive for breastfeeding mothers because of a concern that combined therapy (estrogen/progesterone) contraceptives run the risk of reducing the mother's milk production. For the general population the increased risk of breakthrough bleeding from the use of estrogen-only pills posed a relatively “minor adverse outcome,” surely offset by the confidence that the mothers are producing their maximum capacity of milk.However, as Segev details, the concern of breakthrough bleeding is not a minor inconvenience in a population that conducts its life under strict religious (halachic) law. Per this religious code, a single menstrual-like breakthrough bleeding results in a prohibition of any sexual contact for periods of days and repeated bleeds may result in months of deferred marital relationships with all the inevitable negative consequences for the couple. Thus, not surprising for this population the risk–benefit ratio based on its particular social cultural priorities would support the use of combine hormonal contraceptive preparations.Cordova-Ramos study of the association of the mothers' primary language and breastfeeding rates and patterns is no less intriguing and enlightening. This study was performed in the context of what has already been reported about the realities of the inequalities in medical care and the need for more detailed and nuanced cultural sensitivity in developing medical services. Given the reports of the racial and ethnic disparities in human milk intake in neonatal intensive care units,1–3 such a study was clearly of high priority.What Cordova-Ramos proceed to do is expand how we categorize the mothers beyond the standard labels of race and ethnicity by adding the variable of primary language into their analysis of the results. The authors justified this expanded analysis on the assumption that the mothers' primary language would serve as a marker of cultural identity (let alone immigrant or native born status). What was found, surprisingly, was that there was different and opposite association of the mothers' primary language with mother's milk provision among different groups.For example among Hispanic mothers, non-English- versus English-speaking mothers had lower rates of milk provision, whereas among Black mothers, non-English- versus English-speaking mothers had higher rates of milk provision. These differences likely reflected a much more complex interplay of social and cultural factors that influence continuation of mother's milk provision in minority mothers and highlights the heterogeneity that exists within conventionally labeled racial/ethnic minority groups. Surely it is difficult to justify combining under the label of Hispanic data regarding third-generation Puerto Rico mothers living in New York with data regarding Mexican or other Central American immigrants living in Texas or California.4What is the common thread in these two seemingly unrelated articles and what we should learn from the data presented? The clear message that we should neither analyze the clinical manifestation of any given medical situation only utilizing the broad and somewhat at times simplistic construct of race and ethnicity. No less so, we should be careful in promoting global recommendations or standard management protocols that are not adjusted for specific groups and subgroups. Clearly there is need for greater sophistication and sensitivity to the various subsets of the standard racial and ethnic categories,Homogenizing the differences between mothers based on the standard labels without factoring the specific social, cultural, beliefs, and practices in subgroups preclude appropriate individualized care and therapy. Simply put, we need not only to be attuned to the language (and cultural context) that specific mothers are talking, but also we need to adjust, in turn, our language to be appropriately attuned to these mothers.
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Apr 17, 2023
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