Changing the narrative around infant feeding in Hmong population

May is Asian American Pacific Islander Heritage Month. Help us celebrate by revisiting the work of Tiffany Pao Yang, the daughter of Hmong refugees and a United States Breastfeeding Committee (USBC) Cultural ChangeMaker. This post was originally published on Our Milky Way on June 16, 2019. 

The fifth daughter of Hmong refugees, Tiffany Pao Yang was always introduced as her parents’ first American child.

Tiffany’s family in front of their home in Laos. Her father, left, mother next, paternal grandmother, her cousin and her oldest sister, Mai Houa in red.

“There was a lot of pride in it,” Yang says.

Yang’s parents, her older sisters and their grandmother resettled in Sheboygan, Wis. in the early 1990s, and while having an American daughter was a source of pride for her family, they never lost touch with their roots.

“Growing up, my parents always reminded me and my siblings of our Hmong identity,” Yang explains.

During her Life Sciences Communication, Gender and Women’s Studies and Global Health studies at the University of Wisconsin-Madison, Yang was introduced to public health, and more specifically, health disparities and inequities. She says she saw her family and her community reflected in these courses which ultimately led her to discover her passion for maternal ​and child health.

A recent graduate from the maternal child health graduate program at the University of Minnesota-Twin Cities, Yang connected with the Minnesota WIC program during her graduate studies. The WIC Breastfeeding report further describes health inequities through low breastfeeding rates in the Hmong population.

Tiffany’s mother, sister, Lada, and baby Tiffany.

The report shows that “Traditional racial categories are inadequate to describe breastfeeding rates in Minnesota’s diverse communities … Among Asian infants, the Hmong are least likely to initiate breastfeeding (59%).”

Hmong mothers have the lowest breastfeeding continuation rates too; one in eight Hmong mothers breastfeeds at six months and one in twenty-seven Hmong mothers breastfeeds at 12 months. []

Charged by these statistics, the Hmong Breastfeeding Initiative (HBI) was created to promote and educate the Hmong community about breastfeeding.  The HBI is a collaboration between MDH WIC program, Minnesota Breastfeeding Coalition (MBC), and Ramsey County Public Health; Yang’s work with HBI was organized by the Minnesota Health Department’s WIC program.

Yang and her colleagues facilitated listening sessions and an Equity ​Action Lab with Hmong providers, peer counselors and elders to learn how to better serve the community.

Through their work, they learned that assimilation plays a big role in low breastfeeding rates. Because immigrants don’t see American women breastfeeding in public, they are less likely to do so. Even when Hmong mothers reported breastfeeding in public, they were shamed, Yang explains.

Returning to work and school, sometimes in the very early days postpartum, inhibits breastfeeding too. While this is well-known and documented, cultural factors further complicate this barrier in Hmong families. In Hmong culture, people are sometimes hesitant to handle breastmilk because there is a belief that if breastmilk is spilled into another’s food or drink and is consumed, they will be struck by lightning, Yang explains.

Access to competent, culturally appropriate prenatal and postpartum healthcare is limited too. Yang reports there is currently only one Hmong IBCLC in the nation. Other lactation professionals and peer counselors especially have bridged this gap creating trusted support.  

Tiffany’s mother carrying her sister, Bao, in  a “nyias” (baby carrier). Two of her sisters were born in Thai refugee camps.

The HBI Equity ​Action Lab allowed Yang and participants to create culturally significant breastfeeding messaging, a breastfeeding photo and art contest, and most recently received a grant to create educational breastfeeding videos ​for elders, male partners highlighting the importance of colostrum. In Hmong culture, it is widely believed that colostrum is harmful.

Ya​ng says she is excited about sharing Hmong families’ journeys and changing the narrative. Although breastfeeding rates are low, Yang reminds us that “Hmong women have always breastfed, many do want to breastfeed and many are.”

Tiffany’s dad, mom, and herself at a Hmong market in St. Paul, Minn.

Yang and colleagues presented their work this weekend at the USBC 9th National Breastfeeding Conference and Convening.

In July, Yang and her team plan to create a breastfeeding presence at the 39th Annual Hmong International Freedom Festival. [The 2020 Hmong International Freedom Festival has been cancelled due to Covid-19.]  

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