Exploring Hmong breastfeeding care gaps

In the incredibly informative and engaging webinar Cultural Dimensions in Promoting, Protecting, & Supporting Lactation in East Asian Communities with Tonya Lang, MPH, CHES, IBCLC and Grace Yee, retired IBCLC, Lang and Yee describe the diversity that exists under the AANHPI umbrella, shaking away the stereotypical idea that Asian culture is monolithic. And with such ethnic diversity comes a vast number of languages, Lang pointed out.

Linguistic isolation and other written and spoken language considerations along with assimilation can be barriers to healthy infant feeding success in Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities.

Tiffany Pao Yang, MPH describes the effects of assimilation on the Hmong population in the Twin Cities, Minn. in Changing the narrative around infant feeding in Hmong population.

A 2018 WIC Breastfeeding report describes health inequities through low breastfeeding rates in the Hmong population. 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. [https://www.health.state.mn.us/docs/people/wic/localagency/reports/bf/info/2018bffactsheet.pdf]

Charged by these statistics, the Hmong Breastfeeding Initiative (HBI) was created to promote and educate the Hmong community about breastfeeding.  The HBI was 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.

Continuing this work, with funding from Reducing Disparities in Breastfeeding through Continuity of Care Identifying Care Gaps grant, from National Association of County and City Health Officials (NACCHO), the Hmong Breastfeeding Coalition (HBC) conducted an environmental scan of the Twin Cities (Minneapolis and Saint Paul, MN) on breastfeeding promotion and support for child-bearing age Hmong women and families.

Photo by Samrat Khadka on Unsplash

Last year, a breastfeeding (BF) assessment was created specifically for this project and confirmed what Hmong community members have previously mentioned to HBC in the listening sessions and Equity Action Lab. Additionally, a storytelling collection initiative was launched honoring the oral history that is deeply rooted in the Hmong culture. The findings from the assessment are currently being used to inform HBC’s new projects in partnership with HealthConnect One’s First Food Equity Project, funded by the WKKF Kellogg Foundation. [Find the full report here.]

In their Hmong Breastfeeding Care Gaps video, Yang and her colleague Pa Shasky describe their work, explore Hmong breastfeeding culture and encourage community feedback and insight while speaking “Hmonglish,” a beautiful fusion of Hmong and English.

The coalition’s work has discovered an interesting phenomenon: where there are Hmong-centric community resources, there is no lactation support;  where there is lactation and breastfeeding support, it is not Hmong-centric.

Their work has also pinpointed that breastfeeding and lactation information and support is not only necessary for Hmong mothers, but for the folks who surround them. They often include elders and partners. Hmong elders tend to be very influential in infant feeding and should be included in conversations around healthy feeding and behaviors that support breastfeeding.

Photo by Quang Nguyen Vinh on Pexels

Conversations should go beyond the household too, encouraging breastfeeding in workplaces especially since returning to work is a major breastfeeding barrier for Hmong mothers. Efforts to include teens and youth in infant feeding conversations are necessary as well as they often help with childcare.

Yang also called for Hmong researchers to look deeper into how Nyob nruab hlis, the postpartum rest period, influences breastfeeding outcomes.

HBC will continue working with local and national groups and encourage advocates to share the information they have gathered to help raise awareness about breastfeeding in Hmong culture in the U.S.

Yang and colleagues Zoua Lee & Paokia Yang will participate in the upcoming webinar series   Reclaiming and Celebrating Cultural Human Milk Feeding Traditions in Modern Times: Voices and storytelling from the LGBTQIA+, Indigenous, AAPI and Black communities within Minnesota. Register here.

​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.”

Art by: Khou Vue
Courtesy of the Hmong Breastfeeding Coalition

As Lang and Yee explained in their webinar, cultural traditions are something to incorporate and celebrate, not something to overcome. Providing culturally congruent care is essential to helping mothers obtain their breastfeeding goals and to ultimately support healthy communities. Yang Her is currently the only Hmong lactation consultant in the nation. In partnership,  BreastfeedLA (breastfeedla.org) and the Asian, Southeast Asian, and Pacific Islander (ASAP!) Breastfeeding Task Force of Alameda County, the Asian Pacific Islander Breastfeeding Task Force (APIBTF), breastfeedla.org/aapi-breastfeeding-task-force/) are conducting a nationwide landscape analysis of lactation resources available to AANHPI communities. They are working to compile and create a resource directory to share publicly on the APIBTF website in order to increase access to existing supports in AANHPI communities. Learn more here.

Asian American Native Hawaiian and Pacific Islander Breastfeeding Week 2022: Telling our own stories, Elevating our voices is honored from August 15 to 21. Find out more about this celebration at https://www.facebook.com/APIBTF.

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