Addressing Historic Trauma to Improve Breastfeeding and Safe Sleep Among Indigenous Families
Kim Moore-Salas, IBCLC, enrolled member/citizen of Navajo Nation
Shawn Meyer, RN, BSN, CLC, member of Turtle Mountain Band of Chippewa
Please note, we use the terms Indigenous People and Native Americans to reflect the preference of our interviewees.
“Breastfeeding is a cultural tradition,” shares Shawn Meyer, RN, BSN, CLC, a public health nurse and member of Turtle Mountain Band of Chippewa. “It’s ingrained in our history and the history of many other tribes across the country.”
The Native American breastfeeding tradition Meyer describes, however, has been disrupted by centuries of historical trauma, an insight that helps explain why Native Americans now have one of the lowest rates of breastfeeding of all other racial and ethnic groups.
When Indigenous People were forcefully dispossessed from their land, they not only lost their homes but were separated from their way of life. Cultural teachings and traditions were prevented by mandated assimilation policies, one of the most traumatic being the removal of native children from their families—in these instances, children were placed into boarding schools where their long hair was cut and they were punished, often violently, for speaking their language or practicing their cultural traditions. Even after the boarding schools were closed, hundreds of children continued to be separated from their families until the 1970s.
“My parents were both boarding school children,” says Kim Moore-Salas, International Board-Certified Lactation Consultant (IBCLC) and enrolled member/citizen of Navajo Nation, whose personal experience is representative of her community. “Forced separation violently disrupted first foods for our children and negatively altered the family dynamic, creating a generational disconnect. For many decades, our children have often gone without this imperative natural bonding experience, let alone the significant nourishment needed for them to grow.”
As faculty experts on the NICHQ-led National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN), both Meyer and Moore-Salas know that improving breastfeeding rates not only improves health outcomes for native mothers, but also saves Native American babies, a population who experiences the highest rate of sudden unexplained infant deaths (SUID). Breastfeeding, which can reduce the risk of sudden infant death syndrome (SIDS) —one of the leading causes of SUID—by as much as 70 percent, represents a critical opportunity to preserve the health of the next generation of Native Americans and begin to address an alarming lack of equity in national infant mortality rates.
A first step toward success hinges on addressing how historical trauma damaged Indigenous People’s relationships with public institutions, specifically healthcare. This is especially important for efforts like NAPPSS-IIN that seek to reduce SUID rates by improving breastfeeding rates and safe sleep practices, together.
For a favorable outcome then, the question remains: How do we synthesize the promotion of breastfeeding and safe sleep practices within the context of historical trauma? Collectively our Indigenous healthcare professionals offer these three ideas:
Create a safe space to explore ideas and gain input
Discussions regarding safe sleep practices and breastfeeding with Indigenous families begin with identifying and acknowledging the cultural traditions inherent in both. This is especially true when working with communities that have experienced significant historical trauma.
“Families need to know their voices are being heard and that their traditions are being honored,” says Meyer. “Otherwise, they may understandably hesitate to engage in honest conversations, open up about their own challenges and be receptive to recommendations.”
Talking circles among Indigenous women in their traditional setting are opportunities to have these conversation in a safe space. Moore-Salas advises having healthcare professional from the community, or an Indigenous healthcare professional, facilitate the talking circle.
Similarly, Meyer recommends welcoming people that support the client to attend clinic visits with new and expecting mothers and join in these conversations. This extra step can keep mothers from feeling vulnerable and isolated from their supports; and it elevates the community’s voice as one that deserves attention and respect.
Engage Indigenous communities with a spirit of kinship
“Create trust by building a rapport with the community,” Moore-Salas advises. “Don’t just go in imposing your will to promote change. You have to meet them where they’re at, learn their way.”
Efforts to spread breastfeeding and safe sleep practices can quickly seem condescending and even offensive when delivered by an outsider. Genuinely engaging with the community in the places where they spend the most time—family events, meal sites and youth councils, for example—can encourage authentic relationships that open the door for shared learnings and shared teachings. Moreover, providing education at different community sites also helps reach multiple generations, all of whom play a vital role in maternal and infant health outcomes.
When visiting a Native American community, visitors should also remember that they are guests. Each community has unique traditions and protocols; honoring them involves talking to the community elders and asking permission when appropriate.
Support tribal efforts to reclaim their breastfeeding tradition
Movements to reclaim breastfeeding as an Indigenous source of food, a birthright, and a means for cultural preservation have sparked across Indian Health Services. For example, when Meyer was working with local tribal agencies in Wisconsin, she interviewed women from different communitites, asking them to share their personal stories about breastfeeding. The interview videos were then circulated throughout the community; shared at Tribal and Women, Infants and Children (WIC) clinics; and eventually promoted online through their local tribal health department website.
Similarly, Moore-Salas assists in facilitating the Indigenous Breastfeeding Counselor (IBC) course with course developer Camie Jae Goldhammer, MSW, IBCLC. The course’s curriculum is tailored to the various cultural norms of each community they serve.
“We talk about historical trauma and disparate impact,” says Moore-Salas. “We talk about how the benefits of breastfeeding can unravel the trauma and encourage individual and community healing, while being mindful of and in connection with their specific community’s cultural values and teachings. These conversations help the women of that community put all of the pieces together. Reclaiming breastfeeding as an Indigenous source of food—one that is inherently theirs—forms the glue to hold those pieces together. The women we work with go back to their communities and they start creating coalitions to promote nurturing and intuitive first foods support and education.”
Embracing these best practice approaches can help advocates of infant health competently engage Native American communities, while learning and respecting their unique history.
For more ideas on addressing racial and ethnic disparities, read this recent article on identifying implicit bias from an internationally recognized expert in healthcare disparities and cross-cultural health.
Doula Support Improves Maternal and Child Health Outcomes, Patient and Family Engagement
In honor of World Doula Week, celebrated annually March 22-28, The National Institute for Children’s Health Quality (NICHQ) held a conversation with LaToshia Rouse, CD/PCD(DONA), owner of Birth Sisters Doula Services. Rouse currently serves as the Patient and Family Engagement Co-Chair of the National Network for Perinatal Quality Collaboratives Executive Committee and joined NICHQ’s Board of Directors in March 2022.
Supporting Indigenous Families for Improved Health Outcomes
Indigenous mothers and birthing people, fathers, partners, caregivers, and families, can speak for themselves. So, make sure seats are available – and filled – on your projects, your teams, your boards. Many projects within the MCH field have steering committees, and all should have family representation. As I hope you’ve intuited, it’s not enough to carry a message. When I think about justice, equity, diversity, and inclusion with regard to our committees, our faculty experts, or even in our improvement advisors, I have begun to ask the question: Are there people from American Indian and Alaska Native communities here?
Top NICHQ Resources for Pursuing Change in 2022
Browse a collection of NICHQ articles, webinars, and resources that your community found most valuable in 2022.
NICHQ Employee Spotlight: Kelly Edwards, MPH, Senior Project Manager
Kelly Edwards discusses her journey from NICHQ intern to Senior Project Manager, and shares highlights and key takeaways from the six NICHQ projects she's supported.
Children and Their Families Have a Right to Gender-Affirming Healthcare
As physicians, public health professionals, and care providers, we have an obligation to support youth with unique healthcare needs who are at higher risk for negative health outcomes from discrimination, including bullying, physical assault, and suicide. Join us by engaging in meaningful dialogue about best practices for gender diverse kids to improve quality of life, reduce mental health disparities, and most importantly, help the most historically marginalized kids achieve their optimal health.
3 Ways to Close Gaps in Sickle Cell Disease Care: Recommendations from NICHQ Projects
In the past several decades, clinicians, public health professionals, and those with lived experience have seen advancements in Sickle Cell Disease (SCD) treatments and research that have significantly improved outcomes and increased life expectancies for people living with SCD. For example, the FDA-approved medication hydroxyurea (HU) has been recommended as a SCD standard of care due to its ability to help people with SCD mitigate pain and the need for blood transfusions. Preventative measures, such as screening children and adolescents for risk of stroke and ensuring that all people who have SCD receive recommended vaccinations, have also been instrumental in reducing complications associated with SCD. And recently, development of gene therapies has presented possibilities of a new cure. Conversations on how to improve access to care should continue, and these three recommendations begin with some of the most pressing needs.