Date of Defense:
April 26, 2019
Introduction: The Hmong believe yog tsis muaj mis niam me nyuam tsis loj hlob (without breast milk, babies can’t grow). However, the Minnesota Department of Health (MDH) WIC program reported Hmong Minnesotans are less likely to initiate breastfeeding and have shorter breastfeeding periods compared to other races and ethnicities in Minnesota1. Low breastfeeding in the Hmong community increases the risk of developing long-term diseases such as diabetes and breast cancer that breastfeeding can prevent.2
MDH WIC Program: The Hmong Breastfeeding Initiative (HBI) was created to promote and educate the Hmong community about breastfeeding to increase breastfeeding among Hmong women.3 The HBI is a collaboration between MDH WIC program, Minnesota Breastfeeding Coalition (MBC), and Ramsey County Public Health with technical support from the States of Solution initiative. My work with the HBI was organized by MDH WIC program. My preceptor was Marcia McCoy, a WIC research scientist who started the work of disaggregating WIC breastfeeding data based on race and ethnicity. The WIC Program is housed in MDH’s Division of Child and Family Health (CFH) which “provides collaborative public health leadership that supports and strengthens systems to ensure healthy families and communities.4” MDH WIC program provides breastfeeding promotion and support for communities with low breastfeeding rates.1 Similar to the mission at MDH WIC program, my work with the HBI strives to increase breastfeeding rates in the Hmong community so Hmong babies, mothers, and families can live healthy lives.
Experience: My work as an intern for the HBI began in May 2018 and ended in August 2018. Listed below are my learning objectives and activities.
- Develop a 1-2 page Hmong breastfeeding and birth outcomes in Minnesota fact sheet by August 2018. I analyzed the 2017 Minnesota birth records data file6 and used the variables Hmong births (babies born to Hmong moms), counties Hmong moms live in and birth facilities to evaluate Hmong birth demographics. I also used the variables birth type (vaginal, cesarean), low birth weight (<2,500 g), and preterm births (<37 weeks) to evaluate Hmong birth outcomes. I relied on MDH WIC breastfeeding fact sheets for additional data on Hmong breastfeeding.
- Develop a contact list of healthcare facilities and systems that serve Hmong mothers and births by July 2018. My team and I created a list of Hmong and non-Hmong providers, health organizations, and facilities in the Twin Cities that serve Hmong clients. I organized the contact list using Excel and included information about contact name, contact information, meeting date and time, and their interest in involvement. After creating the list, I created an email prompt to introduce myself, the HBI, and interest in involvement.
- Identify factors that influence Hmong pregnant women and mothers’ decisions to breastfeed by August 2018. Once a contact agreed to meet, I sent a Doodle Poll to schedule a meeting. Between July and August, my colleagues and I held one listening session or interview with three Hmong Hennepin County WIC Program staff and one Hmong WIC breastfeeding peer. We held another listening session with three Hmong Ramsey County WIC breastfeeding peers. We asked participants about their personal or professional experiences with Hmong breastfeeding, influences on Hmong breastfeeding decisions, and recommendations to increase breastfeeding among Hmong women. I co-facilitated discussions and took notes for each listening session. After each session, my team and I debriefed and evaluated the responses.
Results: The top three birth facilities in Minnesota that served the most Hmong mothers and babies in 2017 were Health East St. John’s Hospital, Regions Hospital, and Maple Grove Hospital.6 These facilities are located in the Twin Cities where the largest concentration of Hmong people live in the US.7 Hmong birth outcomes did generally better than the overall Minnesota birth population. There were lower numbers of Hmong cesarean births and lower numbers of Hmong babies born before 37 weeks.6 Hmong WIC staff and breastfeeding peers from our listening sessions discussed the socio-ecological factors that influence Hmong women’s breastfeeding decisions. The Hmong community is a collective society; therefore, many decisions are made together by the family and community. Mother-in-laws and elders hold a powerful role in breastfeeding support since they are often time the caretakers when Hmong mothers and their partners leave the home. In addition, some Hmong view breastfeeding as “inconvenient” for working mothers; therefore, formula is preferred so caretakers can feed her child when she is unable to or is away.8
Lessons Learned: Scheduling dates and times to meet Hmong stakeholders was a challenge. Many people were out of the office during this time of the year (May-August). Planning further ahead of summer holidays and events would have secured meeting dates and times with more stakeholders. Another lesson was recognizing my own biases towards my community. I was born in America, grew up practicing the Christian faith, and am part of a Western academic institution. I see the Hmong community and culture differently from other Hmong people; therefore, I need to approach each listening session and debrief with humility.
Recommendations: Partner with the local WIC programs, especially with Hmong WIC breastfeeding peers, to provide educational outreach. They are a trusted and present agency in the Hmong community. Another recommendation is to reserve a booth at large-scale events such as the Hmong New Year and Hmong Freedom Festival to promote breastfeeding and provide a clean and safe space for breastfeeding moms and babies.
Conclusion: I resumed my work with the HBI after the completion of my field experience in August 2018. My colleagues and I continued our listening sessions with three Hmong providers in North Minneapolis, four Hmong public health nurses in St. Paul, six Hmong elders, and one Hmong International Board Certified Lactation Consultant (IBCLC) from California (the first and only Hmong IBCLC in the nation). In March of 2019, my colleagues and I planned and facilitated the Equity Action Lab. We invited Hmong community members to review our listening session notes, create breastfeeding messages from them, and develop Hmong breastfeeding projects to implement between April and June 2019. Hmong breastfeeding decisions are significantly influenced by cultural, social, and personal factors. Partnering with Hmong locals, Hmong health providers, and health facilities to identify and address these factors will change the breastfeeding culture in the Hmong community.
- WIC. (2018). Breastfeeding in Minnesota’s WIC Program Fact Sheet 2018. Minnesota Department of Health [Fact sheet].
- Minnesota Breastfeeding Coalition. (2018). Birth outcomes and breastfeeding in Minnesota Hmong women. Retrieved from https://insight.livestories.com/s/v2/birth-outcomes-and-breastfeeding-in-minnesota-hmong-women/ce2166b7-3ec4-425c-a081-f74f27100452/
- Minnesota Breastfeeding Coalition. (2018). Hmong Breastfeeding Initiative. Retrieved from https://insight.livestories.com/s/v2/minnesota-hmong-breastfeeding-initiative/9e0dc728-15a9-4f7a-a1c8-7dfe84013fae/
- MDH. (2019). Division of Child and Family Health. Retrieved from https://www.health.state.mn.us/about/org/cfh/index.html
- Minnesota Department of Health. (2018). Data birth2017for Tiffany [Data file].
- Vang, C. Y. (2018). Hmong in Minnesota. St. Paul, MN: Minnesota Historical Society Press.
- Yang, T. (2018). Hmong Breastfeeding Initiative [PDF].