Menu

Why Are the Breastfeeding Rates in Rural America So Low?

A mom from Appalachia shares her thoughts.

Why Are the Breastfeeding Rates in Rural America So Low?

In 2011, moms across the country protested Target, staging “nurse-ins” and refusing to shop there after a breastfeeding mother was threatened with legal action for nursing in the women’s clothing section. I was a television reporter in my home state of West Virginia then and covered this story, admittedly and embarrassingly a little skeeved out. I was in my early twenties, and remember wondering why someone would want to breastfeed in public anyway.

Born and raised in Appalachia, I had no exposure to breastfeeding. I wasn’t breastfed, nor were any of my younger family members. There were a lot of babies in the church I went to growing up, but I don’t remember seeing a single mother nurse her child. It wasn’t until I moved away from the mountains of West Virginia that I realized breastfeeding was actually quite common.

FEATURED VIDEO

Across the country, as many as 82 percent of mothers breastfeed their babies for some amount of time. In rural areas, the numbers are lower, with 68 percent of women starting out breastfeeding. In rural Appalachia, the dichotomy is at its most extreme, with only 57 percent of mothers even attempting to nurse.

Appalachia is comprised of thirteen states, many of which are some of the most economically depressed states in the country and rank near the bottom when it comes to both median household income and breastfeeding rates.

In West Virginia, for example, the median income is $43,000, and less than 35 percent of mothers are breastfeeding by the time their child hits the six month mark.

As someone from Appalachia, I’m as sick as every other Appalachian is of hearing how sad and depressed and poor my beloved home state is. I roll my eyes at lists that rank West Virginia at the bottom, yet again. But you can’t have a conversation about breastfeeding statistics without talking about income. They’re that tied together.

Dr. Susanna Kapourales is a pediatrician in Teays Valley, West Virginia, just a few minutes away from the state capital of Charleston. She grew up in the town of Williamson, where nearly half of the three thousand residents live below the poverty line.

“My mom was the only person in her community who breastfed at all,” Dr. Kapourales said. “She had no support whatsoever; she learned how to breastfeed by a book. She had absolutely no help in the area because nobody breastfed. But she knew that it was better for her babies.”

Kapourales’ mother moved to Williamson as an adult; and for many native West Virginian and other rural Appalachians, the aversion to breastfeeding is deep-rooted.

Though the American Academy of Pediatrics recommends breastfeeding until twelve months, Dr. Kaporales says that most of her patients nurse for about six months and switch to formula. “A lot of people will get to that six months and then either from work restraints with pumping or something else, they just find it easier to use formula.”

The Federal Family Medical Leave Act, which pertains to all fifty states, only applies to employers with at least fifty employees and doesn’t guarantee paid time off. In fact, the United States is still the only developed country that doesn’t offer paid leave for new mothers, something that could really aid in setting good breastfeeding practices into place.

Federal law does also require employers to provide “reasonable daily unpaid breaks” to pump, but the conditions or the culture aren’t always encouraging. If you have an office you can close the door to, it’s a little easier, but what if you work at Red Lobster? Where do you go to pump? For many mothers, pumping at work just isn’t an option.

“Most of the time, they are so exhausted when they get home and they don’t have enough support,” Dr. Kaporales said.

Of course, there are many other factors beside someone’s income that can deter mothers from breastfeeding -- lactation or latching issues, issues with the baby’s weight or even medication the mother needs to take. But perhaps the most profound reason moms don’t nurse, in my experience, is that the act of breastfeeding itself is at odds with cultural norms, leaving them without the support of their family and friends.

Dr. Kaporales said, “some families have been raised to think that it’s weird -- and then others, come hell or high water, do not want to give their babies formula. I see both, and I really think it has to do with their family.”

Cigarette smoking and drug use also play a big part in preventing mothers from breastfeeding.

In West Virginia specifically, 29 percent of residents admit to smoking regularly, and drug use is rampant. At the hospital system Dr. Kapourales works for alone, there are 2,900 births per year -- babies from Ohio, Kentucky and West Virginia. Of those tiny infants, one fifth were exposed to drugs in the womb, and 400 had to be medicated after birth to help combat withdrawal symptoms that leave them screaming and shaking uncontrollably.

In hope to raise the breastfeeding rates across the country, hospitals have adopted a certification system that list them as “baby friendly.” At “baby friendly” hospitals, breastfeeding is encouraged by giving the newborn to the mother right away, foregoing nurseries by leaving the newborn with the mother the entire stay, and providing lactation support before discharge. West Virginia has just one such hospital.

That kind of support, Dr. Kapourales said, is crucial in educating, encouraging and sustaining breastfeeding. It should probably even start during pregnancy.

“In the community, if people don’t have enough support, they get discouraged with it and quit,” she said. “Those first three weeks are hard, and people feel helpless and like they can’t get through it. And if you don’t have that support system to do it, it’s hard.”

But breastfeeding rates won’t rise in these rural areas, Dr. Kapourales said, until breastfeeding is normalized. And the only way to normalize breastfeeding is to do it. In public. All the time. At the grocery store, at your older kids’ soccer practice -- even at Target.

Photography by Belle Savransky for Well Rounded.

14 Toys that will keep your kids entertained inside *and* outside

They transition seamlessly for indoor play.

With Labor day weekend in the rearview and back-to-school in full swing, most parents are fresh out of boxes to check on their "Fun Concierge" hit list. It's also the point of diminishing returns on investing in summer-only toys. So with that in mind, we've rounded up some of our favorite toys that are not only built to last but will easily make the transition from outdoor to indoor play. Even better, they're Montessori-friendly and largely open-ended so your kids can get a ton of use out of them.

From sunny backyard afternoons to rainy mornings stuck inside, these toys are sure to keep little ones engaged and entertained.

Meadow ring toss game

Plan Toys meadow ring toss game

Besides offering a fantastic opportunity to hone focus, coordination, determination and taking turns, lawn games are just plain fun. Set them up close together for the littles and spread them out when Mom and Dad get in on the action. With their low profile and rope rings, they're great for indoors as well.

$30

Balance board

Plan Toys balance board

Balance boards are a fabulous way to get the wiggles out. This one comes with a rope attachment, making it suitable for even the youngest wigglers. From practicing their balance and building core strength to working on skills that translate to skateboarding and snowboarding, it's a year-round physical activity that's easy to bring inside and use between Zoom classes, too!

$75

Detective set

Plan Toys detective setDetective Set

This set has everything your little detective needs to solve whatever mystery they might encounter: an eye glasses, walkie-talkie, camera, a red lens, a periscope and a bag. Neighborhood watch? Watch out.

$40

Wooden doll stroller

Janod wooden doll strollerWooden Doll Stroller

Take their charges on a stroll around the block with this classic doll stroller. With the same versatility they're used to in their own ride, this heirloom quality carriage allows their doll or stuffy to face them or face the world.

$120

Sand play set

Plan Toys sand set

Whether you're hitting the beach or the backyard sandbox, this adorable wooden sand set is ready for action. Each scoop has an embossed pattern that's perfect for sand stamping. They're also totally suitable for water play in the wild or the bathtub.

$30

Water play set

Plan Toys water play set

Filled with sand or water, this tabletop sized activity set keeps little ones busy, quiet and happy. (A mama's ideal trifecta 😉). It's big enough to satisfy their play needs but not so big it's going to flood your floors if you bring the fun inside on a rainy day.

$100

Mini golf set

Plan Toys mini golf set

Fore! This mini golf set is lawn and living room ready. Set up a backyard competition or incorporate into homeschooling brain breaks that shift focus and build concentration.

$40

Vintage scooter balance bike

Janod retro scooter balance bike

Pedals are so 2010. Balance bikes are the way to go for learning to ride a bike while skipping the training wheels stage altogether. This impossibly cool retro scooter-style is built to cruise the neighborhood or open indoor space as they're learning.

$121

Wooden rocking pegasus

plan toys wooden rocking pegasus

Your little will be ready to take flight on this fun pegasus. It gently rocks back and forth, but doesn't skimp on safety—its winged saddle, footrests and backrest ensure kids won't fall off whether they're rocking inside or outside.

$100

Croquet set

Plan Toys croquet set

The cutest croquet set we've ever seen! With adorable animal face wooden balls and a canvas bag for easy clean up, it's also crafted to stick around awhile. Round after round, it's great for teaching kiddos math and problem-solving skills as well.

$45

Wooden digital camera

fathers factory wooden digital camera

Kids get the chance to assemble the camera on their own then can adventure anywhere to capture the best moments. With two detachable magnetic lenses, four built-in filters and video recorder, your little photographer can tap into their creativity from summertime to the holidays.

$179

Wooden bulldozer toy

plan toys wooden bulldozer toy

Whether they're digging up sand in the backyad or picking up toys inside, kids can get as creative as they want picking up and moving things around. Even better? Its wooden structure means it's not an eye sore to look at wherever your digger drops it.

$100

Pull-along hippo

janod toys pull along hippo toy

There's just something so fun about a classic pull-along toy and we love that they seamlessly transition between indoor and outdoor play. Crafted from solid cherry and beechwood, it's tough enough to endure outdoor spaces your toddler takes it on.

$33

Baby forest fox ride-on

janod toys baby fox ride on

Toddlers will love zooming around on this fox ride-on, and it's a great transition toy into traditional balance bikes. If you take it for a driveway adventure, simply use a damp cloth to wipe down the wheels before bringing back inside.

$88

We independently select and share the products we love—and may receive a commission if you choose to buy. You've got this.

Shop

Time-saving formula tips our editors swear by

Less time making bottles, more time snuggling.

As a new parent, it can feel like feeding your baby is a full-time job—with a very demanding nightshift. Add in the additional steps it takes to prepare a bottle of formula and, well… we don't blame you if you're eager to save some time when you can. After all, that means more time for snuggling your baby or practicing your own well-deserved self-care.

Here's the upside: Many, many formula-feeding mamas before you have experienced the same thing, and they've developed some excellent tricks that can help you mix up a bottle in record time. Here are the best time-saving formula tips from editors here at Motherly.

1. Use room temperature water

The top suggestion that came up time and time again was to introduce bottles with room temperature water from the beginning. That way, you can make a bottle whenever you need it without worrying about warming up water—which is a total lifesaver when you have to make a bottle on the go or in the middle of the night.

2. Buy online to save shopping time

You'll need a lot of formula throughout the first year and beyond—so finding a brand like Comforts, which offers high-quality infant formula at lower prices, will help you save a substantial amount of money. Not to mention, you can order online or find the formula on shelves during your standard shopping trip—and that'll save you so much time and effort as well.

3. Pre-measure nighttime bottles

The middle of the night is the last time you'll want to spend precious minutes mixing up a bottle. Instead, our editors suggest measuring out the correct amount of powder formula into a bottle and putting the necessary portion of water on your bedside table. That way, all you have to do is roll over and combine the water and formula in the bottle before feeding your baby. Sounds so much better than hiking all the way to the kitchen and back at 3 am, right?

4. Divide serving sizes for outings

Before leaving the house with your baby, divvy up any portions of formula and water that you may need during your outing. Then, when your baby is hungry, just combine the pre-measured water and powder serving in the bottle. Our editors confirm this is much easier than trying to portion out the right amount of water or formula while riding in the car.

5. Memorize the mental math

Soon enough, you'll be able to prepare a bottle in your sleep. But, especially in the beginning or when increasing your baby's serving, the mental math can take a bit of time. If #mombrain makes it tough to commit the measurements to memory, write up a cheat sheet for yourself or anyone else who will prepare your baby's bottle.

6. Warm up chilled formula with water

If you're the savvy kind of mom who prepares and refrigerates bottles for the day in advance, you'll probably want to bring it up to room temperature before serving. Rather than purchase a bottle warmer, our editors say the old-fashioned method works incredibly well: Just plunge the sealed bottle in a bowl of warm water for a few minutes and—voila!—it's ready to serve.



Another great tip? Shop the Comforts line on Comfortsforbaby.com to find premium baby products for a fraction of competitors' prices. Or, follow @comfortsforbaby for more information!

This article was sponsored by The Kroger Co. Thank you for supporting the brands that support Motherly and mamas.

Our Partners
Chrissy Teigen/Instagram

When Chrissy Teigen announced her third pregnancy earlier this year we were so happy for her and now our hearts are with her as she is going through a pain that is unimaginable for many, but one that so many other mothers know.

Halfway through a high-risk pregnancy complicated by placenta issues, Teigen announced late Wednesday that she has suffered a pregnancy loss.

Our deepest condolences go out to Chrissy and her husband, John Legend (who has been by her side in the hospital for several days now).

In a social media post, Teigen explained she named this baby Jack.

FEATURED VIDEO

"We are shocked and in the kind of deep pain you only hear about, the kind of pain we've never felt before. We were never able to stop the bleeding and give our baby the fluids he needed, despite bags and bags of blood transfusions. It just wasn't enough," she wrote.

She continued: "We never decide on our babies' names until the last possible moment after they're born, just before we leave the hospital. But we, for some reason, had started to call this little guy in my belly Jack. So he will always be Jack to us. Jack worked so hard to be a part of our little family, and he will be, forever."

Keep reading Show less
News