Breastmilk is the optimal form of infant nutrition. That said, the history of breastfeeding practices and the current landscape of breastfeeding support has severely impacted who is breastfeeding in the U.S., resulting in racial disparities in breastfeeding. In fact, for as long as breastfeeding data has been collected, the rates of breastfeeding among Black women has significantly lagged behind white women.
The 16% breastfeeding gap
In 2015, 69.4% of Black infants initiated breastfeeding, compared with 85.9% of white infants, a difference of 16.5 percentage points. Beyond initiation, the disparity continues and deepens. The rates for exclusive breastfeeding at age 3 months were 36.0% among Black infants and 53.0% among white infants. At age 6 months, the rates were 17.2% among Black infants and 29.5% among white infants.
The history of breastfeeding
The story behind these numbers is extremely complex. Part of the issue is that the history of breastfeeding is riddled with racism and systemic oppression. During slavery, Black women were stopped from breastfeeding their own children and were forced to breastfeed the children of their masters, often to the neglect of their own. In slave narratives, you can read heart-wrenching stories of slaves whose own babies suffered or died because they were forced to breastfeed their oppressor’s child. Later, when there were limited work opportunities for Black and brown women, wet nursing became a form of “labor” that they provided to affluent, white women. This created a generational legacy of breastfeeding as an act that Black women were stopped from doing for their own children, forced to do for others or paid to do others. Either way, Black infants became the least likely recipients of their mother’s milk and a generational legacy of little or no breastfeeding continued.
Access to breastfeeding support
Over time, the models of breastfeeding support that were created excluded the needs and lived experience of Black women. For example, La Leche League, the most well-known mother-led lactation support organization which has done great work fighting for the legal rights of mothers for years, historically only set up support groups in white suburban neighborhoods and for many years only catered to stay-at-home mothers.
Yet, for decades, the ‘evidence’ for developing breastfeeding support interventions nationwide was modeled after La Leche League. That data set provided zero insight on the cultural barriers in Black and Latino communities, the impact of employment, or the role of grandmothers, who have been proven to be critical to continued breastfeeding among women of color. Black women were denied the culturally relevant resources.
The lack of culturally relevant support led to fewer Black women breastfeeding which led to a narrative that Black women didn’t breastfeed — a short-sighted approach that became a self-fulfilling prophecy. Physicians assumed Black women didn’t breastfeed so they were less likely to offer breastfeeding information and support.
The role of formula
Meanwhile, 60% of infant in the U.S. are born WIC-eligible. The important supplemental nutrition for mothers and infants also remains one of the largest purchasers of infant formula in the U.S. That created the perception in many communities, that infant formula was “government approved.” Commercial influences continue to aggressively market infant formula in Black communities — another thread in the decline of breastfeeding rates.
Today, the policy gaps that continue to impact all mothers in the U.S. cause disproportionate harm to Black women and other birthing people of color. For example, the U.S. is the only industrialized nation that still does not offer a federal paid leave. Thankfully, some employers have filled in the gap, offering family leave as a critical employee benefit. Unfortunately far too many Black women and other women of color are in fields, including retail and factory work, that by and large don’t offer paid leave, making continued breastfeeding a privilege for those who have corporate jobs or can afford to take unpaid leave.
Black Breastfeeding Week
These systemic barriers on top of the cultural barriers created by a history of racism, have sparked a revolution to address racial disparities in breastfeeding and reclaim breastfeeding in Black communities. That work has been buoyed by awareness movements such as Black Breastfeeding Week (August 25-31), and organizations such as R.O.S.E. (Reaching our Sisters Everywhere) and the National Birth Equity Collaborative, along with a renewed call for more culturally relevant lactation consultants at the IBCLC (International Board Certified Lactation Consultant) level.
Looking forward
The racial disparities in breastfeeding that were created over time will take intentional and concerted work to undo. The work will include leveraging technology and digital platforms to level the playing field when it comes to access to lactation support. It is equally important that we create a new narrative that Black women do breastfeed and that we hold providers accountable to provide equitable access to information and support for all. When it comes to breastfeeding, no mother that wants to feed her baby with her body, should be left behind.
Read more by Kimberly Allers: When breastfeeding isn’t going how you planned.
Kimberly Seals is an award-winning journalist, five-time author and internationally recognized strategist for maternal and infant health. She is the founder of Irth, the first of its kind, Yelp-like app for Black and brown women and birthing people to find and leave reviews of maternity doctors and birthing hospitals. She is also host of Birthright, a podcast about joy and healing in Black birth. Kimberly’s fifth book, The Big LetDown—How Medicine, Big Business and Feminism Undermine Breastfeeding was released by St. Martin’s Press in 2017. Learn more at www.KimberlySealsAllers.com and www.IrthApp.com
