Black Breastfeeding Week: The Importance and Resilience of Black Breastfeeding Mothers
This article was written by Rashell Williams, an IBCLC partnered with TLN. To learn more about Rashell, check out https://latchplus.com/
The essential role of human milk as preventative medicine for mothers and infants is well researched. Despite many initiatives advocating for changes that support breastfeeding, increases in breastfeeding rates in the United States (US) are shadowed by persistent disparities between racial and ethnic groups. According to 2019 data from the Center for Disease Control and Prevention, the rate of breastfeeding initiation in the US is 84.1 percent amongst all women, 87.4 percent amongst Hispanic Women, 85.5 percent amongst white women, 73.6 percent amongst Black women, and 90.3 percent amongst Asian women. The disparity in breastfeeding initiation between racial/ethnic groups varies by state, ranging from a difference of 6.6 to 37.6 percent. Black infants also have the highest infant mortality rate in the US – twice as high as non-Hispanic white infants, and three times as high as non-Hispanic Asian infants. This data and the extensive research available on the benefits of breastfeeding highlight the need for unique and multifaceted approaches to supporting black families and their breastfeeding goals. Black Breastfeeding Week adds essential fuel towards reducing these disparities, reminding us to listen, engage, uplift, and resource the black families we serve.
As an African American woman of Caribbean descent, Registered Nurse (RN), and Internationally Board-Certified Lactation Consultant (IBCLC), I appreciate the opportunity to partner with The Lactation Network to share my experience and perspectives. I take considerable joy in serving women of all communities and building a bond with the families I serve despite our racial and ethnic differences. Most of the black families I work with are happy to receive care from any lactation consultant available, despite race, if the care is considerate, empathetic, respectful, and with excellent customer service. Many black families express gratitude for my presence and expertise as a black RN and IBCLC. They describe feeling more comfortable in my presence and more willing to share their stories so I can support them. Unfortunately, a few families have expressed feeling judged by Caucasian Lactation Consultants. Improving racial relations is still a work in progress in the US and is a necessary component of effective breastfeeding advocacy.
The work of reducing breastfeeding disparities will include efforts to (1) Understand the impact of slavery and racism on feeding practices in black communities, (2) Increase diversity, cultural competence, and inclusive training among lactation care providers, (3) Develop unique strategies that better address the barriers to breastfeeding experienced by black women, (4) Continuously shift our individual perspectives to one that consistently aligns with racial equality.
It would be easy to assume, based on available data, that breastfeeding is not naturally a part of the lifestyle of black communities. However, before black people were forced to come to America as slaves, breastfeeding was an established tradition in African culture. In her book Lactation Management: Strategies for working with African American Moms, author Katherine Barber describes the history of slavery and its impact on breastfeeding. During slavery, Black women had no say over their own bodies. They were repeatedly beaten and raped by their slave masters, forced to have sex with other slaves to breed children, and made to breastfeed the children of their slave masters as “Wet nurses” instead of their own babies. Women often had to return to slave labor soon after giving birth. A time that was meant for bonding with their newborn and recovering from birth was spent in harsh labor, most likely away from their children. There was no “on-demand breastfeeding” under these conditions. Instead, mothers had few opportunities to breastfeed, and their children were fed a mixture of unclean cow’s milk, pieces of cornbread, molasses, or the liquid from greens that were cooked in dirty water. Many infants were malnourished or became sick and died. Imagine the grief experienced by these women who had no choice over who they would mate with, when they would have children, or how their children would be fed. Who knows what postpartum depression may have been like for mothers experiencing this atrocious treatment?
With such a painful history over centuries, it is understandable that some black communities acquired negative associations with breastfeeding. Whereas breastfeeding is usually related to bonding and nourishing a newborn, it was now associated with abuse and psychological, emotional, and physical trauma. As slavery was abolished and black people slowly obtained their freedom, priority went to working to provide for themselves and their families in the harsh realities of racism. Babies were often left in the care of family members and continued to receive breast milk substitutes that were generally unsafe and devoid of the protective and nutritious benefits of human milk. As formula companies gained traction, their advertisements convinced many families that formula was preferred over breastmilk. What was once a thriving tradition of breastfeeding in African culture was stripped from African slaves with unfortunate generational impacts. Understanding and validating this history is important to affecting the breastfeeding disparities that persist.
Lactation is not excluded from the many industries that lack diversity amongst its educators and providers. In the US, breastfeeding activism is primarily led by white, cis-gendered women, leaving a large gap in representation amongst its leaders. Without the wealth of knowledge, experience, and perspectives that diversity brings, outcomes will always veer towards the benefit of those with the majority voice and not necessarily towards those with the greatest need. To date, I have yet to meet another black IBCLC in my community, though the presence of black peer counselors and other breastfeeding support personnel is reassuring. The first time I saw a black IBCLC was on a webinar hosted by the Lactation Education Resources. I was shocked and elated, secretly hoping to see more lactation consultants that looked like me–seeing someone that looks like you in the room can reduce feelings of isolation and bring a sense of ease and belonging.
Though finances are not always the deterrent towards entering into the lactation field, it does play a factor for many black women. Organizations could consider providing scholarships and other opportunities to interested minority groups that have financial barriers to entering the lactation field. The United States Lactation Consultant Association (USLCA) is one example of an organization providing financial aid to marginalized communities seeking lactation certification. Since the availability of many scholarships is based on donations, more investors are needed to bolster the number of scholarships that are created and offered. Additionally, creative solutions are needed for those with a barrier to clinical training due to an absence of available lactation providers in their communities.
CULTURAL COMPETENCE & INCLUSIVE TRAINING
Increasing diversity can come with friction as those accustomed to being the majority adjust to the presence and influence of other racial/ethnic groups. Even as an IBCLC, I have unfortunately experienced prejudices from some of my Caucasian colleagues. Many days I wondered, “would they treat me that way if my skin looked like theirs?” Thankfully I have also had a few colleagues who treated me as their equal, despite our racial difference, providing me with education, training, and support. IBCLCs that regularly attend and apply the knowledge obtained from cultural competency training can enhance their interactions with both families and IBCLCs who identify with other racial-ethnic groups.
Furthermore, it is important for the curriculum to be inclusive when training practitioners to assess breast conditions that are observed on the skin. Aspiring healthcare professionals are predominantly trained to assess breast conditions using images from Caucasian women, limiting their ability to recognize how differently these conditions can present on darker skin. This lack of exposure to diverse images during training can prevent black and brown women from receiving necessary diagnoses and treatments. Untreated breast conditions in black women are one of many factors that can discourage them from continuing their breastfeeding journey. Thankfully, The Melanated Mammary Atlas, which was founded by IBCLC Nekisha Killings, is paving the way for normalizing brown breasts by offering a database of regularly updated images of breast conditions on Asian, Indigenous, Black, and brown skin. The Lactation Network is one of a growing number of organizations partnering with the Melanated Mammary Atlas to increase access to this vital resource amongst Lactation Consultants and relevant health care providers.
Although The American Academy of Pediatrics recommends exclusive breastfeeding for at least six months, the choice to breastfeed for many black families is not as simple as having enough of the “right” information. The long, atrocious history of slavery and its socio-economic, psychological, familial, and generational impact has produced both internal and external barriers to breastfeeding. Black women must often overcome breastfeeding myths, low breastfeeding self-efficacy, cultural stigmas, lack of familial support, lack of education from medical professionals who assume they are uninvested in breastfeeding, and targeted marketing from formula companies. Research also shows that black women are more likely to need to return to work sooner than other racial groups and face the barriers of inflexible work hours and limited maternity leave, especially in low-income areas.
For all communities, it will take education, resources, and support on a familial, community, and legislative level to help overcome these challenges. Lactation consultants, health care providers, and interested stakeholders can partner with groups who are making strides towards increasing support for black families. Having safe spaces for these families to share their stories and receive support is critical. In the words of renowned researcher, author, and speaker, Brene Brown, “We are good stewards of the stories we hear by listening, being curious, affirming, and believing people when they tell us how they experienced something.” Before taking action, ask what role you can play to support their goals.
Race aside, we are all human and deserve care from people who won’t judge us based on our outward appearance, generalize us based on deep-seated prejudices, or diminish us to what society says we are worth. The tricky thing about racism is it can be hard to identify in seed form. We must regularly look into ourselves and evaluate what’s in our hearts. The assumptions we make about people are quick and subtle, with a major impact on how we view and respond to others. When engaging with people who identify with a different racial or ethnic group, I challenge us all to pause and ask ourselves the following questions:
- What beliefs do I have about this person or group of people?
- What evidence do I have for these beliefs?
- Where did these beliefs come from?
- Is it fair to make broad generalizations based on the actions of a few people or on misinformation?
This line of self-reflection is the thread that, once pulled, unravels the lines that divide us, facilitating perspective shifts towards racial equality. It takes our collective commitment to increase breastfeeding rates among black families. Fine-tuning our own perspectives of each other will help us get the details right, making us better listeners. If we listen and engage without the white noise of our assumptions, we can create more effective action plans for reducing breastfeeding disparities. Individual steps may include vulnerable conversations with colleagues and friends, seeking information through books, podcasts, and other forms of media, and ensuring that the stories we listen to are told by the people they are about.
As we celebrate Black Breastfeeding Week 2022, let’s continue to make safe spaces for these conversations. The importance of breastfeeding for public health warrants our unrelenting advancement towards racial equality in the lactation realm. As we celebrate our progress, we focus and press forward, diversifying our teams, developing new strategies that include the voices of those impacted, and shifting our perspectives toward racial equality–together.
Barber, K. (2016). Lactation management: Strategies for working with African-American moms. Praeclarus Press.
Brown Brené. (2022). In Atlas of the heart: Mapping meaningful connection and the language of human experience (p. 265). essay, Random House Large Print.
Chiang, K. V., Li, R., Anstey, E. H., & Perrine, C. G. (2021). Racial and ethnic disparities in breastfeeding initiation ─ United States, 2019. MMWR. Morbidity and Mortality Weekly Report, 70(21), 769–774. https://doi.org/10.15585/mmwr.mm7021a1
Ely, D., & Driscoll, A. (2021). Infant mortality in the United States, 2019: Data from the period linked birth/infant death file. National Vital Statistics Reports, 70(14). https://doi.org/10.15620/cdc:111053
Jones, K. M., Power, M. L., Queenan, J. T., & Schulkin, J. (2015). Racial and ethnic disparities in breastfeeding. Breastfeeding Medicine, 10(4), 186–196. https://doi.org/10.1089/bfm.2014.0152
Scholarship programs and opportunities for lactation care providers. USLCA. (2021, September 17). Retrieved August 13, 2022, from https://uslca.org/scholarship-programs-and-opportunities-for-lactation-care-providers/