Systemic barriers to breastfeeding in the Black community
This Black History Month and every month, we aim to raise awareness of the systemic injustices aimed at Black lactating parents, actively reframe the Black breastfeeding narrative by centering Black breastfeeding joy, and advocate for policies and organizations like Chocolate Milk Cafe that support the Black lactating community.
Offering peer-to-peer support for Black lactating parents, Chocolate Milk Cafe creates “sacred space where families that are part of the African Diaspora can be supported and empowered to breastfeed and provide human milk to their children.” We interviewed LaShanda Dandrich, IBCLC and Chocolate Milk Cafe’s Director of Facilitators, for her expert insight on providing Black families the care they deserve.
The consequences of breastfeeding inequity
In the U.S., Black parents still face the greatest barriers to breastfeeding: According to the available statistics, only 73.6% of Black parents start out breastfeeding. At six months, more white infants (26.9%) were exclusively breastfed in comparison to their Black (19.1%) and Hispanic (23.5%) counterparts. While it’s important to acknowledge this disparity, Dandrich stressed that focusing only on these numbers can reinforce the false narrative that Black people do not breastfeed — and thereby reinforce negative health outcomes, poor medical treatment, economic inequality, and generational trauma. “If you just keep spitting out these numbers, you’re making people believe [Black people] just don’t want to breastfeed. And that’s not true. We are doing it, but we just need the support to do it and to continue doing it.” Instead, Dandrich added, “let’s talk about [Black breastfeeding] joy and celebrate it.”
In the spirit of reframing the Black breastfeeding narrative and orienting our discussion towards solutions, Dandrich explained how low breastfeeding rates in Black communities contribute to poor Black maternal health outcomes, along with devastating consequences for Black infants. According to the ACLU, Black people experience both the highest maternal mortality rate and the highest infant mortality rate. Furthermore, relative to white women, women of color have increased rates of obesity, diabetes, and cardiovascular disease — all conditions that could be alleviated or even prevented by breastfeeding. “Let’s talk about those statistics, right?” Dandrich emphasized. “Childhood obesity is increasing. Asthma, type 2 diabetes … What helps with that? Breastfeeding.”
Systemic reasons for low breastfeeding rates
Breastfeeding obstacles reported by people of color include “lack of social, work, and cultural support,” as well as “lack of maternal access to information that promotes and supports breastfeeding.” Per the ACLU, “forty-five percent of Baby-Friendly Hospitals — those that have adopted a set of policies to ensure that their facilities are supportive of breastfeeding — are concentrated in cities where Black people comprise 3 percent or less of the population.” Furthermore, “Hospitals in communities with an above-average Black population are significantly less likely to promote nursing than hospitals located in other neighborhoods. Black women are also more likely to experience in-hospital formula introduction, which is associated with lowered breastfeeding rates.”
These inadequate efforts to support health outcomes in Black communities are rooted in America’s history. During and after slavery in the U.S., Black lactating parents were forced to be wet nurses for white babies, often preventing them from feeding their own children — at a disastrous cost. Torn from their infants, Black people were cruelly and wrongfully labeled neglectful parents. Breastfeeding became associated with a lack of Black freedom, and not long after slavery, some formula companies capitalized on this trauma. Alongside aggressive formula marketing tactics, Black breastfeeding was exoticized in magazines and other media. Today, these stereotypes are so deeply ingrained in American culture and the American health care system that Black parents are still pushed away from breastfeeding.
“First, I think — just in general, as an American society; Black, white, whatever — that we don’t support breastfeeding,” Dandrich said. Quoting a metaphor often used by Chocolate Milk Cafe, she added, “If the system has a cold, the people of color in that system are going to have the flu.” So if the lactation care system is broken — and it is — marginalized people are the most affected.
Dandrich, a former medical provider, herself, also cited the fact that “Black” is still listed as a risk factor for not breastfeeding in medical textbooks. “That training is passed down from generation to generation … and we know how busy nurses and doctors are. So why would I [as a doctor or in-hospital lactation consultant] expend energy on someone who I’ve been taught is not going to breastfeed anyway?”
In addition to insufficient healthcare and lactation education, coupled with a lack of family and social support, Black parents also face significant employment pressures. 70.7% of Black women are the sole breadwinner in their families. That means Black parents need to go back to work sooner after birth, often to jobs that provide little or no parental flexibility or pumping support. Per the ACLU, “Although provisions of the Patient Protection and Affordable Care Act (ACA) require employers to provide break time and a private location to nurse, many employers fail to comply with this mandate. This is particularly true in low-wage jobs, of which a disproportionate number of workers are Black women, trans people, and non-binary folk.” And many Black people who have raised the issue of lactation accommodations to their employers have faced “reduced work hours, demotion, job loss, and public shaming or harassment in the workplace.”
How can we foster better health outcomes in Black communities?
The first step is raising awareness about the oppressions at play, and not mistaking Black parents’ response to systemic injustice as personal preference. We need to support and promote policies — like extended Medicaid across all 50 states — and organizations that specifically aim to improve health outcomes for Black people. Chocolate Milk Cafe is one such organization: They recently became a 501(c)(3) non-profit organization and rely on donations to sustain their important work. Dandrich also recommends community initiatives like ROSE (Reaching Out Sisters Everywhere), and BMBFA (Black Mothers Breastfeeding Association) to Black lactating parents. And because we need to extend lactation education not just to Black communities, but also to the medical providers who serve them, Dandrich suggests Irth App, a maternal health review app for Black and brown parents created by Kimberly Seals Allers. Beyond all of that, we desperately need Black representation among lactation consultants.
Black lactating parents deserve care from experts who understand their unique experiences, but per the American Psychological Association and NIH, “Most doulas [and International Board Certified Lactation Consultants] are white, middle-class women.” Dandrich explained that there are three pathways towards becoming an IBCLC. “Chocolate Milk Cafe is a pathway one,” she said. In addition to providing peer-to-peer lactation care, they “help Black people become IBCLCs.” Often, pathways require a paid mentorship from an IBCLC, which can be expensive for any aspiring lactation consultant, and cost-prohibitive for many Black lactation consultants. But Dandrich offers her expertise free of charge. “I never charge [for my mentorship],” Dandrich said. “I know other IBCLCs probably charge, but that’s another barrier our community doesn’t need.”
It makes sense that the same systemic barriers impacting lactation health care in the Black community also prevent many Black people from pursuing an IBCLC certification. So just like equity-based programs like The Lactation Network Fund seek to do, it is imperative that we acknowledge those barriers, remove them where we can, and create safe, mutually encouraging spaces for Black IBCLCs and Black parents alike.
We’re here for you, every step of the way. We work with your insurance to provide in-home, in-office, or telehealth visits with an IBCLC.
