Breastfeeding. A topic more controversial than it needs to be. A beautifully necessary activity to nourish and grow human life. A biological advantage mothers have for providing food for their young. Yet, here we are, in August 2020 for National Breastfeeding Month and not much has changed regarding the stigma social abhorrence of breastfeeding in public, the cultural barriers to breastfeeding among Black women, and the lack of support for breastfeeding in the Black community. It is my hope, that through consistent evidence-based education, persistent advocacy, and policy change that we can eliminate the barriers that drive breastfeeding disparities in Black women and knock down the wall that stigmatizes breastfeeding around others. Let’s dive in and explore possible ways to accomplish this.

Breastfeeding in Modern Terms

So, what is breastfeeding? Breastfeeding has long been described as feeding an infant or toddler with milk directly from their mother’s breast and at their mother’s breast (Rasmussen et al., 2017). During In more recent years, because of technological advances, breastfeeding can be a multitude of actions that result in an infant or toddler drinking milk that was removed from their mother’s breast or from another woman’s breast (Rasmussen et al., 2017). This milk can be fresh, stored in the refrigerator for no more than 3 days, or thawed from being frozen for a while. Breastfeeding can also constitute a mixture of spoon-feeding breastmilk, tube feeding, and bottle feeding (Rasmussen et al., 2017). These alternate ways of providing breast milk for an infant or toddler should the child have trouble latching at the breast or if the child is drinking the breast milk of another lactating woman. The ability to lactate is an important fact that you should hold onto as you read further. It will be extremely important when we discuss enslaved wet nurses, as most women are only able to lactate if they have been pregnant and given birth. Induced lactation is possible but largely depends on the successful replication of a complicated hormonal process involving the hormones estrogen, progesterone, and human placental lactogen (LaFleur, 2019).

The Science of Breastfeeding

So, what is the biology of breastfeeding? To mitigate any confusion and make this section a bit shorter, I’ve outlined the science of breastfeeding in the graphic below.

Benefits of Breastfeeding

So, why is breastfeeding so important for infants and toddlers? Breastfeeding has many benefits. Benefits that are linked to improved nutrition, higher IQ scores, emotional maturity, lowered risk of SIDS (sudden infant death syndrome), and lowered risk of developing several comorbidities that manifest later in life (Brennan, 2019).

Disparity in Breastfeeding Rates Among Black Women

According to a 2015 study by Beauregard et al., 69.4% of Black infants initiated breastfeeding, while 85.9% of white infants did. Likewise, Black infants had a significantly lower rate of any breastfeeding at 3 months of age at 58.0% versus white infants at 72.7% (Beauregard et al., 2019). Rates were also significantly lower for Black infants than white infants at 6 months of age. So, why the disparity? Why is it harder for Black women to initiate and continue breastfeeding? A few factors related to racism, the social determinants of health, the historical context of Black women being forced to nurse white enslavers children during antebellum slavery, and societal stigma.

1) Racism in healthcare is so rampant that it even bleeds into maternal and child health. Black women have reported not even being asked if they wanted to breastfeed and were dismissed to formula feeding when they inquired about options. Some even see breastfeeding as something associated lower socioeconomic status (Editor, 2016).

2) According to the Beauregard et al. 2015 study, Black women were more likely to have lower income employment (Beauregard et al., 2019). This severely inhibits a mother’s opportunities for breastfeeding, as low-income jobs likely do not have maternity benefits that allow for maternity leave, using a breast pump at work, etc.

3) The stains of slavery still remain. Enslaved Black women were forced to act as a wet nurse for their enslavers’ children at the expense of their own (Editor, 2016) (West & Knight, 2017). Black slaves were forced to wean their own children for the benefit of their master’s, while enslavers were given a “Breastfeeding Manual for Slaves” (Hammond, 1857-1858).

4) Black women still face societal stigmas around breastfeeding. Many Black families view the act as taboo and still believe the myth that breasts are sexual instead of functional (Editor, 2016). With a lack of social support, it makes it harder for Black women to even entertain engaging in the act.

Solutions for Advancing Breastfeeding Equity

So, what can be done about the disparities in breastfeeding rates among Black and white women and the drivers of those disparities? It is my educated opinion, that policy reform, on all levels, must occur in order to advance breastfeeding equity.

1) Healthcare systems must require lactation nurses and lactation education be provided for free to all pregnant mothers leading up to and after delivery.

2) Insurance providers must be required to fully reimburse these services.

3) Employers and insurers must be required to expand maternity leave to at least 9 months with breastfeeding friendly offices available upon the return of the mother.

4) Public Health institutions and organizations must work to develop community-based participatory programming that breaks down the societal, cultural, and familial stigmas associated with breastfeeding.

5) Public places (restaurants, grocery stores, malls, retail stores, etc.) could do more to provide women with designated, clean, sanitary, and comfortable breastfeeding areas.

Yes, these ideas seem radical. Yes, they will require funding and an abundance of support, buy-in, and advocacy. Yes, we may never see these changes in our lifetimes. But, I believe we can keep fighting for the reformation of breastfeeding policies and stigmas for the betterment of the moms that come after us. I believe we can win.

-Sarabi

References:

Beauregard, J. L., Hamner, H. C., Chen, J., Avila-Rodriguez, W., Elam-Evans, L. D., & Perrine, C. G. (2019, August 29). Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/68/wr/mm6834a3.htm.

Brennan, D. (2019, December 10). The Benefits of Breastfeeding for Both Mother and Baby. WebMD. https://www.webmd.com/parenting/baby/nursing-basics.

Editor, N. C. H. N. M. 3. (2016, March 3). Distant Echoes of Slavery Affect Breast-feeding Attitudes of Black Women. North Carolina Health News. https://www.northcarolinahealthnews.org/2016/03/03/distant-echoes-of-slavery-affect-breastfeeding-attitudes-in-black-women/.

Hammond, J. (1857). Breastfeeding Manual for Slaves. https://www.encyclopedia.com/social-sciences/educational-magazines/breastfeeding-manual-slaves.

Hammond, J. (2020, August 10). Breastfeeding Manual for Slaves. Encyclopedia.com. https://www.encyclopedia.com/social-sciences/educational-magazines/breastfeeding-manual-slaves.

How Breastfeeding Actually Works: Exploring the Science of Breast Milk Feeding. Medela. (2019, October 7). https://www.medela.com.au/breastfeeding/blog/awesome-breast-milk-facts/how-breastfeeding-actually-works-exploring-the-science-of-breast-milk-feeding.

LaFleur, E. (2019, February 9). Induced lactation: Can I breast-feed my adopted baby? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/induced-lactation/faq-20058403.

Rasmussen, K. M., Felice, J. P., O'Sullivan, E. J., Garner, C. D., & Geraghty, S. R. (2017, November 1). The Meaning of "Breastfeeding" Is Changing and So Must Our Language About It. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802247/.

West, E., & Knight, R. J. (2017, February 1). Mothers' Milk: Slavery, Wet-Nursing, and Black and White Women in the Antebellum South. Journal of Southern History. https://muse.jhu.edu/article/647289.

Why is colostrum so important? Medela. (2018, March 8). https://www.medela.com/breastfeeding/mums-journey/colostrum.

National Breastfeeding Month: Changing the Narrative for Black Women