Black women have some of the lowest rates of breast-feeding. One midwife found some surprising reasons why that might be so.

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By Rose Hoban

As certified nurse-midwife Stephanie Devane-Johnson works with her patients in Greensboro, she talks to them about a lot of health issues. But for her pregnant clients, one of the biggest topics is breast-feeding.

Stephanie Devane-Johnson headshot
Stephanie Devane-Johnson. Photo courtesy Central Carolina OB/GYN

“I’m asking about whether they’re going to breast-feed or bottle-feed,” Devane-Johnson said. “If they say they’re going to bottle feed, I say, “What about breast-feeding?’’

But to her frustration, for many black women breast-feeding their babies isn’t the first option.

National data show that only about 59 percent of black women breast-feed, compared to 79 percent of whites and 80 percent of Hispanic women. In North Carolina, those rates are even lower: Only about 44 percent of black mothers breast-feed.

This led Devane-Johnson to explore why more black women aren’t breast-feeding.

Some of the answers she found were surprising: The echoes of slave women being forced to give up their milk still resounded. And black women didn’t talk to their sisters, daughters and granddaughters about how to feed their babies; the bottle was just assumed.

And for some women, breast-feeding was a “white thing.”

Enduring taboos

As part of her research for a doctoral degree at the UNC-Chapel Hill School of Nursing, Devane-Johnson held focus groups to ask black women about breast-feeding. She presented her research at the annual UNC-Chapel Hill Minority Health Conference, held in February at the Friday Center in Chapel Hill.

A Civil War era print of an African American wet nurse.
A Civil War-era print of an African-American wet nurse.

Devane-Johnson described how she recruited 39 women ranging in age from 18 to 89 years old and asked them what conversations they’d had with family members.

Turns out, many hadn’t had conversations at all.

“In the formula-feeding group, it was just assumed,” she said.

She said some women who had breast-fed said it was a topic that couldn’t be addressed in their families.

“If they did breast-feed, they didn’t breast-feed at, say, their aunt’s house, [because] they would tell them, ‘You can’t do that in my house. Breast-feeding is nasty,’” Devane-Johnson said. “You don’t talk about ‘boobies,’ because breasts are sometimes seen as sexual and not as functional.”

And then there was the enduring legacy of slavery.

“There were some older black women who wanted to disassociate themselves from the past, from slavery and the wet-nursing,” she said, explaining that often young slave women were impressed into giving their milk to white infants.

[pullquote_right]”Grew up thinking breast-feeding was a white thing.” – focus group participant[/pullquote_right]“That image of a ‘mammy’ when people would say that,” reads one of the quotes Devane-Johnson collected from her focus groups. “It did conjure up those pictures of the women feeding the white babies and all that.”

And the cultural memory had been passed down even to younger women.

“It really was amazing…. In my 18-to-29-year-old breast-feeding group, there was a young lady in there who said, ‘Yeah, the white men used to steal the slaves’ milk,’” she said.

Devane-Johnson explained that often slave women had to be away from their own children, at the cost of their own children’s lives.

An African American wet nurse, probably post-Civil War.
An African-American wet nurse, probably post-Civil War. Photo courtesy Maryland Historical Society

“A lot of slave babies died during slavery because they weren’t breast-fed. They were fed concoctions of dirty water and cows milk,” she said. Meanwhile, those children’s mothers were giving white children their milk.

And women reported that oral histories have been reinforced by modern technology.

“These pictures are all on social media,” Devane-Johnson said. “Then someone gets pregnant and people talk about breast-feeding. They’ll say, ‘You don’t have to do that anymore.’”

Teaching for change

There are also societal, economic and practical barriers to breast-feeding, Devane-Johnson said, things she’s working with her patients to change.

For starters, breast-feeding isn’t exactly easy, especially at first.

“When you have a sleep-deprived mom trying to breast-feed at three o’clock in the morning, and a matriarch at home is saying, ‘Get that out of that baby’s mouth and get that baby a bottle,’ it’s very enticing,” she said.

[pullquote_left]”There was an empowerment in being able to choose that bottle and not say I’m going to be sitting here with the baby attached to me.” – focus group participant[/pullquote_left]Breast-feeding also can be something of a class issue, Devane-Johnson said. For some women, using formula was “empowering.”

“If you’re raised in your thought process, ‘I have a job, I can afford to formula-feed,’ to them breast-feeding is associated with being poor,” she said. “To some black women. Not to all, but to some.”

And using formula means a woman doesn’t have to be “tied down” to their baby.

Devane-Johnson said part of the solution is teaching women about how much healthier breast-fed babies are: Research shows they have lower rates of obesity, fewer colds and lower rates of diabetes later in life.

But there are also workplace barriers to breast-feeding. She said women need coaching to ask their supervisors about accommodations, which are required by state and federal law.

Marva Price, a black nurse who spent years teaching women to breast-feed, discussed how she’s helped women approach that discussion.

“They have to ask for that – if they can take time away,” Price said. “Can they take time away, can they even pump in their work space or go someplace and have a clean place, even a storeroom?”

She said that over the years she’s worked with patients to help them figure out what to do and how to negotiate with their bosses. Then there are logistical issues: a refrigerator to store the milk, a place to store the pump, a quiet, out-of-the-way place to pump.

“It takes a lot of support,” Price said.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...