By Rachel Crumpler
Love Anderson, a Durham resident, gave birth to her first son 11 years ago. At the time, she didn’t know much about breastfeeding but remembered wanting to do it after reading in a parenting magazine that it supports child development. She thought that sounded important for her new baby who was born with special needs.
However, at the hospital, the doctor pushed for her to use formula while looking at her health forms, which noted she was Black. But when he looked up and saw her light-skinned face and her white husband, Love said his tone started to shift and he provided more supportive advice about breastfeeding.
That moment has stayed with Anderson, and she’s repeatedly heard similar stories from other Black moms.
Maternity care facilities in areas with larger Black populations are less likely to offer lactation support following delivery, according to a study released in 2019 by the Centers for Disease Control and Prevention. Black infants are also more likely to receive formula without a medical indication than white infants, the study found.
Breastfeeding often doesn’t come easily for new mothers and that was the case for Love. After all, it’s a new physical skill and takes time to figure out.
Love sought peer support from other nursing mothers for additional guidance and she remembers attending her first meeting and seeing few parents that looked like her or had common lived experiences.
“I noticed that everybody else in the meeting all had pink nipples and my nipples are brown,” Anderson said. “Their breasts didn’t look like mine.”
Her breastfeeding experience moved her to volunteer in the field of lactation support. She also became a community advocate working with Breastfeed Durham and other organizations to foster a more breastfeeding- and family-friendly environment. She envisions a world where the very first need of every child — to be fed at the breast by the person who birthed them — is able to be met.
It’s an ambitious goal with a long way left to go.
Push for improved breastfeeding rates
Improving breastfeeding rates is a national goal — one emphasized this year by the widespread infant formula shortage that left many families in a panic about how to feed their children while store shelves sat bare for months.
Healthy People 2030, a set of data-driven national objectives designed to improve health and well-being, targets increasing the proportion of infants who are breastfed exclusively through six months of age from 24.9 percent to 42.4 percent before the next decade. It also targets increasing the proportion of infants who are at least partially breastfed at 1 year from 35.9 percent to 54.1 percent.
In the United States, Black infants have the lowest breastfeeding initiation rates of any racial group at 74.1 percent, according to the CDC. The national average is 83.2 percent with Asian infants having the highest rate of initiating breastfeeding at 90.8 percent.
On average, Black women also breastfeed for the shortest period of time, compared to other racial groups.
In June, The American Academy of Pediatrics released an updated policy statement that recommended exclusive breastfeeding of infants for the first six months before introducing nutritious complementary foods and noted the continued benefits to breastfeeding beyond one year.
Research has shown that infants who are breastfed have reduced risks of asthma, obesity, Type 1 diabetes, lower respiratory tract infections, severe diarrhea, ear infections and sudden infant death syndrome. Breastfeeding can also help lower the mother’s risk of high blood pressure, Type 2 diabetes and both ovarian and breast cancer.
Despite the demonstrated benefits, breastfeeding rates have only crept up over the past decade. Only about one in four women in the United States exclusively breastfeed to the recommended six months. In North Carolina, only 22.1 percent of infants born in 2019 were exclusively breastfed to the six-month mark, slightly worse than the national average.
The CDC study notes Black women “disproportionately experience a number of barriers to breastfeeding.”
“The reality is that families face a lot of barriers and these are not individual,” said Olivia Rice, a breastfeeding mother of three and co-founder of the Black breastfeeding peer support group Chocolate Milk of Wilmington. “There are systemic barriers.”
Breastfeeding stigma reaches far back
Part of the reason for consistently lower breastfeeding rates among Black women stems from the legacy of slavery when enslaved Black women were forced to breastfeed their owner’s children at the expense of their own.
“That stigma and shame that came down from those experiences became generational,” said Maya Jackson, founder of Mobilizing African American Mothers through Empowerment (MAAME), a nonprofit, community-based organization that empowers Black, Indigenous and other birthing people of color to navigate health systems.
The demands of slave labor also prevented Black mothers from nursing their children. With generations being stripped of the ability to breastfeed, many Black folks today do not have relatives with breastfeeding experience.
Jackson, a Black mother of four, was the first in her family to breastfeed in two generations. With her first child, she breastfed for about eight months — a major milestone, especially in her community.
Rice said the majority of mothers who come to Chocolate Milk of Wilmington meetings are the first in their family to breastfeed. The decision can come with judgment.
In the Black community in particular, Rice said breasts are seen as a sexual object, not a feeding tool. Additionally, there can be guilt from relatives saying “Wasn’t formula good enough for you? It’s good enough for the baby.”
Targeted marketing of formula to Black mothers in the late 20th century led many to believe formula was just as healthy, or even healthier, than breast milk. For example, Pet Milk’s marketing campaign featuring identical Black quadruplets from Reidsville, North Carolina, generated high profits as Black women opted to purchase formula over breastfeeding, explains Andrea Freeman in her book Skimmed: Breastfeeding, Race and Injustice.
“My grandmother grew up in a generation in which Pet Milk and other infant formulas were being targeted, particularly at Black women, to force them to go back to work quickly,” Jackson said.
Rice said formula is still often assumed to be a Black mother’s feeding choice. Research in Pediatrics found Black infants are nine times more likely than white infants to receive infant formula while in the newborn nursery. Rice was formula-fed as a baby, but she decided to breastfeed her children.
There was a lot she didn’t know.
Lack of knowledge
From the start, many women are at a disadvantage in terms of breastfeeding success because they are not often educated on it. The lack of knowledge is steeper when individuals don’t have relatives or friends that have breastfed so they may not even consider breastfeeding as an option.
Rice went to a 10-day prenatal class when she was pregnant with her first child. Essentially all of the class was on labor and delivery with little focus on infant feeding. It’s an education imbalance, Rice argued. Labor and delivery is just hours of time, compared to the months and years parents will be addressing feeding.
Rice, now an International Board Certified Lactation Consultant (IBCLC), said many women come to her with the most basic questions that should be common knowledge yet it isn’t. The education gap is a fundamental issue that doesn’t set people up for breastfeeding success.
“You think everything’s wrong, and that your body isn’t working,” Rice said. “Most of the people I work with, they don’t have a lot of trust in their bodies to begin with. How are they going to support a baby, like solely on their body, when they don’t have a lot of faith or trust in that to begin with?”
Jackson, a trained doula, said she and the other doulas at MAAME do a lot of pre-planning to develop feeding plans for families before they give birth. She said everyone’s plan is different based on lifestyle, time off from work, availability of breastfeeding facilities at a workplace and other factors.
She also said there should not be judgment if a family does not make it to the recommended six months of exclusive breastfeeding.
For example, Jackson said while she was breastfeeding, she had people fussing at her because she had to supplement with formula since she was working two jobs and couldn’t maintain a pumping routine that was healthy for her.
She found the critique unhelpful. That’s why Jackson said it’s all about finding a feeding plan that best supports the nourishment of the child and the mental health of the mother.
“We have to just start looking at everybody as individuals and in a lot of these cases, it’s really finding out what works best for them to ensure that they have a healthy outcome overall,” Jackson said.
National Statistics About Breastfeeding
- Fewer non-Hispanic Black infants (74.1%) are ever breastfed compared with Asian infants (90.8%), non-Hispanic White infants (85.3%) and Hispanic infants (83.0%).
- Infants eligible for and receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are less likely to ever be breastfed (74.7%) than infants eligible, but not receiving WIC (85.6%), and infants ineligible for WIC (91.2%)
- Younger mothers aged 20 to 29 years are less likely to ever breastfeed (79.9%) than mothers aged 30 years or older (84.9%).
*Statistics from the CDC
Lack of diversity in lactation field
When breastfeeding challenges arise, one source of help are lactation consultants, which have specialized training to help parents and infants with milk supply issues and breastfeeding positions. Some lactation consultants work with hospitals and birthing centers, while others work in private practices.
Janiya Mitnaul Williams attended an online lactation consultant training program where there was just one other person of color in her cohort. After becoming certified as an IBCLC in 2015, Williams became the first consultant of color to be hired in the Cone Health system who was also not a registered nurse.
It can be hard to break into the field, said TaHysha McClain, director of Johnson C. Smith University’s lactation consultant training program. Cost and access to clinical hours are common barriers. She faced those issues herself when she started working to become a lactation consultant in 2010, eventually finding an online program like Williams.
When she got certified in 2019, she remembers being just the third or fourth Black IBCLC in the state.
“One of the barriers in the lactation profession is that people respond more if they look like them, talk like them, when they feel like they relate and have a relationship, and when it comes to lactation there’s very few women of color,” McClain said.
The majority of lactation consultants, an estimated 70.6 percent, are white. Comparatively, about 10.1 percent are Black and 8.9 percent are Latina.
Representation matters for Black families seeking breastfeeding help, Williams said. She calls it the “mirror, mirror effect” where she can walk into a room and is able to connect with Black patients on a different level, putting them at ease.
About three years after Williams’ hiring, she looked around and realized she was still the only Black lactation consultant. That was unacceptable to her and Williams decided to do something about it.
Williams approached her alma mater North Carolina Agricultural & Technical State University — the largest public HBCU in the nation — about starting a Human Lactation Pathways 2 program to train more Black lactation consultants.
NC A&T’s program launched in 2020 with Williams as the director, just a year after Charlotte’s Johnson C. Smith University started its own program with the same goal. The two programs are the only two lactation certificate programs in the country currently housed at HBCUs, and they are already making a difference with new Black lactation consultants entering the profession. To date, the two programs combined have added over 20 lactation consultants to the profession who are currently serving patients.
Increasing diversity in the lactation field will help boost Black breastfeeding rates, Williams said.
Additional support needed
Many breastfeeding issues do not require the help of lactation consultants, and breastfeeding mothers have turned to peer support groups that have emerged in most communities for needed guidance.
For Anderson, breastfeeding outcomes hinge on support — support from partners, physicians and peers.
Greater societal supports such as paid family leave and more workplace accommodations for breastfeeding are also essential to increase breastfeeding rates, Jackson said.
For example, Jackson said she was able to be an extended nurser with her younger children, breastfeeding them to age 4. However, she said that was only possible because the coronavirus pandemic kept her home longer, emphasizing how a return to work often pushes mothers to stop breastfeeding.
“We should all be able to feed our babies the way we want to feed our babies,” Anderson said. “If that’s breastfeeding, you should be able to access the tools and support to be able to make that happen.”