Racism and Racial Trauma are Barrier to Breastfeeding, Study Reveals

Breastfeeding rates in the U.S. have risen over the last 25 years, but Black mothers continue to have the lowest breastfeeding rates. In 2019, researchers from the Centers for Disease Control and Prevention (CDC) found that only 69% of Black mothers breastfeed, compared to 85% of white mothers. This issue is examined in a special issue of the peer-reviewed journal Breastfeeding Medicine. 

In the article "Reimagining Racial Trauma as a Barrier to Breastfeeding Versus Childhood Trauma and Depression among African American Mothers," Maria Muzik, MD, and her colleagues from Michigan Medicine examine the relationship between several maternal risk factors (such as demographic risk, history of childhood trauma, postpartum depression, and lack of social support) and breastfeeding status at six months postpartum.

“Given the preexisting data on low breastfeeding rates among African American mothers, we also examined racial differences in breastfeeding outcomes,” says Dr. Muzik. “We found that African American mothers had reduced rates of breastfeeding at six months above and beyond all the other risk factors in the model, which suggests that African American mothers in our study uniquely experience societal and personal circumstances that contribute to their lower breastfeeding.” 

Racism and Breastfeeding

“It is well established that negative impacts of racism operate at multiple levels to shape public health behaviors and outcomes,” says the study's author Angela Johnson, PhD.  

These include systemic or structural racism that is reflected in workplace policy and practice, lack of access to higher education, discriminatory housing policy, and biased healthcare. For instance, Black mothers in the U.S. are more likely to experience a workplace that is unsupportive of breastfeeding.

Johnson also points out that on average, Black mothers return to work at eight weeks postpartum, which is earlier than women from other racial and ethnic groups. And once they return to work, Black moms are more likely to encounter less flexible work conditions. 

And then there’s the social, historical, and cultural context of breastfeeding for Black women.

“The legacy of slavery has left an indelible mark for hundreds of years,” Johnson says. “Enslaved Black women were forced to breastfeed their masters' babies and forbidden to breastfeed their own.”

Other factors include inadequate access to breastfeeding resources, a lack of breastfeeding role models, the dominance of law enforcement violence against Black families, and mass incarceration with disproportionately imprisoned Black men and women.

"Discrimination increases the volume of stress a person experiences, so Black people are particularly vulnerable to its adverse health impact in its various forms," Johnson says.

Supporting Breastfeeding Among Black Women  

"A multi-systems approach is required to effectively support breastfeeding among Black women," says Johnson. "Interventions must operate at various levels of the social ecological system."

Firstly, it's critical that policies provides paid family leave and workplace flexibility with time and space to pump. Lactation support and community-based breastfeeding advocacy and support programs and services are also vital, Johnson adds.

Secondly, breastfeeding promotion must also occur at multiple points in time to help ensure that mothers can both confidently initiate and maintain breastfeeding. "Community breastfeeding support will include family, personal and professional networks, employers, healthcare providers, faith-based support, breastfeeding peers, and other stakeholders who engage regularly with Black mothers," Johnson says.

Finally, it's important to address breastfeeding self-efficacy, i.e., a mother's confidence in her ability to breastfeed her infant. "Enhancing self-efficacy may be particularly important for Black women, as a critical tool for managing daily life stressors due to individual and systemic racism and discrimination," Johnson says.