How Systemic Racism Contributes to Less Breastfeeding Amongst Black Mothers

For as long as the U.S. government has collected data on breastfeeding rates, there’s been a significant racial disparity.

In 2019, researchers from the Centers for Disease Control and Prevention (CDC) looked at data from the National Immunization Survey-Child relating to mothers who gave birth in 2015, and found that. overall, 83% of U.S. mothers breastfed their babies at birth. But when the researchers broke the numbers down by race, they found that 85% of white mothers said they breastfed, while only 69% of Black mothers did.

A new study from the University of Pennsylvania School of Nursing, published in The Journal of Perinatal and Neonatal Nursing, identifies the best strategies and practices to improve breastfeeding in the Black community.

Insight from subject matter experts (SMEs) was compared to focus group data with Black mothers, who identified factors that both helped and hindered breastfeeding initiation.

Implicit Racial Bias

Due to implicit bias, there's a widespread belief that Black mothers prefer bottle feeding over breastfeeding. The Penn Nursing paper confirms this, discussing research that has shown that Black moms in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are less likely to receive breastfeeding counseling than white mothers in the same program.

Co-author of the Penn Nursing study, Diane L. Spatz, PhD, RN-BC, FAAN, professor of perinatal nursing and Helen M. Shearer term professor of nutrition at Penn Nursing, says that some medical providers make assumptions about patients’ interest in breastfeeding based on their race, ethnicity, and income. This can mean Black mothers are less likely to receive resources for breastfeeding.

Spatz adds that Black patients may not have grown up in a community where breastfeeding was a common practice, and may not have been informed of the health benefits of breastfeeding, compared to using formula.

"One cannot ignore the systemic racism in health care or the fact that formula companies targeted African American women," she says. "Health care providers do not give African American families a fair chance. If you were not breastfed and none of your family members ever were, how do you know this is something you can do?"

Talking About Breastfeeding

"We need to talk about breastfeeding all the time," Spatz says. "It should be in middle school and high school curriculums, it should be discussed at every prenatal appointment, and all families should be given equal information and resources."

Jessica Madden, MD, board-certified pediatrician and neonatologist, International Board Certified Lactation Consultant (IBCLC) and medical director of Aeroflow Breastpumps, agrees. "Children should be educated about the benefits and basics of breastfeeding and breastmilk at a young age," she says.

Madden adds, "This will help them to understand how breastfeeding works and the importance of supporting breastfeeding mothers well before they become parents themselves. It’s especially important for males to receive breastfeeding education, so that they can support their partners who are breastfeeding."

International board certified lactation consultant Leigh Anne O’Connor, IBCLC, LCCE, says there is inherent racial bias in the birthing world, period. "Birth impacts breast-feeding and the racial bias leads to complications in birth and lowered breastfeeding rates," she says.

As a lactation consultant, she has supported many Black people who are the first in their family to breastfeed in generations. "I suggest they create a plan and tell everyone in their immediate circle that they are breastfeeding and would like their support," she explains. "If there are people who are unsupportive, I encourage people to set limits on these people and redirect their often good intentions."

"Representation is important," adds Madden. "Images of people of color breastfeeding in the media would be helpful."

Investing in Healthcare Providers For Black Moms and Babies

The majority of doulas, lactation consultants, and other specialists trained to help mothers navigate pregnancy and breastfeeding in the U.S. are white, says Madden. "There are not enough Black birth and postpartum specialists, or lactation consultants, to support black women through pregnancy, labor and delivery, breastfeeding, and the postpartum period," she says.

"We need to invest in the training of Black doulas, lactation consultants, postpartum care specialists, and health care providers for Black mothers and babies," she says.

This is being done on a local/regional level in certain cities, such as Cleveland, Ohio, with the creation of both Birthing Beautiful Communities and First Year Cleveland. But it needs to be a nationwide effort.

Political Change

The long, complicated history of disparity in breastfeeding rates in the Black community involves issues relating to the workplace. "Many Black women work in industries that do not allow for paid time off, no mandated maternity leave, or a living wage where one may have to work more than one job," O'Connor says. "It's hard to breastfeed without appropriate accommodations."

For lasting political, advocacy efforts to revamp Family and Medical Leave Act (FMLA) and maternity leave policies need to be increased, Dr. Madden adds.

"Ideally, all mothers should be offered 3-6 months of fully paid maternity leave, no matter where they are employed and regardless of whether they work part-time or full-time," she says. "A large percentage of Black mothers are single moms, and therefore have to work outside of the home to support their families. When working mothers have short maternity leaves (or no maternity leave at all), it can be nearly impossible to breastfeed without a lot of support."