I think it is safe to say in 2020 that the majority of the medical community sees breastfeeding as ideal for the mother/infant dyad. Research strongly supports breastfeeding as a protective measure against numerous negative health outcomes including premature death, necrotizing enterocolitis, SIDS, type 2 diabetes, cardiovascular disease, childhood cancer, obesity, breast and ovarian cancers, hypertension, postpartum depression, amongst other chronic diseases. Not only is breastfeeding protective for the breastfeeding dyad but it is incredibly beneficial for society at large. In the United States alone, suboptimal breastfeeding rates are associated with an additional 2,619 premature maternal deaths, 721 child deaths, $3 billion in medical costs, and $1.3 billion in non-medical costs annually (Bartick et al., 2016b).
For these reasons, the World Health Organization recommends exclusive breastfeeding for the first 6 months of life and continued breastfeeding with complementary foods until 2 years or beyond. And yet, US breastfeeding rates tell a story of inaccessibility. According to the CDC, in 2017, 84% of all infants in the US initiated breastfeeding but only 26% of infants were still exclusively breastfed at 6 months. And shockingly 60% of mothers report they did not breastfeed as long as they intended (CDC, 2019). So, the question remains- how do we remedy these numbers to meet the WHO recommendations?
But before we brainstorm solutions, we have to also look at the statistics that account for race. In 2015, only 69% of Black infants initiated breastfeeding compared to the 86% of White infants (Beauregard et al., 2019). Looking at breastfeeding rates at 3 months, the CDC found a 14.7% difference in breastfeeding rates comparing White infants to Black infants. And when looking at 12 month breastfeeding rates, another research study found that 17.1% of Black women were breastfeeding at one year compared to 30.8% of White women (Griswold et al., 2018). These statistics are frightening when we consider the added risk involved in not breastfeeding. And while the data is still lacking, another study found that when looking at the professional lactation field, 87% of Internationally Board-Certified Lactation Consultants (IBCLC’s) were White compared to only 1.6% of non-Hispanic Black IBCLC’s (Johnson et al., 2016).
Ultimately, while meeting the WHO recommendations for breastfeeding seems to be difficult for a large number of breastfeeding parents, it is clear that there are additional significant racial disparities causing concerning inequities. Are we disillusioned to think the breastfeeding recommendations are achievable? I don’t think so, but we have a lot of work to do.
As an IBCLC and having reviewed the research long before having kids of my own, I knew that I wanted to breastfeed for as long as I could. I naively expected breastfeeding to come easy. Instead, I spent many months troubleshooting bursts of mastitis, thrush, pain related to latch issues, postpartum depression, milk supply issues, and navigating the complexities of breastfeeding at work. I had to advocate for myself when my pediatrician told me that the pain was related to my hormones and time would help (when in actuality the pain was related to my son’s inability to latch correctly due to a severe tongue-tie). Yet, I was able to reach my breastfeeding goals with each of my 3 children. Because I now know the data, it must be acknowledged that I am a White, cis-gendered, partnered, middle-class woman, living in a part of Colorado where there is access to breastfeeding support. I now know that these labels carry privileges that not all breastfeeding parents have.
Looking at the data made me curious. If this was my experience, and meeting my personal breastfeeding goals was one of the hardest things I have done, what is it like for so many women without such privileges? While I struggled to breastfeed, and it took going to multiple providers to find medical breastfeeding support, I did not additionally experience discrimination because of the color of my skin. Returning to work was incredibly difficult, but I was afforded 12 full weeks of maternity leave and had a work environment that was supportive of my need for pumping breaks. Navigating post-partum depression was painful, but I did not carry the additional burden that comes from being the recipient of racism or bias. All of this makes me wonder if I would have reached my breastfeeding goals if I carried less privileges. Having worked as an IBCLC supporting breastfeeding families, I am aware that my story is not unique and that many breastfeeding parents with similar issues simply are not as well supported.
The protection and support of breastfeeding has been framed as a human rights issue. This makes equity in breastfeeding not only a matter of public health but also of social justice (Perez-Escamilla & Sellen, 2015). So, what can we do? To begin, it is critical to address the systemic and structural factors that prevent access to breastfeeding for some more than others if we want to make progress. There are policies to be made, legislation to be put in place (such as protections for breastfeeding in all workplaces and universal paid maternity leave as just a starting point), funding to be given, grants to be written, research to be done, each with their own unique role in supporting a parent’s right to breastfeed. For lactation professionals who look like me, our work must also include acknowledging our privilege, exploring ourselves for implicit bias, and listening to voices of those who do not look like us. It will take all of us. Breastfeeding equity is long overdue, and the work is critical.
“As long as poverty, injustice and gross inequality exist in our world, none of us can truly rest.” -Nelson Mandela
To learn more about racial disparities in breastfeeding, and some of the work being done, visit the following:
2018 Breastfeeding Report Card. (2019). Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/data/reportcard.htm
Beauregard, J. L., Hamner, H. C., Jian, C., Avila-Rodriguez, W., & Elam-Evans, L. D. (2019). Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015. Morbidity and Mortality Weekly Report, 68(34), 745-748. https://search-proquest-com.unco.idm.oclc.org/docview/2283917391/fulltext/4B9668116EA840BAPQ/1?accountid=12832
Griswold, M. K., Crawford, S. L., Perry, D. J., Person, S. D., Rosenberg, L., Cozier, Y. C., & Palmer, J. R. (2018). Experiences of Racism and Breastfeeding Initiation and Duration Among First-Time Mothers of the Black Women’s Health Study. Journal of Racial and Ethnic Health Disparities, 5(6), 1180.
Johnson, A. M., Kirk, R., Rooks, A. J., & Muzik, M. (2016). Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers. Maternal and Child Health Journal, 20(S1), 92-102. https://doi.org/10.1007/s10995-016-2085-y
Pérez-Escamilla, R., & Sellen, D. (2015). Equity in Breastfeeding: Where Do We Go from Here? Journal of Human Lactation, 31(1), 12-14. https://doi.org/10.1177/0890334414561062