Black mothers face barriers to breastfeeding

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.