The World Health Organization (WHO) describes breastmilk as the “ideal food for infants,” as it provides essential nutrients and contains antibodies that safeguard infants from illnesses. Studies indicate that breastfed children perform better on intelligence tests and are less likely to develop diabetes or struggle with obesity in adulthood. Mothers who breastfeed also benefit from lower risks of breast and ovarian cancers.1Breastfeeding: achieving the new normal. Lancet. 2016;387(10017):404. https://doi.org/10.1016/S0140-6736(16)00210-5,2Cherished Futures for Black Moms and Babies Is Enhancing Breastfeeding Support in LA to Reduce Infant and Maternal Mortality. Public Health Institute. Published August 29, 2023. Accessed November 7, 2023. https://www.phi.org/press/cherished-futures-for-black-moms-babies-is-enhancing-breastfeeding-support-in-la-to-reduce-infant-and-maternal-mortality
All states have legislation protecting a woman’s right to nurse in public. Some permit women to breastfeed anywhere; others have rules for public spaces, workplaces, and private residences. In December 2022, President Biden enacted the Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP Act), marking a significant milestone for national breastfeeding rights. The PUMP Act provides most nursing workers break time and a clean, private space to pump milk for up to one year.
Despite the well-known advantages of breastfeeding, racial and ethnic disparities complicate nursing for Black women in the United States. Hospitals are nine times more likely to offer formula to Black mothers than to white mothers.2Cherished Futures for Black Moms and Babies Is Enhancing Breastfeeding Support in LA to Reduce Infant and Maternal Mortality. Public Health Institute. Published August 29, 2023. Accessed November 7, 2023. https://www.phi.org/press/cherished-futures-for-black-moms-babies-is-enhancing-breastfeeding-support-in-la-to-reduce-infant-and-maternal-mortality Black mothers are also less likely to exclusively breastfeed for six months, a practice the WHO notes as having the “single largest potential impact on child mortality” among preventive interventions.3Isiguzo C, Mendez DD, Demirci JR, et al. Stress, social support, and racial differences: dominant drivers of exclusive breastfeeding. Matern Child Nutr. 2023;19(2):e13459. https://doi.org/10.1111/mcn.13459,4Global nutrition targets 2025: breastfeeding policy brief. UNICEF/World Health Organization. 2014.
Not all women benefit from social and legislative progress in breastfeeding. Persistent inequities highlight the intersection of deficient labor laws and healthcare access, revealing deep-rooted historical trauma and systemic racism.
During slavery, Black women were often forced to breastfeed the children of white families rather than nurse their own. Because breastfeeding may prevent or delay ovulation, however, many slave owners banned breastfeeding altogether. When the 13th Amendment ended slavery across the United States, Black women sought work as wet nurses and housekeepers for white families. Tending to their employers’ families once again took precedence over caring for their own children.
Racial Barriers to Breastfeeding
Infant formula companies began aggressively marketing to Black women in the 1950s, positioning formula as the same (or better) than breastfeeding. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), where Black women are overrepresented, typically provides free formula. WIC has recently acknowledged breastfeeding as the best choice for infant nutrition but continues to provide formula to women who choose not to breastfeed. It’s a complicated decision, affected by social norms, historical injustice, stress, and work limitations, among other issues. Because a state may pay for only one type of formula, some women must visit numerous stores to find the right brand.
Many workplace protections supporting breastfeeding (like the PUMP Act) don’t apply to part-time, contract, and other kinds of work where Black women are highly represented. A study exploring how eligibility for the Family and Medical Leave Act (FMLA) and Affordable Care Act affects access to unpaid parental leave and breastfeeding breaks found more than 60% of Black workers were ineligible or unable to afford unpaid FMLA leave.5Sprague A, Earle A, Moreno G, Raub A, Waisath W, Heymann J. National policies on parental leave and breastfeeding breaks: racial, ethnic, gender, and age disparities in access and implications for infant and child health. Public Health Rep. Published online February 3. 2023:333549231151661. https://doi.org/10.1177/00333549231151661
Where social welfare and workplace protections fail to provide equitable breastfeeding support, healthcare systems can bridge the gap. However, hospitals that offer access to lactation consultants and nursing resources tend to be located in predominantly white areas.
A Collaborative Effort for Breastfeeding Equity
Cherished Futures for Black Moms & Babies (Cherished Futures) is a joint initiative of the Public Health Alliance of Southern California based at the Public Health Institute, Communities Lifting Communities, and the Hospital Association of Southern California, in collaboration with Antelope Valley Medical Center. In 2022 and 2023, they partnered with five hospitals to improve birth and breastfeeding outcomes for Black mothers in Los Angeles. Breastfeeding rates among Black women rose from 40% to 70%. Lactation consultations with Black patients have increased significantly, from 30% to 100%.2Cherished Futures for Black Moms and Babies Is Enhancing Breastfeeding Support in LA to Reduce Infant and Maternal Mortality. Public Health Institute. Published August 29, 2023. Accessed November 7, 2023. https://www.phi.org/press/cherished-futures-for-black-moms-babies-is-enhancing-breastfeeding-support-in-la-to-reduce-infant-and-maternal-mortality
Cherished Futures advocate breastfeeding for improving short- and long-term health outcomes. The collaborative educates caregivers about the historical context of breastfeeding during and after slavery. Combined with a lack of social support for Black mothers, intergenerational trauma negatively affects breastfeeding rates. More comprehensive lactation education in medical and nursing schools is also needed to promote systemic change.
Access to diverse lactation consultants is a crucial part of Cherished Futures’ success. To expand this effort, the collaborative suggests healthcare institutions work toward keeping enough qualified lactation consultants on staff who represent the diverse communities they serve.
A comprehensive societal approach is needed to address breastfeeding disparities. With the absence of federal paid parental leave in the United States, women face a difficult decision: return to work quickly to support their families or seek breastfeeding support. Balancing both is often unfeasible. Cherished Futures advocates for a federal parental leave program, citing research that highlights numerous health advantages—higher breastfeeding rates, better maternal mental well-being, fewer low-weight births, and reduced infant mortality.6Goodman JM, Williams C, Dow WH. Racial/ethnic inequities in paid parental leave access. Health Equity. 2021;5(1):738-749. https://doi.org/10.1089/heq.2021.0001 Moreover, equitable and inclusive policy reform that seeks financial stability for families has the potential to improve family health outcomes overall.
Footnotes
- 1Breastfeeding: achieving the new normal. Lancet. 2016;387(10017):404. https://doi.org/10.1016/S0140-6736(16)00210-5
- 2Cherished Futures for Black Moms and Babies Is Enhancing Breastfeeding Support in LA to Reduce Infant and Maternal Mortality. Public Health Institute. Published August 29, 2023. Accessed November 7, 2023. https://www.phi.org/press/cherished-futures-for-black-moms-babies-is-enhancing-breastfeeding-support-in-la-to-reduce-infant-and-maternal-mortality
- 3Isiguzo C, Mendez DD, Demirci JR, et al. Stress, social support, and racial differences: dominant drivers of exclusive breastfeeding. Matern Child Nutr. 2023;19(2):e13459. https://doi.org/10.1111/mcn.13459
- 4Global nutrition targets 2025: breastfeeding policy brief. UNICEF/World Health Organization. 2014.
- 5Sprague A, Earle A, Moreno G, Raub A, Waisath W, Heymann J. National policies on parental leave and breastfeeding breaks: racial, ethnic, gender, and age disparities in access and implications for infant and child health. Public Health Rep. Published online February 3. 2023:333549231151661. https://doi.org/10.1177/00333549231151661
- 6Goodman JM, Williams C, Dow WH. Racial/ethnic inequities in paid parental leave access. Health Equity. 2021;5(1):738-749. https://doi.org/10.1089/heq.2021.0001
