Black/African American mothers continue to face disparities that affect breastfeeding rates, be it initiation, duration, or exclusivity. The disparities faced by Black/African American mothers contribute to increased maternal/infant mortality and morbidity rates. The rates are significantly lower with inevitable health consequences for mother and baby. Breastfeeding offers preventive health benefits; exclusive breastfeeding must be maintained to receive these benefits. Due to a combination of cultural, sociological, inequitable health care, racism, implicit bias, prejudices, and trauma from slavery, breastfeeding rates among Black/African American mothers have been significantly affected.
Historical Impact
The tradition of wet nursing for African American women is inherently associated with white supremacy, slavery, medical racism, and the physical, emotional, and mental abuse that enslaved African American women. Thus, the decision to breastfeed and the act of breastfeeding may remain deeply affected by the generational trauma of wet nursing during slavery (Green et al., 2021). Black enslaved mothers were forced to care for white children at the expense of their own children. This dark cloud of trauma forced upon Black enslaved mothers affected the Black/African American mother’s decision to breastfeed and perpetuated the disparities. It created a narrative that Black babies were more hurt and needy; and Black women are unfit and unable to care for their children.
Perhaps, black women did not talk to their sisters, daughters, and granddaughters about how to feed their babies because of the residual fear, oppression, and gendered dehumanization of slavery overshadows the emotional bond between mother and child that is coded in the practice of wet nursing, fostering a stunted and complex experience of motherhood (Green et al., 2021). In my own family, I never heard conversations about breastfeeding or saw breastfeeding modeled as the best way to feed a baby. I always see formula as the feeding choice and model. The many families I support in the state of breastfeeding are never done with their families or discussed. They also shared that they did not see their peers breastfeeding, but they heard about the optimal health benefits of breastfeeding and wanted to give their babies the most natural way of feeding.
Gyamfi et al. (2021) suggest a significant social barrier to AA women’s BF is the lack of BF role models across generations. An additional obstacle is the perceived social value of the female breast as a sexual organ and not a source of nutrition. Targeted messaging is needed to promote the nutritional value and less emphasis on the over-sexualization of AA female breasts. The associated negative connotations of wet nursing, slavery, and medical exploitation are one of the many nuanced cultural barriers that deny Black women and infants the many health benefits of breastfeeding and may be an important factor driving the alarming increase in Black infant rates mortality (Green et al., 2021).
The Impact of Disparities and What Can Be Done to Change the Narrative
Many AA women face unique challenges in initiating and maintaining BF. Notably, insufficient social support, various forms of prejudice, racism, misconceptions about BF versus formula feeding, insufficient financial resources as well as personal factors such as low self -efficacy, negative attitudes, reluctance to breastfeed, misconceptions about benefits and insufficient resources (Gyamfi et al., 2021). Maternal age, education, socioeconomic status, lack of access to resources in their communities, and access to a lactation specialist contribute to the disparities seen among Black/African American mothers. Safon et al. (2021) found that health care providers’ implicit biases about the breastfeeding outcomes of African American mothers were associated with both less breastfeeding support referrals and less assistance when breastfeeding problems occurred. among African American mothers relative to their non-African American counterparts.
Racial treatment differences have led to medical mistrust among many African American and other minority communities in the United States and likely exacerbated racial disparities in breastfeeding. This point emphasizes the importance of bias and the implementation of equitable breastfeeding interventions (Safon et al., 2021). Green et al. (2021) suggest when health care workers fail to incorporate such interventions, staff are perceived as unsupportive and lack sufficient information and skills to educate AA women on BF. As a result, girls lost confidence and relied more on relatives and peers. In addition, women prefer a systematic and professional approach to include partners in BF decisions.
We need to do better to ensure that all health care workers have the basic knowledge and tools to efficiently and effectively assist Black/African American mothers. Women emphasized the need for ongoing, realistic, family-friendly, culturally sensitive care from the first to the fourth trimester. Thus, health professionals who actively interact with AA women throughout the four trimesters of pregnancy should actively promote the initiation and continuation of BF. Additionally, BF support needs to include perinatal programs starting in the community and continuing to the hospital setting and then back to the community so that women and infants receive the benefits of BF (Gyamfi et al., 2021). Changing personal norms, in which breastfeeding is Shavon Johnson, MPH, CLE, CLD viewed as a normal practice; promoting positive attitudes about breastfeeding; and emphasizing mothers’ choice and/or control over breastfeeding may help improve breastfeeding continuity among some US Black mothers (Safon et al., 2021).
Bibliography
- Green, VL, Killings, NL, & Clare, CA (2021). The historical, psychosocial, and cultural context of breastfeeding in the African American community. Breastfeeding Medicine16(2), 116-120.
- Gyamfi, A., O’Neill, B., Henderson, WA, and Lucas, R. (2021). Black/African American breastfeeding experience: cultural, sociological, and health dimensions through an equity lens. Breastfeeding Medicine16(2), 103-111.
- Safon, CB, Heeren, TC, Kerr, SM, Clermont, D., Corwin, MJ, Colson, ER, … & Parker, MG (2021). Breastfeeding disparities among US black mothers: Identifying mechanisms. Breastfeeding Medicine16(2), 140-149.
About the Author
Shavon Johnson, MPH, CLE Founder and CEO of Mom’s Treasure Chest. His passion for “women and children for life” runs deep. She believes that all families should be provided with the right education and services to have the birthing experience of their choice. Shavon has a Bachelor of Science degree in Biology, he also has a Masters of Public Health degree with a concentration in Maternal & Child Health. Later in her career, she obtained training with the Childbirth and Postpartum Professional Association (CAPPA) to become a Certified Lactation Educator, offering lactation education, services, and support. Wanting to offer more to her clients and community, she is certifying as a Certified Labor Doula with CAPPA. Shavon provides education and comprehensive support to the birthing family during pregnancy, labor, delivery, and immediately after birth. She is a Social Worker specializing in transitional aged youth; her role as Program Coordinator for the Maternal & Child Health program she developed offers childbirth services, classes, and resources to young expectant adults and parenting. Shavon holds a CAPPA Faculty Member position where she trains individuals for the Certified Lactation Educator program. Shavon is an active and financial member of Delta Sigma Theta Sorority, Inc.; She is also a member of the SANKOFA Inland Empire Birth Workers Collective, the Riverside Coalition for Black Health and Wellness and the Inland Empire Perinatal Mental Health Collaborative. Shavon’s goal is to educate his community through education and health promotion.
