Some African American women and women of color choose not to breastfeed for reasons based in historical trauma and cultural misperceptions.
“You can’t shy away from slavery or racism,” says Bonita Agee, a Certified Lactation Counselor and coordinator with Grand Rapids-based Strong Beginnings, which uses a holistic approach to reduce infant mortality among communities of color in Kent County.
“During slavery there was a power dynamic between Black women and White women. Enslaved Black women served as wet nurses. These enslaved wet nurses had no power over themselves and were under the direction of their White mistresses.”
The end of slavery was the beginning of trauma-related experiences that led several generations of African American women to forego breastfeeding because of the negative history attached to it.
Black women came to believe that breastfeeding was not something they could do, says Shatoria Townsend, Breastfeeding Coordinator for the State of Michigan.
“That does go back to transgenerational trauma,” she says. “During slavery, our babies were ripped away from us and we were forced to breastfeed the slave owners’ babies over our own. This was enforced with wet nursing and here it is, generations later, and there’s this fear that your child will be taken away from you or that breastfeeding is not meant for us but for someone else.”
Townsend says this has continued to be reinforced when, after giving birth, many African American women were and are interacting with White nurses who may lack the cultural competency or cultural humility to treat and support them and give them a certain comfort level about breastfeeding.
Townsend says cultural humility is having the awareness that “this is a culture you are not fully aware of or know the details behind that culture.” As an example, she says, “I’m not a Native American so I don’t know that culture, but I have the ability to learn from an individual who is.
“Cultural competency encompasses cultural humility.”
Agee says many of the African American women and women of color she’s assisted routinely tell their healthcare providers, when asked, that their breastfeeding journey was going well, but when she asked them, they would admit that they were having challenges.Miaca and Kamau Sandiford of Grand Rapids, MI supported by Kiara Baskin Of Bump to Birth Doula Services at Spectrum Health Hospital.
When asked how often this happens, Agee and Kiara Baskin, a certified Doula and Lactation Counselor and program manager for a community-based Doula program at Baxter Community Center, say “almost always.”
“I think about the culture and community within the African American population in particular,” says Baskin, who also runs her own firm, Bump to Birth Doula Services
. “There can almost always be language barriers or a misunderstanding of their circumstances as it relates to breastfeeding. Medical providers may be using language they may not be familiar with. They may use medically correct terminology that our community may not be familiar with.”
The diagnoses of breast issues are historically based on the experiences of White women and the photos on charts in medical offices and the breast models used are based on White women’s anatomy, says Baskin. She adds that providers need to dig a little deeper to be able to address issues specific to Black women and women of color who have melanated skin.
She recalls an incident where a Black woman was told that she could potentially suffocate her baby while breastfeeding because her breasts were too large. This, she says, is an example of not understanding a Black woman’s anatomy.
“I had a woman reach out to me via text who I had known for a while who was Latinx and a first-time mom because the nurse had told her that because her areolas were too large, she was not a candidate for breastfeeding,” Agee says. “This was a lack of understanding about melanated anatomy.”
No arguing with the numbers
Research shows that more than any other racial or ethnic group, Black women have a lower rate of initiating breastfeeding with their infants, Agee says.
That initiation rate is 77.3% compared to 86.3% for White women. The goal established by Healthy People 2020, a program of nationwide health promotion and disease prevention goals set by the United States Department of Health and Human Services is 81.9% for all women.
Agee says the study is a “10-year look at what is going on in breastfeeding. They provide a tentative goal and information on how families can reach that goal, which is one of the goals we look at in terms of standardizing what breastfeeding should look like.”
These are among the disparities brought to the forefront during Black Breastfeeding Week, observed during the last seven days in August as part of National Breastfeeding Month.
Townsend says these statistics are evidence of what she calls a “public health crisis” for Black women, women of color, and their infants.
“We know that there is a disparity at the state level, but for those of us as African American people, we’ve known that this disparity has existed for a long time,” she says. “We have Gov. Whitmer who signed the ‘Black Breastfeeding Week’ proclamation
this year which was the first time this was done. Having the support of a Governor who has made racism a public health crisis enables us to move forward and say, ‘Hey, this is a crisis for us.’ We need to encourage more Black women and women of color to produce and provide human milk to their babies.”
African American women and their babies are disproportionately impacted when breast milk is not seen as a viable option, says Shannon Wilson, director of Medicaid Outreach and Quality with Priority Health. She says 30% of Black babies are born prematurely and weigh less.
“When you have babies born weighing 5 or 6 pounds rather than 7 or 8 pounds, that will significantly impact a child’s ability to be healthy later in their life,” Wilson says. “On the other side of delivery, that’s where breastfeeding comes in because it has the ability to give babies the best outcomes.”
Numerous studies have shown the benefits of breastfeeding for both the mother and the baby. Former U.S. Surgeon General Regina Benjamin said breastfeeding is “one of the most highly effective preventive measures a mother can take to protect her child and her own self.”
Research has shown that breastfed babies are less likely to develop asthma. Breastfeeding also has been shown to reduce the risk of sudden infant death syndrome and the risk for obesity later in life.
Benjamin said, “For mothers, breastfeeding reduces the risk of both ovarian and breast cancer.”
Many advocates for breastfeeding refer to the colostrum, the first form of milk produced after giving birth, as “liquid gold” because of the antibodies it contains which protect newborns from disease. This has become especially important given the pandemic.
Townsend says the disparities that already existed have been made worse by the pandemic.
“With COVID-19, we cannot stress enough the importance of starting a baby off on the right foot with breastfeeding,” Wilson says. “There is a correlation between breastfeeding and infant mortality. We could decrease Black infant mortality by 50% if we could get more African American women to breastfeed.
“It’s really about just having these conversations and getting the word out.”
Support is key
From a Doula perspective, Baskin says the support services are “pretty much nonexistent” for women of color who leave the hospital after giving birth. She says she refers her clients to HUGS (Helping Us Grow Support)
, a breastfeeding support group for Black women to access resources and a similar group for Latinx women called Café Con Leche
The weekly HUGS meetings which are now taking place in a virtual space have between 10 to 12 participants representing new moms to those with two-year-olds, says Agee, who serves as the facilitator. The Café Con Leche meetings are directed by a Latinx woman. Both programs are offered through Strong Beginnings, Healthy Start.
HUGS includes more than 20 community partners who are trained as peer counselors in a curriculum that addresses breastfeeding from the African American perspective.Kiara Baskin, a Certified Doula and Lactation Counselor and program manager at Baxter Community Center
“Representation is really a key factor in the success of Black women breastfeeding. When they are in the home and creating relationships with clients, they are also women of color, so we understand the importance of representation,” Agee says. “We try to make sure we create a safe space to get their breastfeeding needs met.”
She says she thinks Black women and women of color are more honest with her and her counselors than their healthcare provider because the counselor is someone who looks like them and knows their culture and experiences.
To better support Black women and women of color, Agee says healthcare providers need to address implicit bias which will help to de-center the whiteness seen in the healthcare field.
“They should be allowing Black women to lead their own journey and come alongside and support them,” Agee says. “What is happening right now is preventing Black women from breastfeeding or starting to breastfeed and hospitals need to be more representative of the patients they care for.”
Agee is one of 11 certified lactation counselors with Strong Beginnings who are Black or women of color.
She says the lack of racial diversity in their field is among the reasons that Black and Brown women are less likely than their white counterparts to breastfeed. This disparity in the profession was included in a 2019 Lactation Care Provider Demographic Survey
done by the United States Lactation Consultants Association.
Lactation counseling as a profession didn’t take off until the 1980s. When it did, it was a predominantly white-led profession similar to breastfeeding support organizations at the time like La Leche clubs, says Sekeita Lewis-Johnson, a co-founder of the Southeast Michigan IBCLC’s (International Board-Certified Lactation Consultants) of Color from the Detroit area.
She says the real turning point came when then-Surgeon General Benjamin issued a call to action in 2011 to increase support for breastfeeding that included women of color and those who support their efforts.
Among the barriers for African Americans and people of color who wanted to break through that white ceiling was the cost of earning the necessary certifications and credentials. Agee says there is one certified IBCLC in Kent County who is a Black woman. She is serving in a volunteer capacity until she can find a job which will use her skills.
“You do not have to have to [be] a (Registered Nurse) certification to be an IBCLC. I was an RN before I became IBCLC but most of my colleagues are not and what that leaves them with is trying to be creative and find positions in the community so they can make a livable wage,” Lewis-Johnson says. “They either start doing it on their own as consultants or form an LLC company of some sort.
“This is a national concern. If you’re not licensed, it leaves the IBCLC trying to see how they can make ends meet.”
IBCLC is an international standalone credential. Lewis-Johnson says there are three different pathways to becoming an IBCLC
and each one requires a certain amount of college courses; clinical hours that could be anywhere from 300 to 1,000 hours; and participation in an international board-certified exam.
While IBCLC’s are able to work in hospitals without being RN’s, Lewis-Johnson says that is up to individuals, hospitals, or healthcare systems to decide.
Baskin says there is definitely opportunity to make an impact in the space of lactation professionals. Those in private practice have to take into consideration the populations in need of their services and their ability to pay.
“That’s where we see the disparities,” she says. “We have these specialists in private practice, but there’s no reimbursement through health insurance and some can’t afford to work for the prices set. We actually have some who work for free to make sure women have that breastfeeding support.
“It’s unfortunate that they weren’t able to be compensated appropriately. In Kent County we have the opportunity to change the narrative and how we can get reimbursement through Medicaid or private insurance.”
When the lactation profession became more racially diversified, additional obstacles were put in place, including the preference for an RN license. Prior to this, Lewis-Johnson says lactation consultants working in hospitals did not have to have an RN license.
Wilson says earning the necessary certifications can be “quite daunting.” She says there’s a concerted effort now with the medical and healthcare communities to create more opportunities for Black women and women of color who want to be lactation professionals.
In an effort to address this inequity, Priority Health has partnered with the Michigan Department of Health and Human Services through its Division of Infant and Maternal Health to advocate for and promote Black Breastfeeding Week August 25-31.
“In addition, our company has contributed a scholarship to You Overcoming Lactation Obstacles (YOLO) to provide support and resources for lactation professionals of color in southeast Michigan,” Wilson says.
The recipient of the $1,500 scholarship is Shonte Terhune, BS, IBCLC, who runs YOLO in Flint.
“We are looking at how we engage and provide support for lactation consultants to make sure they get paid for what they’re doing, particularly among the Black community,” Wilson says.
Pay equity and making space for Black lactation professionals is vital, Townsend says. She frequently hears from women who say the hospital they are staying in doesn’t have Black lactation specialists on staff, or does not have a way to access them on weekends or overnight.
“Black lactation counselors and specialists and IBCLC consultants are needed to help close this gap. “They need to be invited and feel welcome at the table to really bring home this change,” she says.
Photos courtesy Bonita Agee and Kiara Baskin, respectively.