When it comes to infant nutrition, the Centers for Disease Control and Prevention (CDC), health experts, and U.S. Department of Health and Human Services (HHS) are united by one belief: breast milk is the gold standard. According to the Centers for Disease Control and Prevention, breastfed babies have a lower risk of asthma, type 1 diabetes, and sudden infant death syndrome, and are less likely to have ear infections and stomach bugs. The birthing or breastfeeding parent may be less likely to develop breast and ovarian cancer, type 2 diabetes, and high blood pressure.
While the main goal is to confer these benefits to all infants and birthing people, there are disparities in breastfeeding rates. While breastfeeding appears to be a matter of personal choice or preference, these disparities warrant thorough investigation. Only 66% of Black infants are breastfed, when compared to more than 82% of white and Latinx infants. The disparities go beyond initiation. When Black birthing people breastfeed, they don’t often stick with it for long. Only 44% of Black birthing people breastfeed for at least six months, when compared with 62% of white birthing people, and 57.6 percent overall.
Founded by Kimberly Seals-Allers, Kiddada Green, and Anayah Sangidele-Ayoka, Black Breastfeeding Week aims to highlight the challenges and triumphs of Black breastfeeding mothers and birthing people. As we work to commemorate the occasion — and National Breastfeeding Month overall — we should take a hard look at what’s contributing to these conditions in our much-needed efforts to enhance the accessibility of breastfeeding.
More specifically, we should evaluate these factors through a framework that acknowledges the systems and structures contributing to disparate infant feeding outcomes and experiences among race — the first food justice framework. This framework is at the core of our First Foods Justice Breastfeeding Certification Program for Doulas at the Mama Glow Foundation.
In addition to shedding light on the disheartening reality that inequality remains deeply entrenched in our modes of being, it stands as a praxis. While developing the content for the course — which rests on a number of realizations on which the United States’ vibrant workforce of doulas, midwives, lactation consultants, and other birth workers operate — not only were we clear on the necessity of the work, but also astonished at the lack of teaching and content around the framework. The principles of first food justice should govern many teachings within the world of infant nutrition, and it should be among the first things we educate its various players on.
Coined by Penny Van Esterik, the term “first food justice” acknowledges the absence of the first food system from the general discourse surrounding environmental and food justice. It centers an analysis of the systemic and structural factors that undermine the people, resources, and processes related to infant feeding to highlight the significance of the ultimate goal: the condition where all babies have the full ability to exercise their right to eat and caregivers their right to feed. The framework of first food justice encourages us to consider the social forces that either thwart or promote this consumption. It’s important to note that parents can’t exercise their “full” ability to feed in the absence of informed consent, or education about what’s best for themselves and their babies.
One systemic barrier barring Black birthing people from breastfeeding is the decision-making occurring within the biomedical sphere. Unfortunately, the biomedical sphere has been the target of predatory practices of formula companies, and they draw in certain demographic groups — like low-income Black women — by targeting hospitals within their communities. As formula grew less popular among white birthing people with growing information, formula companies ramped up their efforts at reaching Black birthing people. This has long standing effects, and is among the factors behind Black birthing people’s disproportionate rates of formula use.
Breastfeeding requires optimal conditions, and those of the United States labor force are not conducive to success. Black birthing people’s rate of labor participation sits at the highest of all demographic groups, and despite laws that protect the right to breastfeed at work, Black women often find themselves in a tough position. Amani Echols of the American Civil Liberties Union cites the nature of their jobs as the source. Black people are less likely than their white counterparts to occupy jobs that offer greater flexibility, economic stability, and better benefits, such as paid family leave. What this means is that they aren’t often attempting to breastfeed under circumstances that are ideal; rather, it’s more beneficial for them to forego the endeavor in favor of infant formula.
For many people, the best solution would be to ground themselves at home. For many Black women in the United States, unfortunately, this is not an option. Within our modern labor force, Black birthing people tend to be the financial leaders in the nuclear family structure. 70.7 percent of Black birthing people are the sole breadwinners of their family unit, and 14.7 percent are co-breadwinners. What this means is that putting food on the table, buying clothes, and other pressures may primarily fall on them. Under these circumstances, it only makes sense that breastfeeding does not figure high on the list of familial priorities. While breastfeeding is natural, it is not intuitive. Unfortunately, the time and effort it requires is often lost to survival for Black birthing people.
Furthermore, the insular nature of the nuclear family structure may play a role. Research increasingly points to the contribution of social support to breastfeeding self-efficacy in Black women. What this means is that Black birthing people who are connected to systems and resources outside of the home are more likely to experience a heightened sense of confidence in their ability to breastfeed. It only makes sense that this sense of confidence is either non-existent, or depleted, in the absence of these structures of support. Lack of education about breastfeeding limits peer, family, and social support within Black families, which means breastfeeding is an effort and a journey many Black birthing people must embark on alone.
The framework of first food justice is significant because it enables us to come to a subtle, yet glaring realization: when it comes to Black breastfeeding rates, a constellation of structural and social factors contribute to the current state of affairs. It is through intentional effort, policy change, and the active decision to acknowledge historical legacies of predatory practices that we can actively change these realities.
Bintou Diarra is the Editorial Lead at Mama Glow, MS2 at Warren Alpert Medical School of Brown University.
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