Black/African American mothers continue to face disparities that impact breastfeeding rates, be it initiation, duration, or exclusivity. The disparities faced by Black/African American mothers aid in the increased maternal/infant mortality and morbidity rates. The rates are significantly lower with inevitable health consequences for mother and baby. Breastfeeding offers preventative health benefits; exclusive breastfeeding must be maintained to receive these benefits. Due to the combination of cultural, sociological, inequitable healthcare, racism, implicit bias, prejudices, and trauma from slavery the breastfeeding rates in Black/African American mothers have been significantly impacted.

Historical Impact

The tradition of wet nursing for African American women is inherently linked to white supremacy, slavery, medical racism, and the physical, emotional, and mental abuse that enslaved African American women endured. 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 nurse White children at the expense of their own children. This dark cloud of trauma forced on Black enslaved mothers has impacted the Black/African American mother’s decision to breastfeed and has perpetuated the disparities. It has built a narrative that Black babies are sicker and needier; and that Black women are unfit and cannot take care of their children.

Perhaps, Black women did not talk to their sister, daughters, and granddaughters about how to feed their babies because the residue of terror, oppression, and gendered dehumanization of enslavement overshadowed the emotional bond of mother and child codified in the practice of wet nursing, galvanizing a stunted and complex mothering experience (Green et al., 2021). In my own family, I did not hear conversations about breastfeeding or see breastfeeding modeled as the optimal form of feeding for the infant. I have always seen formula as the choice of feeding and modeled. The many families I support state breastfeeding was never modeled in their families or talked about. They have also shared they haven’t seen their peers breastfeed, but they have heard of the optimal health benefits of breastfeeding and want to provide their babies with the most natural form of feeding.

Gyamfi et al. (2021) suggests a significant social barrier in AA women’s BF is the lack of BF role models across generations. An additional barrier 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 the AA female breast. The associated negative connotation of wet nursing, slavery, and medical exploitation is one of the many nuanced cultural barriers that denies Black women and infants the many health benefits of breastfeeding and may be a key factor promoting the alarmingly increased rates of Black infant mortality (Green et al., 2021).

The Disparities Impact & What Can Be Done to Change the Narrative

Many AA women encounter unique challenges in initiating and sustaining BF. Notably, inadequate social support, various forms of prejudices, racism, misconceptions about BF versus formula feeding, insufficient financial resources as well as personal factors such as low self-efficacy, negative attitudes, unwillingness to breastfeed, misconceptions about the benefits and inadequate resources (Gyamfi et al., 2021). Maternal age, education, socioeconomic status, lack of access to resources in their communities, and access to someone who specializes in lactation contribute to the disparities seen in Black/African American mothers. Safon et al. (2021) found that health care providers’ implicit biases about African American mothers’ breastfeeding outcomes were associated with both fewer lactation support referrals and less help when breastfeeding problems occurred among African American mothers relative to their non-African American counterparts.

Differential treatment because of race has led to medical mistrust among many African American and other minority communities in the United States and has 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 failed to include such interventions, staff were deemed not supportive and lacked adequate information and skill to educate AA women on BF. As a result, women lost confidence and relied more on relatives and peers. In addition, women preferred a system and professional approach to be inclusive of the partners in BF decisions.

We have to do better to ensure all healthcare workers have the basic knowledge and tools to efficiently and effectively assist Black/African American mothers. Women emphasized the need for persistent, truthful, family-inclusive, culturally sensitive support from the first to the fourth trimester. Thus, health professionals who actively engage with AA women throughout the four trimesters of pregnancy must proactively promote BF initiation and continuation. Further, BF support needs to integrate perinatal programs beginning in the community and continuing to the hospital setting and then back into the community so women and infants can receive the benefits of BF (Gyamfi et al., 2021). Changing subjective norms, such that 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 continuation among some U.S. Black mothers (Safon et al., 2021).

Bibliography

• Green, V. L., Killings, N. L., & Clare, C. A. (2021). The historical, psychosocial, and cultural context of breastfeeding in the African American community. Breastfeeding Medicine, 16(2), 116-120.
• Gyamfi, A., O’Neill, B., Henderson, W. A., & Lucas, R. (2021). Black/African American breastfeeding experience: cultural, sociological, and health dimensions through an equity lens. Breastfeeding Medicine, 16(2), 103-111.
• Safon, C. B., Heeren, T. C., Kerr, S. M., Clermont, D., Corwin, M. J., Colson, E. R., … & Parker, M. G. (2021). Disparities in breastfeeding among US black mothers: Identification of mechanisms. Breastfeeding Medicine, 16(2), 140-149.

About the Author

Shavon Johnson, MPH, CLE Founder and CEO of Mom’s Treasure Chest. Her passion for “woman and child across the lifespan” lies deep. She believes that all families should be provided the proper education and services to have the birth experience they choose. Shavon holds a Bachelor of Science degree in Biology, she also holds a Masters of Public Health degree with a concentration in Maternal & Child Health. Later in her career she gained 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 complete support to the birthing family during pregnancy, labor, birth, and immediately postpartum. She is a Social Worker specializing in transitional aged youth; her role as Program Coordinator for the Maternal & Child Health program she developed offers birthing services, classes, and resources to expectant and parenting young adults. 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 her community through health education and promotion.