Boosting Racial Equity in Breastfeeding

By Sascha Mayer, Mamava Cofounder + Chief Experience Officer and Megan Fulwiler, Content Director at Mamava

Breastfeeding rates have increased over the years with an overall initiation rate of just over 84%, but racial and ethnic disparities persist, especially among Black mothers. While 70% of Black mothers initiate breastfeeding, the gaps continue to grow after birth with only 58% still breastfeeding at three months compared to 73% of white mothers.  

Mom adjusting nursing apparel she is wearing after pumping.

Breastfeeding may be a personal choice, but it’s one that is also deeply impacted by our country’s long history of racial inequality and persistent forms of structural racism. The health benefits for both babies and mothers are well documented, yet the reality is that breastfeeding can all too often be a privilege for those with resources such as family support and paid family leave. All mothers deserve to have the education, resources, and support necessary for breastfeeding should they choose to do so. Here are three essential ways we, as a nation, can help increase breastfeeding rates and reduce ongoing maternal health inequities. 

Provide breastfeeding education in hospitals

Maternal healthcare and outcomes are inextricably linked with systemic racism. Many of the important advancements in the field of gynecology are a result of racist and violent practices inflicted on the bodies of Black women. This legacy endures in the statistics. Compared to white women, Black women are three to four times more likely to die a pregnancy-related death, four times less likely to receive prenatal care visits, and 49 percent more likely to deliver babies prematurely. To make matters worse, Black mothers are also nine times more likely to be given formula at the hospital than white mothers. This racial bias is especially troubling given that black infants have higher rates of prematurity and infant mortality than white babies, and breastfeeding could help. Hospitals that adopt the Ten Steps to Successful Breastfeeding report significant improvement in decreasing the racial gap in breastfeeding rates. New tools like the app Irth (birth without the bias) help Black and Brown parents use crowdsourced data to choose the perinatal and postpartum providers that are right for them. 

Boost social support

If it takes a village to raise a child, it definitely takes one to breastfeed. Having support from partners, family, and social networks can make a big difference for a new mom. Beyond bias and systemic racism in our healthcare system, there are additional complex social and cultural stigmas around breastfeeding that are “generationally persistent” and passed on through families. Breastfeeding is a learned behavior, so if breastfeeding has not been practiced by women in a family, a lack of cultural and social acceptance can negatively impact a new mother’s decision to nurse. For many Black women, breastfeeding remains steeped in the history of slavery when Black mothers were forced to be wet nurses for white babies, often at the expense of feeding their own. Research shows that peer-to-peer local community groups can help increase both breastfeeding initiation and duration. In fact, even virtual groups,  such as finding support online in Facebook groups, can help new parents. 

Improve workplace support for breastfeeding employees 

Improving lactation support in hospitals and at home is key to helping reduce racial disparities in breastfeeding rates, but so too is increasing workplace support for new parents. At the level of individual workplaces, employers need to do more to improve access to lactation accommodations for all categories of workers. According to the CDC’s Breastfeeding Report Card, only 49% of all workplaces provide a lactation space. Without a secure and sanitary space to express milk, many working mothers simply cannot continue to provide breast milk for their babies. And at the level of public policy, we need to make a federal paid family leave a reality or we risk perpetuating health disparities for years to come. The wealth gap leaves many working families of color without an economic margin to take time off to care for a newborn. 

Breastfeeding rates can look like a simple data set, but any discussion of breastfeeding needs to acknowledge the complex historical, social, and economic factors that can impact Black mothers. (We’ve put together a reading list as a helpful starting place!) After acknowledgement comes the necessary work of challenging and then dismantling structural barriers that perpetuate maternal health inequities.