Black Breastfeeding Week: 40 Years Strong

Black Breastfeeding Week was created because for over 40 years there has been a gaping racial disparity in breastfeeding rates. The most recent CDC data show that 75 percent of white women have ever breastfed versus 58.9 percent of black women. The fact that racial disparity in initiation and even bigger one for duration has lingered for so long is reason enough to take seven days to focus on the issue, but here are a few more:

1. The high black infant mortality rate: Black babies are dying at twice the rate (in some place, nearly triple) the rate of white babies. This is a fact. The high infant mortality rate among black infants is mostly to their being disproportionately born too small, too sick or too soon. These babies need the immunities and nutritional benefit of breast milk the most. According to the CDC, increased breastfeeding among black women could decrease infant mortality rates by as much as 50 percent. So when I say breastfeeding is a life or death matter, this is what I mean. And it is not up for debate or commenting. This is the only reason I have ever needed to do this work, but I will continue with the list anyway.

2. High rates of diet-related disease: When you look at all the health conditions that breast milk—as the most complete “first food,” has been proven to reduce the risks of—African American children have them the most. From upper respiratory infections and Type II diabetes to asthma, Sudden Infant Death Syndrome and childhood obesity—these issues are rampant in our communities. And breast milk is the best preventative medicine nature provides.

3. Lack of diversity in lactation field: Not only are there blatant racial disparities in breastfeeding rates, there is a blatant disparity in breastfeeding leadership as well. It is not debatable that breastfeeding advocacy is white female-led. This is a problem. For one, it unfortunately perpetuates the common misconception that black women don’t breastfeed. It also means that many of the lactation professionals, though well-intentioned, are not culturally competent, sensitive or relevant enough to properly deal with African American moms. This is a week to discuss the lack of diversity among lactation consultants and to change our narrative. A time to highlight, celebrate and showcase the breastfeeding champions in our community who are often invisible. And to make sure that breastfeeding leadership also reflects the same parity we seek among women who breastfeed.

4. Unique cultural barriers among black women: While many of the “booby traps”™ to breastfeeding are universal, Black women also have unique cultural barriers and a complex history connected to breastfeeding. From our role as wet nurses in slavery being forced to breastfeed and nurture our slave owners children often to the detriment of our children, to the lack of mainstream role models and multi-generational support , to our own stereotyping within our community—we have a different dialogue around breastfeeding and it needs special attention.

5. Desert-Like Conditions in Our Communities: Many African American communities are “first food deserts”—it’s a term I coined to describe the desert like conditions in many urban areas I visited where women cannot access support for the best first food-breast milk. It is not fair to ask women, any woman, to breastfeed when she lives in a community that is devoid of support. It is a set up for failure. Please watch this video and educate yourself on the conditions in many vulnerable communities about what you can do (beyond leaving comments on blogs) to help transform these areas from “first food deserts” into First Food Friendly neighborhoods.

Ms. Tibbs, it’s National Breastfeeding Month. Why is breastfeeding a public health priority?

Calondra Tibbs: Breastfeeding is a critical public health issue, as it is the optimal source of infant nutrition, and has long-term health benefits for mom and baby. Breastfeeding protects babies from infections and decreases the risk of leukemia, sudden infant death syndrome and obesity. For mothers it reduces their risk of breast and ovarian cancer, diabetes and heart attacks.

Breastfeeding has many benefits, so why are there still disparities among black women and women living in poverty?

Tibbs: Disparities persist, as with many health outcomes, due to several barriers such as low availability and access to breastfeeding support, lack of family and community support, unaccommodating workplace and childcare environments, and aggressive marketing of infant formula.

Among infants born in 2014, black infants had the lowest breastfeeding rates of all reported race/ethnicity groups. Only 68 percent of black infants were ever breastfed as compared to 85.7 percent of white infants. Initiation rates for infants of mothers living in poverty was 73.2 percent among infants born in 2014.

Structural barriers disproportionately impact women of color and women living in poverty. For instance, birthing facilities using breastfeeding-friendly practices are less likely to be located in communities with high percentages of people of color or residents living in poverty.

In addition, the lack of federal legislation regarding paid family medical leave to support working families can impact decisions on returning to work. One-in-four women return to work within two weeks of delivery, and low-wage earners return to work sooner than higher wage earners. This limits the ability of women to establish breastfeeding prior to returning to work. And, although there are mandates for workplaces to support breastfeeding women, those working in the service industry are less likely to have adequate accommodations to support the pumping and storing of human milk.

Why has it been so important to increase breastfeeding rates among black infants?

Tibbs: Although there have been great strides in breastfeeding, this persistent disparity in breastfeeding rates suggests that there are other factors that impact breastfeeding in the black community. The goal of our collective efforts should be to improve maternity care practices for black women; champion workplace and paid family medical leave policies; provide skilled and culturally-attuned breastfeeding support in communities; and engage the broader community to promote a culture of breastfeeding.

What is the local health department’s role in supporting breastfeeding?

Tibbs: Local health departments can play a vital role in supporting breastfeeding and ensuring access to breastfeeding support. Local health departments and their partners are uniquely positioned to address breastfeeding by supporting policy, systems, and environmental changes that enable women to breastfeed at optimal rates. These include encouraging breastfeeding-friendly workplace and hospital practices and expanding community-level breastfeeding support.

The Centers for Disease Control and Prevention, recognized the critical role local health departments have in supporting breastfeeding in underserved communities. This effort, led by the NACCHO, supported 72 projects in 32 states. Collectively, they provided over 90,000 one-to-one encounters and over 3,000 breastfeeding support groups. Grantees also instituted innovative practices to address structural barriers to breastfeeding by building workforce capacity, partnering with worksites and collaborating with hospitals and healthcare providers to ensure continuity of care for breastfeeding mothers. These efforts were positive steps towards increasing breastfeeding among black women and women living in poverty.

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