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 head goal is to work to confer these benefits to all infants and birthing people, there exist 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 do not 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. As we work to commemorate National Breastfeeding Month and Black Breastfeeding Week, we should evaluate the factors 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.
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 cannot exercise their “full” ability to feed in the absence of informed consent or education about what is best for themselves and their babies.
One systemic barrier barring Black birthing people from breastfeeding is the decision-making occuring 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 are not often attempting to breastfeed under circumstances that are ideal. Rather, it is more beneficial for them to forego the endeavor for 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.
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.
