Health Equity 101: Meet the Lactation Consultants Working to Address Racial Disparities in Breastfeeding

In the midst of the turmoil and confusion during the onset of the coronavirus in the U.S., a series of modern civil rights protests became one of the largest—if not the largest—uprisings in U.S. history.

The Black Lives Matter (BLM) movement has been growing since 2012, when Trayvon Martin, an unarmed Florida teenager, was shot and killed by a police officer who was responding to a neighborhood watch call about a “suspicious” person.

The public outrage eventually led the police officer George Zimmerman to be charged, but to the frustration of many, he was acquitted. This injustice was just one example in a string of countless others in which a Black civilian has been killed on the spot during a police encounter.

The reality is that a disproportionate number of those that are killed by police officers are African American—a symptom of systemic racism against Black Americans that goes back centuries, which has gone unchecked for far too long.

With social media, people have been able to voice their outrage against these atrocities, popularizing the #BlackLivesMatter hashtag, which became the rallying cry to increase the accountability of law enforcement. But approaching 10 years of advocacy on social media, the number of African Americans that have been killed by cops has only increased.

Most recently, Breonna Taylor and George Floyd’s unconscionable killings launched a new level of backlash so resounding, the movement has reached an unprecedented level of support. The New York Times estimated that a whopping 26 million people attended at least one of the 4,700 BLM protests that took place across the U.S. between May and July. (This does not include the protests across the world, in Europe, Asia, West Africa, South America, and Australia.)

Conversations have started to pop up on all media platforms—from print to TV newscasts to YouTube—about how the U.S.’s racist roots continued to weave into our present-day culture and the changes that need to be made so that we can work toward ending these disparities. Police brutality is one major aspect that must change, but there is a myriad other aspects where we can still find tangible evidence of racial inequality in the U.S.

One of those areas is motherhood. From pregnancy to childbirth and postpartum, Black mothers are at a disadvantage.

On the campaign trail, U.S. senator and Democratic vice president nominee Kamala Harris has been speaking about the injustices that Black women face during pregnancy; African American women are two to three times more likely to die from pregnancy-related causes than white women.

A study from the Centers for Disease Control and Prevention (CDC) identified that 60 percent of these deaths could have been prevented with better healthcare, communication, and support, as well as access to stable housing and transportation, The New York Times reported.

Another area of concern is breastfeeding. According to a study released in 2020 from the CDC, 83 percent of mothers in the US breastfed their infants after birth but only 69 percent of Black mothers do. That’s a 16 percent disparity. African American moms also have the shortest duration of breastfeeding, with less than 45 percent doing so at six months compared to 62 percent of white women.

We interviewed a breastfeeding peer counselor to learn more about the hardships that Black mothers are facing.

Meet the Expert: Earlisha Killen

Earlisha Killen is a breastfeeding peer counselor for the Riley County Health Department’s Women, Infants, and Children (WIC) program in Kansas, where she works to support breastfeeding mothers, a position that she has held for three years. She holds a Certified Lactation Counselor (CLC) certification, which many nurses, childcare professionals, and doulas choose to obtain to widen their skillset.

She is also the treasurer of the Kansas Breastfeeding Coalition (KBC), where she has served for two years. She holds a bachelor’s of science in human nutrition from Kansas State University and is a mother of three children.

Killen has a passion for breaking down the barriers that Black mothers face in breastfeeding and spreading awareness about the benefits of breast milk. Before we get to breaking down why African American women breastfeed at a lower rate than white mothers, let’s establish why it’s so important that women have the option to breastfeed in the first place.

Why Breastfeed?

“Breastfeeding is safe and natural—and it’s more than just food for the baby,” Killen said. “There is that opportunity to bond.”

It is true, of course, that baby formula is the best alternative when breastfeeding is not an option, but Killen says there are risks to consider, such as factory contamination: “So much so, it often gets recalled,” she added.

According to the CDC, powdered infant formula is not considered sterile. Manufacturers report that it is not possible to eliminate all germs from formula—and sometimes, recalls must be made. This can lead to cronobacter infections, which has a 40 to 80 percent mortality rate. But even if your baby is not exposed to contaminated batch, the consumption of formula can lead to childhood obesity, diabetes, eczema, and asthma.


“[Breast milk] is also a protective factor against sudden infant death syndrome. We talk a lot about SIDS with moms,” Killen said. The syndrome affects about six babies per every 1,000. About 2,300 babies in the United States die of SIDS each year. Breastfeeding has been shown to lower the risk because it promotes safer sleeping, which prevents SIDS from occurring.

“There’s a lot of different factors that go into it [SIDS]. There’s no ‘tell all’ as to why it happens,” Killen said. “Part of it has to do with unsafe sleep habits, but formula is a huge factor. And it happens more in African Americans and in boys.”

The final downside of using formula is that it’s very pricey. At $25 per can, feeding eight times a day, it costs into the hundreds of dollars a month to feed a baby with formula, even with government aid.

“Yes, there is formula available, but no one is making a significant profit off of breastmilk. There is a 300 to 400 percent markup on formula,” Killen added.

The moral of the story is that breastfeeding is the best way to go if you can. “It is the stepping stone for immunity. You could save your baby from being a patient you have to take care of every day,” Killen said.

Why Breastfeeding Rates Are Lower Among Black Mothers

With so many advantages to breastfeeding, it’s worth exploring why almost one-third of African American mothers aren’t breastfeeding their babies. As it turns out, there are many factors at play.

Racist Historical Roots and Lack of Representation

Like police brutality against Black Americans, which dates back to the days of lynching, disparity in breastfeeding also has a long history.

“Breastfeeding for the African American population—a lot of it goes back to slavery,” Killen said. “We, women of color, nursed our slave masters’ children and our children often died because we didn’t have enough milk.”

Being forced to act as wet nurses for slave owners and, in turn, not being able to nurse their own babies is a factor that has influenced African American families to become somewhat dissociated with breastfeeding.

This can be thought of as a lack of representation. We hear this phenomenon talked about often when it comes to gender disparity in certain male-dominated industries. For example, in engineering, we see fewer women portrayed as engineers and as a result, fewer girls grow up wanting to become them. So is the case with breastfeeding: if African American girls do not see their mothers, sisters, and aunts breastfeeding their babies, then they may steer clear of breastfeeding when they have their own children.

“A lot of time, I am the only support system that a breastfeeding mother has,” Killen said. She often has clients whose families think the practice of breastfeeding is strange or off-putting, and are not cooperative when it comes to babysitting and handling the breast milk.

Even within breastfeeding counseling, there is a certain problem of a lack of representation of Black women.

“A lot of African Americans will say, ‘Oh, you’re white so you don’t really understand,’” Killen said. “You don’t have to be a certain color, but it helps. It’s perception. When we have white people telling Black people what to do, Black people don’t really like that. [When there’s representation], there’s that unity. There’s that feeling of, ‘I’m Black and you’re Black. You know my struggles.’”

The organization Chocolate Milk Cafe, which has a chapter in Kansas City called Uzazi Village, offers breastfeeding counseling classes specifically for African American and/or Black women to provide “a sacred space where families that are part of the African Diaspora can be supported and empowered to breastfeed.”

The KBC has a strong working relationship with Uzazi Village. Their executive directors meet frequently to coordinate and inform each other’s work. “The KBC stands in solidarity with Uzazi Village and supports their work whenever and however possible,” Killen said.

Having Black peer counselors available in the majoritively white city has been a boon to encouraging African American mothers to learn how to breastfeed in Kansas City.

Logistical Challenges

Another huge factor preventing more Black mothers from breastfeeding is the sheer challenge of pumping throughout the day while holding down their jobs.

African American workers face more hurdles to find any kind of work—let alone quality jobs—than their white counterparts do, often culminating in lower pay, poorer benefits, and less job stability. The kinds of workplaces that many of Killen’s clients go to earn their livelihoods aren’t concerned about their employees’ needs, as far as accommodations for breastfeeding or childcare.

“I have moms that say, ‘I just don’t have the time,’ or ‘I have to go back to work and my job won’t let me pump.’ A lot of our clients work in fast food so they don’t have the privacy to go and pump,” Killen said.

“That is one of the things I do with the KBC: to try and find moms the space to pump at their jobs. Even if you’re working an eight-hour shift and you take your 15-minute breaks to pump, that’s what you have to do.”

It takes most moms about 15 to 20 minutes to gather their supplies, pump, and store their milk to take home later, which is difficult to juggle while working a full-time job.

“If you don’t remove the milk from your body, you are going to stop producing it and you’re going to dry up,” Killen said. So, for working mothers, sticking to breastfeeding takes serious dedication. It’s easy to see why some mothers opt for formula instead.

White mothers are also more likely to be stay-at-home moms than Black women, but even working white mothers are more likely to have employers that offer benefits and schedule flexibility, which means they have an easier time arranging their breastfeeding schedules.

These disparities open up a whole other can of worms that need to be addressed, but as far as managing in the meantime, Killen recommends that her clients get creative about finding places to breastfeed. The website Mamava shows users a map with the closest lactation room available to the public. “Some businesses have signs that say, ‘Breastfeeding is welcome here,’ which basically means that they’ve trained their staff not to not disturb you.’’

Societal Resistance

Related to the logistical challenge is the stigma associated with breastfeeding in public—and even breastfeeding, in general. Killen told of her own personal experience during her time working at a retail job in which she was met with resistance from her employer to provide her the time and physical space to pump during her breaks.

“I remember looking at my boss and telling her, ‘Legally, you are required to give me a place to pump. If you can get paid to smoke a cigarette for an extra 20 minutes, I should be able to pump,’” Killen said. “All I was asking for was 15 minutes, three times a day in an eight-hour shift. I fought it, but the thing was, she was a mom. She breastfed her kids, but she was a stay-at-home mom. I shouldn’t have had to fight for myself, but I did. I loaded them with the facts.”

Even with laws in place made to protect breastfeeding mothers, employers don’t necessarily respect their needs. Many of them view providing time and privacy for breastfeeding as a favor, not an obligation to their employees—even fellow mothers.

“I tell all of my clients as soon as they get pregnant, talk to your boss about it. Have that conversation the second that you are pregnant because I can guarantee it will take them a few months to come around,” she said.

A Lack of Education About the Benefits of Breastfeeding

Finally, there is simply a general lack of education about breastfeeding. Having the time to spend reading and researching about how to breastfeed is a privilege that some mothers—especially those that are in a low-income bracket—just don’t have.

“When it comes down to it, they are more worried about labor and daycare and the cost of diapers,” Killen said. “Learning to breastfeed is more than just figuring out how to latch. It’s about timing feedings, especially if it’s a working mother, having a private place to pump, and keeping breastmilk cool.”

“There is a lack of knowledge and lack of seeing that it’s actually a good thing, not a bad thing. And I’m going to be 100 percent honest. I’ve had so many clients both white and Black that say that breastfeeding is ‘disgusting.’ People sexualize breasts. They don’t like the idea of their baby nursing on their breast or perhaps their significant other claims their body. I can’t be judgemental, but I remind families all the time that breasts serve two purposes.”

The Importance of Breastfeeding Support

The availability of breastfeeding peer counselors to low-income mothers is important. They provide vital information that helps mothers choose how they will feed their babies, give them tips if they are struggling to get their baby to latch, bust misconceptions, and encourage mothers to persevere when challenges arise.

In the African American community, promoting breastfeeding has another dimension of significance; it means making sure that Black children get all the advantages that their white peers face.

“There’s always something that brings us 20 steps back. I don’t want to say we’re done doing the work that needs to be done,” Killen said, “but as times change, we make headway. The Black breastfeeding rates are finally increasing and that’s one thing I absolutely love to see.”

Nina Chamlou

Nina Chamlou

Writer

Nina Chamlou is an avid writer and multimedia content creator from Portland, OR. She writes about aviation, travel, business, technology, healthcare, and education. You can find her floating around the Pacific Northwest in diners and coffee shops, studying the locale from behind her MacBook.

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