- Ayanna Robinson, Ph.D., MPH
Race, Social Justice, and Support – A Journey through Breastfeeding
As I think back on my breastfeeding journey, there were key points of intervention that undermined my voice and showed either lack of genuine support or lack of trust in my abilities to breastfeed. I decided before my daughter was born that I would breastfeed for at least a year, according to recommendations by the American Society of Pediatrics. I expressed my desire to breastfeed after giving birth, yet I still left the hospital with bags of formula and formula coupons. Sending formula home with mothers who are breastfeeding sends a mixed message about their ability to be successful in breastfeeding, a message that we cannot trust our own bodies to naturally produce the food to nourish our babies. Barely out of college, I qualified for WIC when my daughter was born, and I'll never forget that first and last visit to my WIC office. I was told by my counselor that I should take the formula vouchers, that I would need formula “so other people could watch my daughter when I wanted to go out”. This was prior to the Affordable Care Act, but I was given this advice even though I expressed my desire to exclusively breastfeed. In that moment, I felt like I was being written off as a stereotype, a character in a myth about Black mothers and breastfeeding. I wondered what made the counselor believe that I would need formula? Was it my age? My race? We cannot deny the stereotypes that are placed on Black mothers mirrored in apathy from health care professionals who promote formula over breastfeeding to Black mothers or provide little to no breastfeeding counselling based on assumptions rooted in an implicit bias.
Human milk is celebrated as the optimal source of infant nutrition. It lays the foundation to improve the health outcomes for women and children, yet many mothers are not breastfeeding according to national recommendations, which is not necessarily a reflection of their own desires. Assessment, policy development, and assurance are the three core functions of public health. It brings into question ethics to recommend mothers should participate in a behavior without ensuring that every woman has the support and resources to carry out her decision. It is analogous to suggesting that people live active and healthy lives, eating 5 servings of fresh fruit and vegetables daily, while living in food deserts or without access to safe spaces in their communities to be physically active. Discussions on breastfeeding and breastfeeding disparities allow us to examine the topic within existing systems like racism, discrimination, and sexism. It opens our eyes to the intersectional existence of Black mothers and how it relates to our everyday experiences and decisions. Breastfeeding is a social justice issue.
I was my own case study that segmented into my research on breastfeeding among African American mothers. Despite the contradictory messages I received at these points of care, my confidence in my ability to breastfeed was high. I went on to exclusively breastfeed for six months and continued to breastfeed, after adding solid foods, for a total of 15 months when my daughter began to self-wean – all while being a full-time graduate student and working part-time. So, what was the recipe that allowed me to defy statistics as a relatively young mother? I attribute my determination in breastfeeding, in part to my upbringing. My parents created an environment filled with positive racial socialization where ancestral ways of doing and knowing were embraced. For me, this also translated to my view of breastfeeding as a normal way infant feeding and, when others reflected doubt, a stronger determination for me to continue. In addition to the family support I received, I received support from a mom friend who was also breastfeeding, and a caring IBCLC in the hospital who visited me shortly after given birth and checked in with me a week after my daughter was born. My encounters with both individuals also added to my confidence in breastfeeding.
Support and self-efficacy are facilitators for sustained breastfeeding and while my own journey through breastfeeding was joyous and without any major difficulties, there are many Black mothers who still don’t receive the support they need for breastfeeding. For mothers who are in less supportive family/peer environments, care and support from health care providers becomes even more critical and when our health care providers doubt our abilities, we begin to doubt ourselves. We can no longer afford to ignore the voices and experiences of Black mothers as it relates to breastfeeding or other areas of our health. We have to frame our view not only to focus on mothers and their decisions, but on the institutions that continue to fail them. The health of future generations depends on it.