Impact Stories

Black Breastfeeding Week: Celebrating Community Bonds, Breaking Barriers for Birth Equity

Impact Story | August 28, 2023
Los Angeles, CA (Public Health Alliance of Southern California)-- August 25 to 31 marks the 11th annual Black Breastfeeding Week. This year's theme, “We Outside: Celebrating Connection & Our Communities,” honors the beautiful bonds within Black communities and uplifts breastfeeding as a vital strategy for improving the health outcomes of Black mothers, birthing individuals, and infants. The week also presents an opportunity to drive systemic change and take steps to ensure that all families, irrespective of race or location, get the support they deserve to reap the benefits of breastfeeding.
 “As we continue to support families with breastfeeding, we're actually supporting the building of communities. We're building healthier and more thriving communities. Disparities we see for maternal and infant health very much reflect low breastfeeding rates,” said Asaiah Harville, Birth EquityManager and International Board-Certified Lactation Consultant (IBCLC) withCherished Futures for Black Moms and Babies (Cherished Futures.)

Opportunity for Change: Addressing Disparities in Breastfeeding 

Despite the long-term benefits of breastfeeding for mothers, babies, and society, the data reveal preventable barriers and disparities. 

Infant formula companies have a longstanding history of aggressively targeting and exploiting Black communities through marketing campaigns. This trend continues today, making it no surprise that in Los Angeles County birthing hospitals, infants of color are often less likely to be exclusively breastfed upon discharge.  This report notes the areas of Los Angeles County with the highest rates of infant mortality also have the lowest rates of exclusive breastfeeding at three months and the fewest lactation support resources. 

Black mothers in the U.S. are 2.5 times less likely to breastfeed and nine times more likely to be offered formula by hospitals, than white moms. These stark numbers are more than statistics; they represent a system that has repeatedly failed to provide adequate lactation support for Black families, further perpetuating the inequities that exist in infant feeding. 

Hospitals that predominantly serve Black communities frequently fall short in providing post-delivery breastfeeding support. As Harville points out, these glaring disparities present opportunities for hospitals to reassess and rebuild practices to ensure that all families receive the comprehensive care they deserve.

Racism and Its Influence on Black Breastfeeding Rates Today

 Harville explained that in examining disparities in breastfeeding rates among Black families, it’s crucial to dispel the notion that they simply don't want to breastfeed—in reality, breastfeeding is a privilege for many. Harville said it's essential to offer context and understand the complete picture, as these myths and misconceptions can exacerbate health disparities. 

For women of African descent in the United States, there is a unique lived experience that factors into views on breastfeeding. Enslaved women were denied autonomy of their bodies and were forced to nurse their enslaver’s infants, often at the expense of their own infants. This gross human rights violation resulted in lasting intergenerational trauma and stigma around breastfeeding in communities of color.  While this is not the only factor in choosing an infant feeding method, it is one that plays a role in the way some view the role of breasts and infant feeding, and the ways in which some families and communities determine how they will feed their babies.
We really have to start bringing together the narrative with the data, identify the gaps, identify opportunities for improvement, but also dispel myths that have now been passed down as a result of chattel slavery,” Harville emphasized. 
Today, most lactation consultants are white, Harville pointed out, which can lead to a lack of understanding and cultural competency. White lactation consultants may struggle to address the deep-rooted hesitancy passed down through generations or to properly support Black families and meet their individual needs.
"We think myths around ‘Well, they just want to formula feed anyway,’ but we don't think about the impact of the lack of paid maternity leave,” Harville explained. “And so often, Black and Brown women, who are already being underpaid, don’t have as much leave time. They don’t have the ability to spend the time to get support because sometimes they have to go back to work really quickly. So there are lots of factors that influence those myths. And I think the misconceptions come from just a lack of knowledge, and really a lack of awareness of all the factors that really do influence breastfeeding decisions.”

Positive Impacts of Black Breastfeeding

Breastfeeding offers extensive health benefits to both infants and mothers. Harville noted these benefits are particularly impactful in Black communities and other communities of color, as they reduce the risk of several racial health disparities. 

Breastfeeding’s correlation to a decrease in sudden infant death syndrome (SIDS) holds a special significance for Black infants. Black babies tragically face higher mortality rates and an increased frequency of preterm births. But there's hope and strength in understanding that these disparities can be partly alleviated by reducing barriers to breastfeeding. 

Harville also highlighted that breastfeeding is integral in building strong, healthy foundations for infants as it improves their gut health and overall immunity.  This natural connection between mother and child lessens the chance of gastrointestinal illnesses, ear infections, colds, and flus. It also helps prevent diabetes and obesity in childhood and throughout life. 

Harville revealed a lesser-known fact: the long-term benefits of breastfeeding also extend to the feeding parent. Breastfeeding can reduce the risk of cardiovascular disease,  the leading cause of death among Black women in America.
 “When we think about the benefits of breastfeeding for moms, we think about the reduction in breast cancer and ovarian cancer risks, which are very serious and things that we want to reduce our risk for. We also think about the short-term risks in terms of reducing postpartum hemorrhage, which is one of the leading causes of maternal morbidities here in this country,” Harville said.

 Cherished Futures and Antelope Valley Medical Center Making a Difference in Breastfeeding Support

Cherished Futures is a collaborative of local hospitals, public health departments, insurance companies, and Black leaders that develop innovative strategies to improve Black maternal and infant health outcomes. Cherished Futures' mission is to drive systemic change to ensure birth equity. A central part of its work focuses on two-year cohort partnerships with hospitals in the Los Angeles area. By committing to working with Cherished Futures, these medical centers strive to transform the way the healthcare system serves Black mothers and their babies. 

Recognizing that enhancing Black breastfeeding rates can be a strategy to prevent infant and maternal mortality, two hospitals in the Cherished Futures 2022-2023 cohort, including Antelope Valley Medical Center, are focusing on breastfeeding as a clinical intervention to improve infant and maternal health. 

 Yvonne Reifenstahl, a registered nurse at Antelope Valley Medical Center, noted that no specific initiatives were in place for Black breastfeeding before collaborating with Cherished Futures. Upon initiating their work with Cherished Futures, Reifenstahl said the center analyzed its data by race and ethnicity, discovering significant disparities in Black breastfeeding rates. After examining the data, they began investigating the underlying causes of disparities and potential solutions to address them during the patients' hospital stays. 

With the help of Cherished Futures, Antelope Valley Medical Center is now educating staff about the historical and cultural context of why Black families may not be choosing to breastfeed. The center is updating these learnings quarterly to facilitate in-depth and holistic understanding.
“It's really important for our nursing staff to understand that history and how that history has shaped Black culture in regards to the choice to breastfeed,” Reifenstahl said. “If a Black mom asks for formula, the nurse shouldn't assume she just doesn't want to breastfeed or is looking for something for free, but rather to take the time to discuss why she is asking for formula and make sure that she is making an informed decision about what is best for her and her baby.” 
In addition to doing outreach at community events, Antelope Valley Medical Center launched a free monthly Community Black Breastfeeding Support Group, which is open to all interested people. Reifenstahl anticipates this new approach will have the most significant long-term impact.
 “Giving these moms and babies the benefits of breastfeeding and creating positive experiences for them can begin a cultural shift in the view of breastfeeding and hopefully lead to more Black families choosing to give breast milk. Our goal is that the efforts that we're doing here will be creating that ongoing change within our community,” Reifenstahl emphasized.
Just a year into the cohort, Antelope Valley Medical Center is seeing striking impacts.  Reifenstahl expressed pride in the significant progress made, pointing to an increase in exclusive Black breastfeeding rates from around 40% to 70%. To date, they’ve also increased lactation consultations with Black patients from 30% to a complete 100%.

Reifenstahl describes her work with Cherished Futures as a wonderful and eye-opening experience and strongly encourages other hospitals to get involved. Her advice to other hospitals is simply to take the first step.
"It's really overwhelming at the beginning when you're first looking at the big picture, institutional changes. But even a small change, just taking one step, can lead to significant results. And once that one step is taken, it really leads the way, it opens up to the next step, the next step, and starts to just create a path,” Reifenstahl said.

  The Big Picture: Envisioning a Future of Health Equity through Collaboration, Support, and Innovation

Innovative initiatives like Cherished Futures, along with the coordinated support, effort, and best practices implemented by hospitals like Antelope Valley Medical Center, can truly drive transformational, systemic change. 

Cherished Futures and Antelope Valley Medical Center serve as a model for how cross-collaboration can create tangible, meaningful differences in patient experiences, health outcomes, and society. 

Though it is crucial for hospital systems to spearhead this transformation, the urgent need for policy changes and community-led solutions cannot be understated. These shifts can help rectify disparities, dismantle barriers, uplift community-driven interventions, and empower Black families to breastfeed. 

Harville outlined various steps that hospital systems, governments, insurers, community organizations, universities, and residents can take and support to remove barriers to Black breastfeeding: 

Prenatal Education:
Hospitals should amplify efforts to educate expectant parents about feeding options and milk production, and encourage them to inquire about infant feeding during pregnancy.
 Harville explained, “We can't change the trauma that they may have experienced, but we can change the way that we support folks in that moment. So I think it really starts with prenatal education. We find that when folks are educated during their pregnancy about their feeding options, they are more likely to at least try breastfeeding.”
 Lactation Education for Healthcare Providers: Since lactation education is not mandatory in nursing or medical school, integrating it into curriculums is essential. This can help ensure healthcare providers are equipped with the necessary tools to support and facilitate patient breastfeeding.

 Increasing Black Lactation Representation: Increasing diversity and representation in healthcare leads to better health outcomes for Black patients. By reducing barriers to becoming a lactation consultant—like decreasing educational and exam cost burdens—we can help guarantee healthcare providers reflect the communities they serve and that patients receive the culturally competent care they deserve.  

Federal Paid Maternity Leave:   Supporting the introduction of federal paid maternity leave legislation, to allow time for breastfeeding and recovery from childbirth, is key to enhancing health outcomes. Having no federal paid maternity leave in the U.S. predominantly affects the health and well-being of Black women, who face higher risks of maternal mortality. Historic policies have limited Black wealth accumulation and access to education, resulting in income inequality. Black individuals are often less likely to have jobs with benefits like paid family leave, compared with their white counterparts. Implementing federal paid maternity leave would be a lifeline for families by offering them the flexibility and economic stability needed to breastfeed.  

Marketing Regulations for Breast Milk Substitutes:
It's crucial to pressure infant formula companies to stop targeting Black and low-income communities with their marketing campaigns. By reforming the ethical standards of infant formula advertising, we can prevent the stigmatization of Black families' relationships with breastfeeding and relieve undue social and economic pressures on parents to opt for formula.  

Improving Insurance Coverage: Ten states, many home to large Black populations, have not expanded Medicaid, creating a gap in essential maternity services. Though the Affordable Care Act (ACA) mandates coverage for breastfeeding education, lactation consultation, and breast pumps, these benefits often remain inaccessible and  Black women disproportionately rely on Medicaid or go uninsured. States that have expanded Medicaid show progress in Black maternal and infant health. Yet the lack of standard coverage for doulas and lactation consultants, due to inconsistent private insurer practices, impedes efforts to boost breastfeeding and foster health equity. Expanding Medicaid and enhancing private insurance practices to include these services is a vital step toward promoting health equity.  

Celebrating this 11th Annual Black Breastfeeding Week means committing to fostering environments and clinical strategies that truly honor, support, and uplift every family’s choice and potential. Black Breastfeeding Week is both a milestone and movement. It’s a movement to honor the love and autonomy of Black communities and reclaim the power of breastfeeding to enhance outcomes and prevent racial health disparities. 

The lessons, success stories, and strategies shared above are the seeds of change that can reduce barriers to Black breastfeeding and put us one step closer to making health equity a reality. Ultimately, the choice of how parents feed their babies lies with them. However, we know that when communities, organizations, public health, and healthcare systems unite with knowledge, compassion, and purpose, a more equitable future that supports lactation as preventative medicine is within reach.

  More About the Mission of Cherished Futures for Black Moms & Babies

 Cherished Futures is a multisector collaborative effort to reduce Black infant deaths and improve patient experience and safety for Black mothers and birthing people in Los Angeles County by driving systems change at the clinical, institutional and community levels.

Cherished Futures is a joint initiative of Communities Lifting Communities, the Public Health Alliance of Southern California, and the Hospital Association of Southern California. 

Over the past year, Cherished Futures’ work with five participating hospitals (AVMC, Miller Children’s and Women’s Hospital Long Beach, St. Francis Medical Center, Torrance Memorial Medical Center and UCLA Health) is working to improve birthing experiences and outcomes for Black moms in several areas, including breastfeeding. 

Cherished Futures for Black Moms & Babies is funded in part by Ballmer Group; Centene Foundation for Quality Healthcare; First 5 LA, a leading public grantmaking and child advocacy organization; and L.A. Care Health Plan, which provides health coverage to low-income and uninsured residents of Los Angeles County.