I was 8-years-old, the same age my daughter is now, when I first witnessed it. My mother had taken me to visit a family friend who just had her first child. She and I stayed several feet away from the newborn. My mother never once asked to hold her, but we watched on, as the mother comforted and coddled. In her mother’s arms, this living doll wiggled and cooed, and in response, mid-sentence, without even looking down, the mother released her breast from her bra and brought her baby to it. I giggled.
My mother asked, “what are you laughing about? She’s feeding the baby.” I squirmed. Then she said, “This is how I fed you and your brother. This is how human babies eat. Their mommies’ breasts are their bottles. It is the reason that mommies have breasts.”
Just like that, breastfeeding was normalized for me. As the youngest in my family, I had never seen this beautiful and necessary act before, and there was never any need or opportunity to discuss it before that impactful moment.
From that point on, breastfeeding became a part of my imaginary doll play. Later on, it was my new parent- and toddler parent- hack and ultimately—my life’s work. Today, I am a women’s wellness consultant, offering services that range from pelvic floor occupational therapy, to perinatal yoga and massage, to breastfeeding support, as an international board certified lactation consultant (IBCLC). I work in a children’s hospital, supporting the families of some of the most fragile infants in the southeast. I also teach human lactation to physicians, midwives, doulas, nurses and most importantly, aspiring lactation consultants.
In 2020, there were approximately 3.6 million babies born in the United States, according to the Vital Statistics Surveillance Report. Comparatively, there are approximately 19,000 certified lactation consultants in the country, which is not nearly enough to adequately support all of the parents and families who need it. Breastfeeding is natural. It is not necessarily easy, and without support and historical context, many families find it to be inconvenient, unnecessary and impossible.
Way Back When …
Humankind has survived infancy by receiving the milk from the breasts of the birthing mother—sometimes a close relative or neighbor. This phenomenon is the way we not only existed but also thrived until relatively recently. Our very survival was dependent upon an infant having access to its mother’s milk. Prehistoric paintings and carvings depict mothers feeding their young from their bosoms, as all mothers of mammals do. At some point between the 1500s and late 1700s, breastfeeding became out of fashion for wealthier families in the west, who shifted the responsibility to enslaved- wet nurses or fed their infants a very unhealthy artificial milk, made from animals, bread and water, fed to them in filthy containers. Many “hand fed” children died young during this period and in the 1800s, doctors affirmed that direct breastfeeding was most ideal, whenever possible, as it was healthier, cleaner and more sustainable.
The infants of many enslaved wet nurses also perished, as they were often fed only after the children of their master. By the 1900s, chemists joined physicians in attempts to make an artificial feeding formula that was more like human milk, served in glass bottles, which were able to be sterilized.
During the first world war, working mothers had to be separated from their newborns, making bottle-feeding and pacifiers unfortunate necessities. Affluent white women used a cow-based formula regularly, which was readily available at drug stores. However, Black mothers, who were unable to afford the formula, continued to feed their own children from their breasts. In 1946, Pet Milk hired a white doctor in North Carolina, to target Black consumers by enticing them to purchase their infant formula. This mad scientist delivered, removed, named and raised a set of quadruplets, now known as the Fultz Quads. They were taken from their sharecropping family who was paid nominally, in exchange for inhumane experimentation and predatory advertisement. The four girls were exploited, being featured in Ebony magazine by the age of one, and traveling to fairs, as the literal poster children for Pet Milk. Their images, all throughout Black publications, helped to increase company profits by 600%. The Fultz Sisters grew up as celebrities, as fewer and fewer Black women were breastfeeding. Providing infant formula was now seen as an accessible status symbol among the Black community and breastfeeding rates plummeted, creating disparities that we have yet to overcome today. At the same time, Black and African breastfeeding was seen as savage and uncouth on the pages of world magazines.
By the 1970s, white women were beginning to appreciate breastfeeding again; especially women who could afford to stay home with their children. Black women were working outside of their own homes and were by this time, heavily reliant upon infant formula. My own grandmother, who had breastfed seven children of her own, tried to convince my mother not to breastfeed, as it was seen as unfashionable and unnecessary. After all, my mother had a husband, a home, a good job and could afford formula. Fortunately, my mother insisted on breastfeeding us for as long as she could.
With breastfeeding support groups catering to white stay at home moms, and formula companies targeting poor, undereducated, working Black mothers, the cultural differences in breastfeeding began to deepen and widen. Unfortunately, the differences are not simple matters of culture, preference and convenience. There are immediate and long term medical benefits to providing human milk to infants. There are also known risks to providing artificial milk to infants. Infant formula has its place for infants and families who need it and for those who choose to provide it. However, no matter what the label says, it will never contain the balanced nutrition, disease fighting antibodies, bioavailable hormones that living, human milk does. For some fragile Black babies, these differences can mean life or death.
Right About Now …
Today, the Black maternal and infant mortality rates are on par with developing nations and war torn countries. Putting aside prenatal health, education, access to care and socioeconomic status, Black mothers and infants are 2-3 times more likely to have complications, including death, within the first year of birth, than other groups—ask Serena Williams and Allyson Felix. Because it is nutritionally dense and easily digestible, human milk is the preferred first food of infants who need special care. It allows infants who are born early, small or sick, to eat and grow better and to heal faster, leading to a more desirable health outcome, even over time. Human milk can lower mortality rates by up to 50 percent. Despite these facts, the Center for Disease Control and Prevention finds Black infants are nine times more likely to be offered infant formula in hospitals than other children—an act which often derails breastfeeding altogether.
Structural racism has denied too many Black parents the opportunity to provide human milk to their children. They are bombarded with formula ads and samples. Mothers are often forced to return to work within weeks of the birth which decreases the likelihood that a full milk supply will be established. Once new moms return to work and despite the federal regulations around breastfeeding support in the workplace, it is much less likely that a Black mother has the break time, space or compassion from her employer to express her milk every 3 hours while at work. This is how a lactation consultant may find herself on Capitol Hill advocating for paid parental leave.
Because we have now gone multiple generations without breastfeeding, many mothers today have no breastfeeding family members or friends. Fortunately, over the last eight years, there has been an explosion of breastfeeding support circles and online imagery, celebrating unapologetic Black breastfeeding and support.
The professional field of lactation is overwhelmingly white, old and in many instances racist. It was never created to support Black families. These factors make supporting the families who need it most unlikely. If care providers are not able to humanize Black mothers, value the lives of their Black children or humble themselves, they will not be able to provide competent or compassionate care that supports the end goal of providing human milk. Professional and educational leadership in lactation is shifting, as there are now more self-preserving, Black centering and community-based organizations than ever. The old guards and gatekeepers of this relatively new profession are finding themselves in rooms, on panels, in books and on boards with people whose hospital beds they would have dismissively walked by 10 years ago.
August is National Breastfeeding Month. Within it, we celebrate World Breastfeeding Week, Indigenous Milk Medicine Week, Asian American, Native Hawaiian and Pacific Islander Breastfeeding Week and Black Breastfeeding Week. In its ninth year of Black Breastfeeding Week, we take “The Big Pause: Collective Rest for Collective Power” and after centuries of first food sabotage, we need it and we deserve it.