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By society’s standards, I was accomplished and successful. I graduated in the top 1% of my high school class, attended a prestigious undergraduate university, graduated with distinction from medical school and attended a top-tier pediatric residency program. However, in 2007, within minutes after giving birth, I realized I had no clue how to breastfeed my newborn son. I realized that I had never seen a Black woman breastfeeding her baby during medical school or my pediatric residency.
I only saw Black breastfeeding firsthand when my sister unapologetically nursed her children in 1999 and 2001. When my baby nieces cried, my sister proudly breastfed without shame or guilt. Breast milk is the gold standard for nutrition during the first two years of life, but the repercussions of chattel slavery have removed Black women from full bodily autonomy. With my sister as my only role model, I learned to unapologetically provide my babies with my milk, reclaiming my Black body and agency as a fully humanized individual. I also regained my power to reduce health risks for my children and myself.
The American Academy of Pediatrics recommends breastfeeding to reduce sudden unexpected infant deaths (SUID) that are attributed to sudden infant death syndrome (SIDS). SUIDs are explained and unexplained infant deaths under 1 year old, while SIDS are unexplained deaths after investigation. A recent editorial article in Pediatrics highlighted widening disparities in SUID death rates between 2019 and 2020, with non-Hispanic Black infants at three times the SUID death rates as non-Hispanic white infants. The protective effect of breastfeeding increases with exclusivity, but any breastfeeding has been shown to be more protective against SIDS than no breastfeeding. Unfortunately, disparities in Black breastfeeding mirror disparities in SUID death rates. According to the 2022 Centers for Disease Control (CDC) breastfeeding report card, fewer non-Hispanic Black infants (74.1%) are ever breastfed compared to Asian (90.8%), non-Hispanic White (85.3%) and Hispanic infants (83.0%). Lest we think it is not happening here, breastfeeding rate disparities persist in Indiana as well.
Importance of breastfeeding:Op/Ed: Breastfeeding offers health benefits for Hoosier babies, moms and saves money
Once families leave their birthplace, breastfeeding rates drop slowly but consistently, suggesting they need additional support that facilitates extended exclusive breastfeeding. However, there are ways to increase Black breastfeeding rates. First, close support systems (i.e., partner, grandma, auntie, papa) can normalize Black breastfeeding. Second, Black-led lactation peer support groups have been shown to improve infant-safe sleep practices and increase breast milk rates in African American communities. Third, education of medical providers on the history of racism Black people experience in medicine, social determinants of health and implicit bias is vital. Furthermore, practices that support breastfeeding are key in the early hours and days to help new parents establish and reach their breastfeeding goals. Culturally supportive policies and community support can help families sustain breastfeeding. Examples of policy change include, but are not limited to, paid family leave, universal child care, universal health care and a living wage. Finally, local health data for Indiana breastfeeding rates needs to be stratified according to race and ethnicity at the county and preferably zip code level, not to invalidate breastfeeding disparities but to measure improvement.
The counterargument for targeting Black communities with these social safety net programs is reverse racism. Isabel Wilkerson’s book “Caste: The Origins of Our Discontent” points out that Black people have been at the bottom of a caste system for hundreds of years. The Black community endures and dies from policies, laws and regulations disadvantaging them through systemic racism. By claiming our full humanity through practices such as breastfeeding, we can reconcile hundreds of years of injustice and improve our nation’s infant mortality rate by reducing inequities in the SUID death rate.
My two oldest remember me breastfeeding their youngest sibling as a baby. My youngest proudly pretends to breastfeed dolls instead of giving them a bottle of formula. Generational change is happening, and it will lift all boats.
Dr. Melissa Klitzman is an assistant professor of clinical pediatrics at the Indiana University School of Medicine.
Tiffany Davis is director of Maternal and Child Health and project director for Indianapolis Healthy Start at Marion County Public Health Department. In addition, she is an adjunct faculty member at Indiana University.
Klitzman and Davis lead a community-university partnership in forming a Black peer-led lactation support group.
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