Dozens of studies and papers have documented the low rates of breastfeeding among Black mothers in the United States, but few have delved into how systemic and institutional racism contribute to the issue.
Melissa Petit decided to take up that challenge as a Master of Nursing student at the Washington State University College of Nursing. She was lead author on a paper recently published in the Journal of Nutrition Education and Behavior, with three WSU College of Nursing faculty members as co-authors.
As a longtime registered nurse and lactation consultant, Petit said she knew she wanted to examine breastfeeding as her master’s degree project. Black women have the lowest breastfeeding rate of any race or ethnicity in the United States and the gap is widening even though breastfeeding has proven and extensive health benefits for mothers and babies.
Petit was struck by “the lack of research through the lens of race” to explain the disparity, she said.
She reviewed more than three dozen previously published studies and papers on the subject, then used critical race theory and the social-ecological model to look at factors that might contribute to low breastfeeding rates for Black women. Despite its recent notoriety, critical race theory is useful to examine the root causes of health disparities, such as housing, education and employment, Petit said.
A few examples noted in her paper:
- Breastfeeding education helps increase breastfeeding rates, but breastfeeding literature is dominated by images of White mothers, offering little in the way of role-modeling to women of color.
- Healthcare providers may have subconscious bias about who breastfeeds and who doesn’t, leading them to offer less help to some mothers based on those assumptions – a situation Petit said she personally witnessed as a nurse.
- A healthcare facility’s designation as a “Breastfeeding Friendly Hospital” has been effective in increasing breastfeeding rates for Black women. But Breastfeeding Friendly Hospitals are more prevalent in ZIP Codes with larger White populations, and less prevalent in ZIP Codes with larger populations of people of color.
- The United States offers no paid family leave for new mothers, limiting the time a lower-income woman might spend with her infant and disrupting the establishment of breastfeeding routines.
“There are so many social and structural inequities,” Petit said. “It’s not just breastfeeding, it’s all areas. It’s impacting the healthcare we provide to patients.”
Says the paper, “Dismal maternal and infant mortality rates for Black women and Black newborns reflect the endemic racial bias and lack of equity in health care. Reducing disparities and inequities in breastfeeding rates among Black women in the U.S. will not only affect maternal and infant mortality rates, but will also begin to address the larger systemic inequities and disparities evident in our society.”
Perspective: “Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the U.S.,” Journal of Nutrition Education and Behavior. By Melissa Petit, MN PH, BA, RN, IBCLC; Denise A. Smart, DrPH, MPH, BSN, RN; Victoria Sattler, PhD, MN, RN; Natsuko K. Wood, PhD, RN.