We Need To Talk About The Economic And Racial Disparities In Breastfeeding

by Katie Acosta
Originally Published: 
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Three months after my second child was born, I was scheduled to attend an academic conference. This conference did not require me to travel out of state, but I did have to leave my baby for upwards of eight hours, during which time I would have few opportunities or spaces to pump my breast milk.

The night before the conference, I organized and inventoried everything I would need. I had my work bag and laptop, plus a second bag with my breast pump, electric cords, and tubing; a hands-free pumping bra; empty bottles to pump into; and ice packs and a mini-cooler bag to keep the milk cold. I looked like an overzealous holiday shopper, not a professional going across town to a meeting.

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When I arrived at the conference, I looked at the hotel map to locate the room designated for lactation. When I couldn’t find it, I asked a hotel employee for assistance. I explained I was attending the conference and my program stated there would be a lactation room. The bewildered young man repeated, “Lactation space. Hmm.” He apologized for not being able to help. I kept looking.

Eventually, I learned the lactation space would not be available until the following day. I sat in a boardroom with my colleagues for several hours, and finally we were given a 15-minute break. I went into the women’s restroom, found an outlet by the sink, plugged in my breast pump, took off my top, put on my hands-free bra, and started the process.

My colleagues filed in, one after the other, making small talk about the city and the weather while I leaked milk into four-ounce bottles. “How old is your baby?” one asked.

“Three months,” I answered, and smiled. This was not my preferred method of mingling with cohorts, but I was grateful they continued to go about business as usual.

Twenty minutes later, I turned off the pump, secured the milk in the cooler, took off the hands-free bra, put my shirt back on, washed my hands, and ran back into the meeting. I pumped again on the ride home. Pumping while driving is an interesting, albeit more private, adventure. I was exhausted and thirsty (you have to hydrate when you breastfeed), and most of all I missed my baby.

I nursed my baby for 14 months, and this conference was just one of many awkward situations.

A student worker once tried to unlock my office door while I was pumping. The student, who wanted to drop off a package, thought I was out and didn’t hear me call, “I’m busy!” In she came, and there I was, boobs out and attached to four-ounce bottles.

I pumped in an airport bathroom during a layover and almost missed my connecting flight. As I boarded the plane with my cooler in hand, a flight attendant told me I would have to place my package in the overhead bin, rather than at my feet.


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“I’m not putting my milk up there,” I said, hugging the cooler. “What if it spills?” We compromised and put it at the front of the plane.

While going through security for another flight, a TSA agent had to manually check the contents of my carry-on because the scanner kept showing an “unusual mechanical device” inside. I stood with her behind a semi private screen.

“Do you have a pacemaker in there, ma’am?” she asked.

“No, it’s a breast pump,” I replied as she pulled out my breast shields and examined everything.

“That looks like it hurts,” she said.

Despite these encounters, throughout those 14 months I was intensely aware that my situation is exponentially better than that of most parents of newborns in the United States. I have a supportive partner, I am financially stable, and I have a career that affords me flexibility to devote the time and energy needed to breastfeed. My experiences represent a best-case scenario in this country.

I know this because 17 years ago I breastfed my first child. I was 19, and I didn’t have a job or a college degree or a stable place to live. I relied on WIC and public assistance. I didn’t have a breast pump or the financial resources to purchase one, never mind all the accessories that make the process more efficient. I couldn’t leave the baby for very long because he wouldn’t drink formula and I couldn’t express milk. I nursed him for six months before giving up.

I never saw a lactation consultant or went to a support group meeting. I don’t have a single memory of breastfeeding him in public. More importantly, I don’t have any recollection of a medical professional encouraging me to keep going. Don’t get me wrong: I received lots of information about why “breast is best.” It helps bond, it’s natural, it’s cheaper (this one is a misnomer). I even attended a breastfeeding class the hospital offered while I was still pregnant. But I don’t remember any support after the baby was born.

When my son was born, he was placed in the NICU. Despite the fact that he was thriving, I was never allowed to bring him to my room. I was allowed to hold him for only a moment before they took him from me. No one mentioned the golden hour.

“I want to see my baby,” I told the nurse.

She stared down at me. “Nobody is going to hurt your baby,” she said, and walked away.

When I was able to walk, I went to the NICU and asked if I could breastfeed my son. A nurse handed me a chair. I tried to get him to latch while nurses moved all around me caring for other newborns. No one said anything or offered to help.

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I was dispatched from the hospital 24 hours before my son. They told me he had to stay in the NICU because he wasn’t feeding properly, but that didn’t make any sense. I was supposed to be breastfeeding, and no one had ever observed me. How did they know he wasn’t feeding properly? No one asked if I wanted to pump for him while we were separated. No one asked if I was okay with giving him formula, but I assume that’s what they did.

When my son was finally released from the hospital, they told me a nurse would be visiting my home. I was not asked if I wanted this service. I was given no reason why this nurse would be checking on me. This was not standard practice, and again, my child was not ill. He received no medical intervention in the NICU, I received no special instructions for his care, and he was on no medication. The visiting nurse came twice and offered the only validation regarding my efforts to breastfeed. She weighed him on a portable scale and smiled. He was gaining weight.

Today, I am a sociology professor of family, race, and ethnicity. I know the statistics all too well. Middle-income mothers who are 30 and older are far more likely to breastfeed their children than their younger and poorer counterparts. I mothered two newborns at very different times in my life, so I experienced firsthand the intricate factors that go into creating this disparity. I didn’t have the resources to invest in the many gadgets designed to make breastfeeding easier. Seventeen years ago, medical insurance companies were not required to cover the cost of breast pumps for new parents. (We have Obamacare to thank for that changing.)

But this inequality is the result of more than financial resources. As a poor, brown, single parent, I was not treated like a mother. I was not respected as the person who knew what was right for my child. Medical professionals treated me like someone who needed vetting. No one encouraged me to breastfeed because no one wanted to facilitate my parenting until I had been vetted. That’s not about financial resources. That’s racism.

I’ve spent many years thinking about what the red flag in my file might have said. Was it an actual red flag, or were people just reading my young brown body in a particular way? Something about me signaled I was not competent. If my experience indicates what poor women of color experience in childbirth, then our society needs to take more ownership for the inequalities that exist between poor children of color and their white middle-class counterparts.

My two children couldn’t be raised under more different circumstances. My daughter will have far more opportunities than I was ever able to offer my son. Their drastically different starts in life will continue to influence them into adulthood. Neither of my children will be spared the effects of racism, but moving up the socioeconomic ladder has already made things easier for my second.

The more health practitioners become obsessed with the benefits of breastfeeding for babies, the more attention they devote to class inequality and its impact on parents’ breastfeeding choices. But until we start owning the impact that racism has on the medical care that people of color receive, I doubt we will get very far.

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