Women's healthcare in the U.S. is meager at best, with the state of maternal healthcare even worse — especially among BIPOC parents, who face shame, stigma, a lack of access and support, and a lack of representation at every turn from pregnancy well beyond the postpartum period. And while breastfeeding can be hard as hell for anyone, the challenges disproportionately affect Black and Indigenous parents.
At 69.4%, Black parents have the lowest breastfeeding rates of any racial or ethnic group, according to 2019 data from the Centers for Disease Control and Prevention (CDC), and they also breastfeed for the shortest period of time in comparison to other groups. The CDC found that hospitals serving predominantly Black patients are less likely to offer lactation support and/or in-hospital formula after delivery than white patients. Native Americans have one of the lowest rates of breastfeeding, at 73%. In comparison, 85% of white mothers breastfeed, receiving more resources and support to do so than their BIPOC counterparts.
Sadly, as maternal health experts tell Scary Mommy, these modern stats aren't the only factors that contribute to low breastfeeding rates among women of color. Centuries of historical and generational trauma are still impacting nursing parents today, contributing to a seemingly never-ending cycle rooted in racism with far-reaching impacts on parents and babies of color at the times when they need the most support.
What is historical and generational trauma?
"Historical trauma is the lasting impact of oppression on Indigenous people," Kiana Shelton, licensed clinical social worker with Mindpath Health, tells Scary Mommy. It manifests in multiple ways, and its origins begin with the use of enslaved Black women as wet nurses, something Shelton calls a "uniquely gendered form of exploitation."
For Indigenous and Native American populations, being forced from their native lands often led to parents being separated from their children, who were placed into boarding schools where they faced physical and emotional abuse for practicing their cultural traditions. Hundreds of Native children remained separated from their families until the 1970s, according to the National Institute for Children's Health Quality (NICHQ).
"Generational trauma is trauma passed down through lineage or family history," adds Krishna Avalon, a life coach specializing in trauma-based healing. This type of generational stress can manifest as "avoidance, apathy, dissociation, anger, outrage, reactivity, or numbing and distracting oneself constantly. It can also lead to panic attacks or social anxiety," she says, citing the racial inequities presented by the COVID-19 pandemic as a recent example.
"The intersection of historical and generational trauma sits here," notes Shelton. "To be a wet nurse, you had to be lactating, meaning you had a child of your own very recently." That meant Black mothers could not nourish their own children while being expected to care for someone else's child, an injustice with ripple effects across generations. Black women "not having autonomy over our bodies is a thing," underscores Erika Dudley, IBCLC, CBS, an Indiana-based Nest Collaborative lactation consultant.
What are the impacts on breastfeeding parents today?
"Historically, formula has been marketed to Black women and communities of color. The message was that there was no pain involved; you can put it in a bottle. It became the norm and a status symbol to be able to provide formula to your baby," explains Dudley.
And that's not the only way the impacts of historical and generational trauma manifest in modern breastfeeding. Says Shelton, "There are many misconceptions about BIPOC health, such as incorrect ideas about pain tolerances or even how symptoms present in melanated bodies." Adds Dudley, "There are actually textbooks that still say Black skin is thicker, insinuating that Black women can tolerate more pain. That information is still in textbooks, and there are older physicians practicing who may have read those textbooks and new residents learning the same outdated and inaccurate information."
This means that BIPOC women are forced to confront microaggressions when talking about pain or concerns with their providers. "There's a history of Black women's bodies being oversexualized, of not being in control of their bodies — all of this is accounted for when reaching out for care," says Dudley.
"The medical community is slowly acknowledging these errors; however, we continue to see across the board downplayed or dismissed concerns," says Shelton, citing Serena Williams' traumatic birth story as a "prime example of this not being an issue about wealth," and instead a result of the Black maternal health crisis in the U.S. — this all without mentioning the systemic and/or structural racism that is reflected in workplace policy and practice, lack of access to higher education, discriminatory housing policies, and lack of paid parental leave.
"As a generalization, women of color need more support across the board due to higher levels of stress and often limited resources," adds Dr. Felice Gersh, an OB-GYN and founder of the Integrative Medical Group in Irvine, California. "Stress impacts milk flow and also can impact the infant's latching on and successfully nursing. Nutrition also is a hugely important factor in the success of nursing."
Dudley says all these factors contribute to inequities in maternal healthcare today, noting, "There were multiple generations who didn't see people nursing, and it really changed the trajectory of Black women breastfeeding or even considering it as an option." And while formula is a great option for many parents, Dudley hopes BIPOC nursing parents are presented with every option so they can be empowered to make the choices that suit them best.
How can you change the course?
As for what new parents of color need as they embark on their breastfeeding journey, it's simple: the same support their white counterparts receive, along with equal representation, says Jessica*, a Nest Collaborative client. "Having safe spaces, with professionals who look like us, would really allow us to talk about our issues and process them as a community," she tells Scary Mommy. "It is important that time is taken to educate us about breastfeeding and how it impacts both nursing parents and babies. There are so many benefits that come with breastfeeding, but there are also challenges. Feeling safe enough to ask questions and process our feelings about breastfeeding would help tremendously."
Adds Dudley, "Black parents don't automatically have that education piece from providers. They're not aware of how health concerns or conditions can impact their breastfeeding experience, or that journeys can be sabotaged before babies are born. Labor interventions and birth trauma can also influence their experiences. Microaggressions, biases, and tone policing create a domino effect that can derail their journey."
Education is a vital part of the growth of women’s confidence in their postpartum period, says Shelton, explaining, "Knowing the 'why' can often help women identify what their 'how' will look like.” Another crucial element, per Dudley: "Getting people — whether they're breastfeeding or not — involved in policy change. If your partner, your family, your village is not on board, it's really hard to go against the grain."
Self-care is also vital whenever possible, notes Avalon. "Find ways to be present and feel safe in your body, both during and when not breastfeeding. Mothers who have experienced trauma in their bodies may feel triggered or uneasy if breastfeeding is an unpleasant experience. Maybe the baby isn't latching, or maybe the baby is pulling, biting, or scratching while nursing. This could trigger a memory in the body when a new parent didn't feel safe in their body."
Only when each and every pregnant and postpartum patient is seen, heard, and cared for will these cycles begin to break for good, which is long overdue and deeply necessary.