Racism and Resistance: A Qualitative Study of Bias As a Barrier to Breastfeeding

Abstract

Background: Nearly 75% of Black non-Hispanic babies born in 2016 ever breastfed. However, Black mothers still experience barriers to breastfeeding, perpetuating disparities in exclusivity and duration. Subjects and Methods: Using data collected from five focus groups with Black mothers (N = 30) in Washington, District of Columbia during summer 2019, we critically examine the influence of institutionalized and personally mediated racism on breastfeeding. We also explore the counter-narratives Black women use to resist oppression and deal with these barriers. Results: Themes surrounding institutionalized racism included historic exploitation, institutions pushing formula, and lack of economic and employment supports. Themes regarding how personally mediated racism manifested included health care interactions and shaming/stigma while feeding in public. At each level examined, themes of resistance were also identified. Themes of resistance to institutionalized racism were economic empowerment and institutions protecting breastfeeding. Themes of resistance to personally mediated biases were rejecting health provider bias and building community. Conclusions: There are opportunities for health providers and systems to break down barriers to breastfeeding for Black women. These include changes in clinical training and practice as well as clinicians leveraging their position and lending their voices in advocacy efforts.

Breastfeeding in Context: African American Women’s Normative Referents, Salient Identities, and Perceived Social Norms

“…Examples of intentionally working to shift norms included nursing in public, including uncovered, offering verbal encouragement to other African American mothers nursing in public, and promoting breastfeeding to other African American women in their sphere (Davis et al, 2021).…”

“…Findings were also mixed on perceptions of expectations around infant feeding. Influence and expectations from family, close friends, and healthcare providers (Davis et al, 2021) were common but highly variable as to whether they encouraged breastfeeding or formula/bottle-feeding. Reasons for the pressure also varied from cost-effectiveness, to pressure to return to work, to health benefits, to implied skepticism that the mother could succeed at breastfeeding.…”

Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother–Infant Dyads

“…This study also adds to a small body of research showing that racial discrimination plays a role in breast milk feeding decisions among African American mothers [ 36 ]. Current findings indicate that mothers experiencing higher levels of racial discrimination over the previous year are more likely to report cessation of any breast milk feeding by age 3 weeks, supporting the idea that larger societal contexts such as structural racism may influence breast milk feeding disparities and health inequities [ 37 ].…”

Racial Inequities in Breastfeeding Counseling Among Pregnant People Who Use Cannabis

“…Additionally, cannabis use and breastfeeding guidance were based on self-reported data; therefore, there is potential for recall bias. Based on our findings and prior studies demonstrating structural and interpersonal racism in the context of breastfeeding support, [13][14][15][16] efforts are needed to improve care equity for non-Hispanic Black birthing people. Specifically, maternal-child health researchers have highlighted the need to address the effects of structural racism on breastfeeding outcomes.…”