Moving mothers of color from the margins to the center of the breastfeeding movement

Excerpt from Smith, P.H., Labbok, M., & Chambers, B. (Eds.) (2017). Breastfeeding, Social Justice, and Equity. Amarillo, TX: Praeclarus Press.

A valuable framework

The purpose of this paper is to introduce 10 principles for how public health professionals can apply Black feminist theory in their work in the breastfeeding movement as researchers, intervention developers, frontline health educators and program implementers, and social and health equity advocates. In general, Black feminism is an interpretative framework for understanding the meaning of research findings on multiple levels, with close attention to social, political, and economic dynamics that explain how Black women are impacted by social and health issues in particular. When thinking about how to apply Black feminism in public health, and more specifically, in breastfeeding, Black feminism is a valuable framework on at least three broad levels (Collins, 2000):  

1. Black feminist theory provides an interpretive framework for examining how social, political, and economic issues impact Black women in particular.
2. Examination of repeat patterns of power and control: Black feminism is generally defined as a pattern of thought that recognizes how systems of power are configured and maintain socially constructed categories of race, class, and gender.
3. Action-oriented: The larger premise is grounded in a “politics of empowerment” that demands action at the individual (agency) and systematic levels.

From theory to action: 10 principles of Black feminism

How to move from theory to action by examining 10 principles of Black feminism with special attention on how to apply them in breastfeeding advocacy.

Theme No.1: Respect the individual’s right to self-definition and self-valuation.

In conducting my research, on Black women in general and Black mothers in particular, the resounding theme is that mothers on the margin want to be recognized as “more than mothers.” The following are a few of the diverse mothers and mothers who are on the margins of the breastfeeding movement because of the multiple roles and status set they have in society: (1) adolescent and young mothers between the ages of 15–21 (Shanok & Miller, 2007; Zachry, 2005); (2) “mothers” between the ages of 11–14 years old (Boyer & Fine, 1992); (3) minimum-wage/hourly wage job working mothers (Baker & Milligan, 2008); (4) mothers with rapid repeat pregnancy (Boardman, Allsworth, Phipps, & Lapane, 2006); (5) single, working mothers who have “2nd shifts” (Johnston & Esposito, 2007); (6) mothers with alcohol and drug dependency problems (Gentry, 2004); (7) collegiate mothers (Flam, 2014); (8) unwanted pregnancies carried to full term (Finer at al., 200); and (9) the “dysfunctional,” “distant,” and/or “deviant” mom (Schur, 1984) as defined by society standards of motherhood.

One way to fully understand the unmet needs of mothers on the margin is to examine their lives through the theory of Maslow’s Hierarchy of Needs, where health educators take into account the competing needs of mothers on the margin as it relates to her needs for (1) basic necessities, (2) safety, (3) belongingness and love, (4) self-esteem, and (5) self-actualization (Maslow, 1943).

Theme No. 2: Controlling images

The theme of controlling images suggests that health educators pay close attention to the words, socialization processes, and symbols used to objectify a group of people in ways that justify continued economic and social disenfranchisement. For breastfeeding, it requires that we acknowledge the historical beginning of Black women serving as nursemaids for White mothers. The controlling images of Black mothers being forced to give their breastmilk to White babies continue to surface as historical barriers as to why Black women in today’s time do not breastfeed.  

One of the many ways to addressing the lingering impact of controlling images is to replace the “public health” model of building rapport to one of building a relationship. I developed the RELATE model as a way to engage clients as subjects and not public health objects. The RELATE model is comprised of six core elements: (1) reality, (2) empathy, (3) listening, (4) action, (5) touch-base, and (6) empower (Gentry, 2015).

Theme No. 3: Race, class, and gender

When it comes to marginalized mothers, health educators must understand the interconnectedness of race, class, and gender as a way to detect “who” and “what” is influencing and informing breastfeeding choices. From a Black feminist standpoint, this is done by examining how race, class, and gender intersect to inform individual factors and choices, the social context and constraints that are beyond the control of the individual mother.

Theme No. 4: Unique experiences

A thorough understanding of unique experiences among diverse groups of mothers on the margins of breastfeeding will result in breastfeeding advocates being more committed to multiple levels of intervention. For example, at the community level, interventions need to address the lingering impact of racism, stigma, and shame associated with breastfeeding among poor mothers, in particular. At the small group intervention level, health educators can create opportunities for support systems to continue beyond the group level engagement. Individual sessions are needed as well to unpack those barriers that may be more personal and embarrassing, or even dangerous to discuss in a community or group-level setting.  

Theme No. 5: Matrix of domination

This theme represents the overall organization of power relationships, rules, and regulations associated with systems in our society. For breastfeeding, that means we must immerse ourselves in a deeper understanding of how the following systems impact breastfeeding decisions before we “blame the victim” for her choice not to breastfeed: (1) family, (2) social and health services, (3) political/governing, (4) educational, and (5) business/economics.

Theme No. 6: Structure and agency

Organizations and individuals must change in order to create opportunities for optimum levels of health and well-being. First, Black feminism is compatible with public health theories on behavioral change. In the case of breastfeeding, behavioral change theory represents the “agency” of individual mothers to make changes in their decision and action to breastfeed (Gentry, Elifson, & Sterk, 2005; Prochaska, Redding, & Evers, 2008).

At the structural level, public health professionals need to be more politicized to the changes needed in the “taken-for-granted” rules and regulations governing home, school, work, and community-based programs that conflict with mothers’ willingness and ability to breastfeed.

Theme No. 7: Reality, roles, relationships, and risk-taking

Closely related to the RELATE model (theme No. 2), breastfeeding advocates must be more sensitive to the everyday reality of mothers on the margin.  As an example, the doula model typically associated with middle- and upper-class, primarily White mothers was adapted and tailored for adolescent mothers of color. The overall conclusion of the program was that doulas had to go beyond the call of their traditional “doula duties” to really reach and engage this group of marginalized mothers (Gentry, Nolte, Gonzalez, Pearson, & Ivey, 2010).  

Theme No. 8: Rigorous research, responsible application

This theme suggests that a Black feminist approach is very much grounded in examining the empirical research on breastfeeding among adolescent mothers. For this project, a cursory review of existing findings on breastfeeding among mothers on the margin revealed the following reasons as to why these mothers choose not to breastfeed: (1) embarrassment, (2) no visible milk production, (3) increased breast size, (4) breast soreness, (5) pain, (6) lack of interest, (7) family choice, (8) father’s choice, (9) poor maternal nutrition,  (10) inconvenience, (11) leaking milk,  and (12) return to school/work (Dykes, Moran, Burt, & Edwards, 2003; Dyson, Green, Renfrew, McMillan, & Woolridge, 2010; Earle, 2000; Earl et al., 2000; Feldman-Winter & Shaikh, 2007; Hannon, Willis, Bishop-Townsend, Martinez, & Scrimshaw, 2000; Ineichen, Pierce, & Lawrenson, 1997).

A Black feminist action-oriented stance, however, suggests that researchers unraveling these barriers have a responsibility to continue the work needed to develop theory-based and/or data-informed solutions for removing these constraints.  

Theme No. 9: Problem-solution paradigm

In looking at ways to solve problems associated with mothers on the margin and breastfeeding, my model for advancing Black feminism offers a dynamic framework for examining the problems and related solutions. This paradigm includes deeper discussions about the following “Ps” as a way to comprehensively address any and all problems associated with a particular public health issue: (1) problem-definition, (2) p-values, (3) personal experiences, (4) person(s)-impacted (partners, parents, peers, professionals), (5) places of risk and protection, (6) practices, (7) programs, (8) partnerships, and (9) policy.

Theme No. 10: Empowerment, activism, and social justice

I leave you with a final message of empowerment as grounded in the 10th theme that focuses on empowerment, activism, and social justice.  This is where we talk about the links between knowledge and action at the most radical extreme if necessary, much like the “ACT-UP” movement in New York when gay males took to the streets in New York to demand social justice for those impacted by HIV/AIDS. So, too, must those of us fighting in the breastfeeding movement be willing to act-up for the inclusion of marginalized mothers. We must all commit to bring our A-game!

Advancing Black feminism in breastfeeding with “7 As” that remind us to bring our “A” game.

The 7 As of Black feminism

1. Bring comprehensive assessment tools that examine issues commonly raised among mothers on the margin of breastfeeding.
2. Bring analytic skills that are sensitive to the unique experiences of Black women and girls in breastfeeding.
3. Bring the courage to address health risks with relevant interventions and appropriate implementation settings that are more effective from marginalized and disenfranchised mothers.
4. Bring a spirit of advocacy for challenging and changing individuals, organizations, and systems that perpetuate health threats which result in mothers on the margins not breastfeeding.
5. Bring your positive affirmations to the field to help build up those who frontline staff who get beat up, broken down, and take unfair hits in advocating for breastfeeding among mothers on the margin.
6. Bring your willingness to aggravate people, politicians, and policies that work against positive health outcomes for women.
7. Bring your willingness to act up, disrupt, and dismantle the matrix of domination.

Act up, disrupt, and dismantle, because, as Audrey Lorde reminds us, the master’s tools will never dismantle a system that works for the powerful minority; that responsibility belongs to the mothers and daughters of the breastfeeding movement. So, I need you to awaken, arise, and work in unity, share the knowledge, and love those who are unlovable until they can love themselves and their children.

Thank you!