The Summer of 2016 will go down in history as a particularly awful one in terms of gun violence in the U.S. Black men and police officers were shot. Many people were killed when a gunman opened fire at a gay nightclub in Orlando, Florida. We grieve the losses and hope that changes in our system will result. Only time will tell.
In the face of these violent events, and the discrimination that led up to them, is breastfeeding even relevant?
The short answer is Yes. Breastfeeding can’t stop racism and discrimination, but it can protect new mothers from their effects. To understand why this is so, let’s look at what happens to people physiologically when others discriminate against them.
The biology of discrimination
A fascinating book called Social Pain summarizes many studies, and describes the neurobiology of social exclusion (Dickerson, 2011; Eisenberger, 2011). The basic premise is this: we are designed to be in relationships with others. It’s important for our survival. When we are not—when we are excluded—our stress response is triggered, including the inflammatory response system. These are our survival mechanisms.
Social exclusion activates the same part of our brains as does physical pain—the anterior cingulate cortex (ACC). The ACC is a component of the limbic system of the brain, responsible for producing emotional responses to physical sensations of pain, the same part that is activated for other mammals, too, in the separation-distress response. The response to social exclusion is hardwired for all mammals, including human beings.
The act of discrimination says to the recipient, “You are not one of us. You are not part of our group.” These behaviors can be in the form of threats of overt violence, or they can be in the form of microagressions, subtle but offensive comments or actions that are often unintentional but unconsciously reinforce a stereotype. People who dismiss microaggressions might accuse people of being “too sensitive.” Sometimes, there might be misunderstandings. But keep in mind how such behavior affects the people who experience it. These often careless utterances have a physiological effect on the person who hears them. Microaggressions tell people that they are being excluded from the group, and that is why it is important to be aware of them.
So what happens when people experience ongoing discrimination? A chronic activation of the stress response system increases chronic inflammation and disturbs sleep. Many researchers have studied this effect. One study asked participants to indicate the frequency with which they experienced “everyday” discrimination using a scale. The items included experiences such as, “You receive poorer service than other people at restaurants or stores” and “People act as if they think you are not smart.” The higher they scored the experiences, the higher were their levels of inflammation (Lewis, Aiello, Leurgans, Kelly, & Barnes, 2010).
Inflammation and disturbed sleep are physiological time bombs and increase rates of heart disease, diabetes, and a body mass index (BMI) >30—in other words, the exact pattern you see in many of our minority populations (Suarez & Goforth, 2010).
The obesity statistics are particularly relevant. Consistently, across countries marginalized populations tend to have higher BMIs. The more marginalized they are, the higher the percentage of people with a BMI >30. In the U.S. and UK, women of African descent have the highest rates. But other groups, such as American Indians and people from Southeast Asia, tend also to have a higher percentage than Whites with BMIs >30. In the UK, the Irish are split out as a separate group from British Whites. Interestingly, a similar pattern of higher BMIs emerges. You also see a similar pattern for people who have lower incomes (Goodman, McEwen, Huang, Dolan, & Adler, 2005).
The critical role of breastfeeding
Exclusive breastfeeding acts as a powerful counter to these physiological effects (Groer & Kendall-Tackett, 2011). It is one of the mechanisms that downregulates, or turns off, the stress response. Baby at the breast actually lowers two important stress hormones in the short term: adrenocorticotropic hormone (ACTH) and cortisol. Further, when the researchers tried to stress the mothers in their study, they couldn’t because of the lovely little cloud floating around them (Heinrichs et al., 2001). In other words, when breastfeeding, there occurs a short-term lessening of the stress response. When mothers experience that day after day, it lowers their lifetime risk of the Number One killers of women in the U.S.—heart disease and diabetes. These were the findings of a study of 139,000 women with a mean age of 63 (Schwartz et al. 2009).
There is an important caveat to these findings: in most of these studies, exclusive breastfeeding lowered risk, partial breastfeeding did not. In our study of 6,410 new mothers, we found that exclusive breastfeeding improved mothers’ sleep, lowered their risk of depression, and had a dramatic effect on self-reported anxiety and anger (Kendall-Tackett, Cong, & Hale, 2011). This was even true when women had a history of sexual assault, which puts them at high risk for both sleep problems and depression. There was still an effect from the sexual assault, but it was significantly lower (Kendall-Tackett, Cong, & Hale, 2013).
I was honestly surprised that we found no significant difference between partial breastfeeding and exclusive formula-feeding. I thought we would see a dose-response effect: the more they breastfed, the better the response. Instead, we found a threshold effect: that exclusive breastfeeding is a very different physiological experience than partial breastfeeding. It is one more reason to continue to support exclusive breastfeeding wherever possible.
How shall we respond?
As individuals, and as a culture, we must continue to eliminate discrimination. One way to do that locally is to foster trust, and then have open discussions in the population you serve. How do they describe themselves? Is there any terminology that people find offensive? A Jewish friend once told me that the term “Nipple Nazi” for describing a breastfeeding advocate was highly offensive to her and asked me never to use it. I understood why that expression was offensive, so was happy to comply with her request. Other terms may seem benign, so if you don’t understand why they are offensive, the best strategy is to ask.
As a woman with a disability, I’ve been on the receiving end of many microaggressions. For example, I struggle with stairs and a conference organiser once volunteered to “carry me upstairs”—a very demeaning way to speak to me, I thought. I’m sure she was trying to help and had no idea how offensive that was. It took me a long time before I started speaking up, and it was only after being injured at a conference after the organisers had ignored my requests that I spoke up at last.
Sometimes these conversations can be uncomfortable and really tense. I’ve seen some ugly ones that were not at all productive. It’s important to set some ground rules about communicating respectfully, even when frustrated. Perhaps you’ll make some mistakes along the way. But having these conversations will deepen your relationships within the community, and will make you even more effective in helping the women you serve.
In summary, breastfeeding can be a radical act that helps women who experience discrimination take back their health. American Indian lactation consultant and social worker, Camie Goldhammer, describes breastfeeding as “food sovereignty,” a powerful way to take back your culture. We can help women overcome the physical effects of discrimination, one woman at a time. By doing so, these women can become powerful agents for change in the broader culture.
Thanks for all you do for mothers and babies. You make a radical difference.
Kathleen Kendall-Tackett, PhD, IBCLC, RLC, FAPA
Dickerson, S. S. (2011). Physiological responses to experiences of social pain. In G. MacDonald & L. A. Jensen-Campbell (Eds.), Social pain: Neuropsychological and health implications of social loss and exclusion (pp. 79-94). Washington, DC: American Psychological Association.
Eisenberger, N. I. (2011). The neural basis of social pain: Findings and implications. In G. MacDonald & L. A. Jensen-Campbell (Eds.), Social pain: Neuropsychological and health implications of loss and exclusions (pp. 53-78). Washington, DC: American Psychological Association.
Goodman, E., McEwen, B. S., Huang, B., Dolan, L. M., & Adler, N. E. (2005). Social inequalities in biomarkers of cardiovascular risk in adolescence. Psychosomatic Medicine, 67, 9-15.
Groer, M. W., & Kendall-Tackett, K. A. (2011). How breastfeeding protects women’s health throughout the lifespan: The psychoneuroimmunology of human lactation. Amarillo, TX: Hale Publishing.
Heinrichs, M., Meinlschmidt, G., Neumann, I., Wagner, S., Kirschbaum, C., Ehlert, U., & Hellhammer, D. H. (2001). Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology & Metabolism, 86, 4798-4804.
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22-26.
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine, 8 (1), 16-22.
Lewis, T. T., Aiello, A. E., Leurgans, S., Kelly, J., & Barnes, L. L. (2010). Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults. Brain, Behavior & Immunity, 24(3), 438-443.
Schwartz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., & Cauley, J. A. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics & Gynecology, 113(5), 974-982.
Suarez, E. C., & Goforth, H. (2010). Sleep and inflammation: A potential link to chronic diseases. In K. A. Kendall-Tackett (Ed.), The psychoneuroimmunology of chronic disease (pp. 53-75). Washington, DC: American Psychological Association.