Reflections on Lactation in the African-American Community

When I started my journey of advocacy and counseling back in 2000, the idea of an organization to promote breastfeeding and provide lactation support to African-American women was new, different, and long overdue. Today, the need is as strong as it ever was, and I have seen a distinct evolution in the promotion of breastfeeding to Black women.

The lactation profession has grown by leaps and bounds. When I trained as a Breastfeeding Peer Counselor (BPC), there were but a few, and those who were employed largely worked for the Women, Infants and Children’s Program (WIC). Now, BPCs are trained throughout the spectrum of health care settings. The number of professionals with the International Board Certified Lactation Consultant (IBCLC) credential has also increased exponentially, although too few are employed by hospitals, and fewer still are African-American.

Today, more people understand what “lactation” means, and that there is someone, other than an obstetrician or pediatrician, to call on for breastfeeding support. Breastfeeding has never been more advertised, discussed, and cajoled in the media than in recent years.

Yet breastfeeding rates in the African-American community are still much too low. The upside? Initiation rates have increased. The downside? Compared to all the work that has been done, from the individual practitioner to government campaigns, the rates have inched along much too slowly.

When I founded the African-American Breastfeeding Alliance (AABA) in 2000, breastfeeding promotion for Black women was consigned to:

WIC breastfeeding support
One Anita Baker sponsored WIC video
Outdated photos
La Leche League Breastfeeding Peer Counselor Program

There were no websites, blogs, brochures, newsletters, or campaigns targeting breastfeeding in the African-American community.

In fact, the issue of African-American women breastfeeding was but a small blip on the public health scene. Since then it has ebbed and flowed, along with funding to support the cause. The Blueprint for Action on Breastfeeding published by the Department of Health and Human Services, and championed by Former Surgeon General Dr. David Satcher, encouraged support of breastfeeding in communities of color. Then, and now, most lactation research studies focus on Black mothers from the WIC or low-income populations. A miniscule number of research and recorded data takes into account the nuances of Black women from Middle America.

Over the past 17 years, many lactation practitioners, organizations, and government agencies have championed the importance of breastfeeding, supporting breastfeeding, increasing breastfeeding rates as well as strategies to improve breastfeeding among African-American women and their families. National ad campaigns, national statewide coalitions, panel discussion at conferences, and even celebrities breastfeeding have shed light on this important topic. At the grassroots, community level, amongst African-American women in the birth world, breastfeeding has been a burgeoning health issue that has never ebbed.

I firmly believe the answer to any problem comes from within. The hindrance to a dramatic shift in African-American breastfeeding rates is three-fold:

the breastfeeding politic
organizational sustainability
our approach to lactation promotion

From Milk, Money and Madness, we viewed a glimpse of breastfeeding politics as it related to infant formula, society, history, economics, health care, and parenting. The breastfeeding politic I’m referring to is the collective of organizations and agencies that have been at the helm of all breastfeeding policy, promotion, campaigns, and who have crafted the professional standards. These groups have been well meaning and successful in the way the profession, and largely society, looks at lactation. Still, Black breastfeeding rates remain the lowest in the country.

To date, African-American organizations have not been leading the lactation health campaign for our own community. We’ve been at the table—as partners and collaborators, but when it comes to creating standards of practice for breastfeeding in the African-American community, we have not been the captains of our own ship. We are invited to meetings and consulted on projects, yet our organizations have not had the financial sustainability to manage programs and make change.

Leading workshops for lactation professionals for over 15 years, I’ve seen a severe lack of cultural understanding. That’s the primary reason I wrote my second book on lactation management and African-American moms. “Cultural competency” is by no means a new phrase. If we can’t be internally proactive and confront inequities at the organizational level within lactation, how can we expect to effect change for mothers?

In this labor of love, it’s exciting to watch the changes, the ups and downs, the challenges that exist amongst my peers. Perhaps if we shift our perspective, decipher a sustainable funding stream, and give our approach a face-lift, breastfeeding in the African-American community will no longer be an issue to target, but a positive change to reflect upon.