A recent Centers for Disease Control and Prevention (CDC) report shows that Black mothers in the U.S. are 2.6 times more likely than white mothers to die of pregnancy-related complications in the United States. Some of these deaths occur during delivery, but most (64 percent) occur after hospital discharges when moms have taken their babies home.
To save families from burying Black mothers, solutions must extend beyond the delivery room. Fortunately, breastfeeding is an intervention that can improve moms’ mental and physical health. Breastfeeding has also been linked with a lower risk of maternal mortality.
Unfortunately, Black moms are considerably less likely to breastfeed due not only to limited access to help with breastfeeding and medical bias but also structural racism and the legacy of slavery.
As a medical sociologist and a breastfeeding researcher, we recognize the importance of culturally sensitive interventions to improve Black perinatal health. Specifically, we need programs that support Black lactation professionals so that they can support Black women beyond delivery. These solutions are critical to improving health outcomes.
Lactation professionals — including International Board-Certified Lactation Consultants (IBCLCs), especially those who are Black — can help monitor Black moms well beyond the postpartum period. Given the growing evidence that people of color experience better health outcomes when their care provider is of the same race or ethnicity, this representation among perinatal and lactation professionals is particularly important for Black women. However, there just aren’t enough Black IBCLCs. Less than 2 percent of IBCLCs identify as Black. We need more Black lactation professionals to support Black moms in the postpartum.
Lactation professionals include lactation consultants, lactation specialists, lactation educators and peer educators. They specialize in the management of breastfeeding in hospitals, birthing centers and in patients’ homes. They provide one-on-one and group support for an array of lactation challenges: perceived low milk supply, poor latch, breast pain, and even hormonal and emotional changes.
Research shows that programs that support moms well beyond delivery have a positive effect on maternal and infant health. Lactation professionals can help develop the mother-infant relationship while screening for mental health disorders, which are one of the main contributors to pregnancy-related deaths. While a mom might not see her obstetrician until six weeks postpartum, by this time, IBCLCs have often already spent ample time with their patients.
For the past decade, Black lactation leaders have called for increased funding for IBCLC training programs at historically Black colleges and universities (HBCUs). Some have responded, with North Carolina A&T State University and Johnson C. Smith University establishing programs for students to obtain their IBCLC while in college.
Concentrating efforts in HBCUs is ideal because it improves two systems: It expands access to the breastfeeding curriculum through higher education, and it helps Black mothers reclaim birth and breastfeeding. But these efforts are also expensive. Government programs, such as Women, Infants, and Children Nutrition Program (WIC), and lactation non-profits, such as La Leche League, train community members to become peer counselors, ensuring even more nearby support for new moms. Not only do we need more IBCLCs, we need better local peer networks to be available to Black moms postpartum.
To be sure, simply educating a larger cohort of IBCLCs or peer lactation counselors is not enough to counter low breastfeeding rates. Anti-breastfeeding bias for Black women has deep roots in enslavement — without control over their own bodies, often forced to breastfeed the children of their masters and often unable to appropriately breastfeed their own children — and racism — as hospitals are nine times more likely to suggest that a mother feed her baby formula when they are Black — that evolved into perpetual barriers to breastfeeding. However, expanding the number of lactation professionals in the workforce will give Black women allies and social support as they encounter unequal social systems and fight against centuries of bias on their breastfeeding journey.
Programs in some states work to ensure moms receive the support they need long after delivery. For example, in California, the midwives at Kindred Space and Martin Luther King, Jr. Community Hospital in Los Angeles provide lactation education and support that is specific for communities of color. Collaborative efforts between the University of California, Davis and organizations like Cultural Representation is Empowerment work to reach underserved communities in the San Joaquin Valley, where immigrant mothers struggle to find obstetric support.
In the Midwest, the Indiana Black Breastfeeding Coalition provides breastfeeding classes and a walk-in lactation clinic where Black moms can meet with an IBCLC one-on-one or in a group setting. MelaMama Maternal Wellness is an Indianapolis nonprofit formed in response to the paucity of support for breastfeeding moms of color and provides both in-home and telehealth postpartum services.
Over two million women in the U.S. live in maternity care “deserts,” which are counties where there is no obstetric care. This means that beyond delivery, moms experiencing pregnancy-related complications, many of whom are at risk of health disparities, must travel long distances to see an obstetrician. A supportive lactation professional can be especially helpful in such cases in developing and maintaining breastfeeding practices while monitoring a mom’s overall postpartum health.
Even one maternal death is too many. We must continue to support breastfeeding as a meaningful effort to help end the crisis of maternal deaths in Black communities.
The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth or of their respective affiliated employers/organizations. This blog post was originally published in The Messenger in August 2023 before the publication’s closure.