Black Maternal Health Week: The Politics of Breastfeeding
Birth Equity (noun):
“The assurance of the conditions of optimal births for all people with a willingness to address racial and social inequalities in a sustained effort” — Joia Crear-Perry, MD, National Birth Equity Collaborative
Note from the Editor-in-Chief
This article was originally published on August 31, 2018 in recognition of Black Breastfeeding Week and is pre-published today with updated statistics below from a conference I attended as a nurse in training for Black Maternal Health Week. For more information, we encourage you to visit the site of our friends at Black Mamas Matter for whom we fundraised last month. Their partner organisation ROOTT also has some incredible resources, which you can find here.
I also highly suggest listening to the audio or reading this NPR piece, which honours the life of my fellow Johns Hopkins graduate Shalon Irving. She is a textbook example of the kinds of strains and stresses that make high-achieving black women vulnerable to poor health.
The Statistics on Black Maternal Health
Of the 7,208 deaths within a year of the end of pregnancy that occurred during 2011–2014 and were reported to CDC, 2,726 were found to be pregnancy-related. Considerable racial disparities in pregnancy-related mortality exist. During 2011-2014, the pregnancy-related mortality ratios were:
12.4 deaths per 100,000 live births for white women; 40.0 deaths per 100,000 live births for black women; and 17.8 deaths per 100,000 live births for women of other races
Women receiving no prenatal care 3-4x more likely to have pregnancy-related death than women who do & a third of African American women do not receive recommended number of prenatal visits*
There’s relatively little research on how paid leave affects maternal health but we know that receiving equal pay should also come with the benefit of paid leave. Health effects include: Ability to attend medical appointments; Increased breastfeeding; Decreased infant mortality; Improved maternal mental health; and Decreased stress.
While France, Germany, Spain, Sweden, and the U.K. all decreased their maternal mortality rate by up to 50 percent between 1990 and 2015, U.S. experienced an increase of 16.7 percent.
The biggest takeaway from the conference and the above statistics was that policy implementation is key. As nurses, doulas, and midwives, we can provide plenty but only so much, especially with the barriers of healthcare access. You can see in the map to the right how many parents do not have the right to take any paid leave to take care of their infant. Additionally, the chart above by Joia Crear-Perry, MD, FACOG is an overwhelming yet blatant example of all the factors that affect this issue.
What you as a reader and potential advocate can do is investing the time to learn what your representatives are doing or not doing regarding Black maternal health disparities and paid leave. Especially if you live in our community of the D.C. Metro Area, we highly urge you to take action by doing the research and shifting these abominable statistics.
Contained Bodies, Confined Milk and the Politics of Black Breasts
The racial disparity in reaping the benefits of breastfeeding is due to the intergenerational experience and support. It stems from the legacy of enslaved Black mothers neglecting their children to nurse white babies.
Perhaps I should be sharing my story here. It is Black Breastfeeding Week after all and I’m Black, I have breasts, and milk flowed from them in spite of the challenges of pregnancy, childbirth and chronic illness, for five years and change. My challenges were met with multigenerational support and I leaned on memories of how breastfeeding was modeled for me as a child. I attended support group meetings during the day. I returned to work but I missed my baby and hated pumping, so I left and never came back. I stayed home with that baby, ate good food, made cream-top milk, and one more baby. It all came easy to me, even in the face of minor challenges. My body a living example of the multidimensional interaction of privilege and breastfeeding. And I know I’m not the norm. So, I don't deserve to take up the only space here.
You see, before having my first baby, I worked in childcare subsidy, research, and advocacy. Paperwork passed over my desk with heartfelt requests from mothers wishing to return to work just days after cesarean births with physicians releasing them to work faster than their milk could come down. Double takes at case files with work schedules that exhausted me just looking at them and I found myself wondering “didn't she just have a baby?” Mothers leaving their babies at home for night shifts to care for other people and even other people’s babies.
Black breasts do not exist separate from Black bodies and the situated existence we navigate in this world nor the racialized experience of motherhood. Racism and classism intertwine to act as a containment, working to make some of us feel as if we are walking in quicksand. Add to this the complexities of new motherhood and the needs of the postpartum body and now we have a cocktail for failure. Literal milk plugs. So, although her precious body may be able to produce milk, her situation prevents her and her baby from receiving it. Even the intention to breastfeed cannot save the milk of the mother who cannot find time for pump breaks as she works the night shift as a security guard. Or, perhaps she cannot figure out why pumping is not working, but she doesn't have the time to seek the educational or financial resources to help her problem solve.
And it wasn’t until I became a mother that I could truly see them. You know that maternal empathy that only kicks in when you have a baby, finally engulfing you with the joy and pain of other mothers. Well at least that’s what happened with me. So, the memory of these mothers lingers in my heart. It has caused me to resist engaging with imagery of a sort of Black breastfeeding that comes with ease and lean into the stories of women who want so badly to breastfeed their babies but face socioeconomic blocks due to lack of support, resources, and empowerment.
Essential to the solution is the acknowledgement that breastfeeding is a privilege, not a right. To paint the picture that breastfeeding should come easy, as long as you’re lactating and of course doing everything right, is a disservice to the many black women that face socioeconomic constraints that prevent them and their babies from accessing life giving milk. Many black women simply do not have the luxury. Luxury comes with privilege. A type of privilege held by white women and to a certain extent Black women, like myself, who faced little to no challenges while nursing their babies. So, today I’m creating a loving space for the women who despite their loving intention to feed their babies were met with road blocks that changed their paths. I’m stepping down in order to lift them up and letting them know that in spite of everything, you loved that baby and gave the best you had while navigating circumstances no one should have to. And for that reason alone, you are a queen.
Here’s How Kamala Harris’ New Bill Would Address the Racial Gap in Maternal Deaths
NOTE FROM ALMILA KAKINC-DODd, EDITOR-IN-CHIEF
The photo to the left is an eerie depiction of not only the impact of slavery that continues into today in the U.S. but also worldwide. At first glance, this can presumably be a black woman enslaved to be a "wet nurse" for a white family. Yet, this was taken all the way across in Adana, Turkey, where the Ottoman Empire had its own dark practises of slavery. And I am a part of that lineage, as my father's side is Afro-Turk. It's near a province called "Saglikli," which ironically means "healthy" and is adjacent to Mersin, the birthplace of my father.
Today is his birthday. He abandoned me, my sister, and my mother 14 years ago when I was 10-years-old. As I stare at this photograph, I contemplate that lineage. I think of the milk that fed his that led to my nurturing, which flowed from the privileged breasts of my white-passing mother. What would it have been like if there was a racial switch and my father had abandoned us when I was an infant? What if instead of my father, my mother was Black in Turkey? What would my health look like now? These are unanswerable questions but the question I know the resounding answer of "yes" to is this: "Is there an unjust public health crisis occuring for black mothers and can we reverse it?" And we can only do so when we wholistically approach it by uplifting fellow Black mothers socio-economically.
Bingham D, Strauss N, Coeytaux F. Maternal mortality in the United States: a human rights failure.Contraception. 2011;83(3):189-193. doi:10.1016/j.contraception.2010.11.013
Osterman MJK, Martin J. Timing and Adequacy of Prenatal Care in the United States, 2016. Hyattsville, MD: National Center for Health Statistics; 2018.
Cover illustration courtesy of Petra Erikkson via Essence Magazine.