Here's Who Has The Most Difficulty Breastfeeding In The U.S.

by Josie Rhodes Cook

There is still a lot of stigma surrounding breastfeeding in the United States. Some parents also have more difficulty breastfeeding in the U.S. than others, and the disparities are frankly glaring, and deeply unfortunate. Every parent should feel like breastfeeding is an option, and should feel supported in their decision to breastfeed their baby — or not to, because that's a choice all new parents should have as well. Unfortunately, that's just not the reality in the U.S. today.

Back in August, The New York Times interviewed Dr. Chelsea McKinney, of NorthShore University HealthSystem, about the barriers that keep some women from pursuing or continuing breastfeeding. She was the lead author of a National Institutes of Health community study published in Pediatrics about the disparity in breastfeeding rates between black, white, and Hispanic moms.

That study determined that black mothers were least likely to initiate and maintain breastfeeding. Basically, they had the most trouble deciding to try breastfeeding in the first place, and the most difficulty with continuing to breastfeed their babies in the days, weeks, and months following their births. That's a pretty good indicator that black women have the most difficulty breastfeeding in the U.S., and other reports and studies have, sadly, come to similar conclusions.

The Pediatrics study found that 61 percent of black mothers initiated breastfeeding, compared to 78 percent of white moms. A whopping 91 percent of Spanish-speaking Hispanic mothers initiated breastfeeding by comparison, as did 90 percent of English-speaking Hispanic mothers in the study, which followed 1,636 mothers who gave birth between 2008 and 2010 in Baltimore, Washington, D.C., and Lake County, Illinois, The New York Times reported.

Interestingly enough, each data-collecting site tried to include mothers of "low socioeconomic status," the Pediatrics report noted. So the difference didn't seem to be a matter of socioeconomic concerns and disparity. Rather, the Hispanic mothers tended to have a reported family history of breastfeeding, and that seemed to help explain the higher breastfeeding rates among that population.

When it comes to helping all mothers consider breastfeeding right from the start, Kinney said that hospitals that serve lower-income populations “often rely on formula companies for financial support and lactation consultants are seen as supplemental, not essential." She also added, according to The New York Times:

If a mother doesn’t make it clear that she wants to exclusively breast-feed, the nurses, who are already overwhelmed, will just pop a bottle in a baby’s mouth in the hospital. You’re already at a disadvantage.

So it's clear that hospital staff need to be trained so that they can not only tell mothers that breastfeeding is an option, but so they can also support them if they choose to try breastfeeding their babies. Populations that are especially vulnerable to not initiating breastfeeding, like black women, may need more support than others.

And the Pediatrics study was far from the only report, study, or article that found that black mothers seem to have the most difficulty with breastfeeding in the U.S. Breastfeeding Medicine, the official journal of the Academy of Breastfeeding Medicine, published a piece on the "racial and ethnic disparities in breastfeeding rates and practices" back in 2015, and noted that black women had the lowest rates of breastfeeding initiation. They also had the lowest rates of continuation of breastfeeding at 6 months and 12 months.

In 2013, The Nation's Health, the monthly newspaper of the American Public Health Association, reported that the greatest improvement in breastfeeding rates in the U.S. was among black women, but that their rates were still low, especially compared to white and Hispanic mothers.

To get a truly fact-based report on breastfeeding numbers in the U.S., you need look no further than the Centers for Disease Control and Prevention. The latest CDC data reflects what those other studies and articles claim — that major breastfeeding disparities definitely exist, and that it's more difficult to start breastfeeding and to stick with it for some women than for others.

The CDC reported that fewer non-Hispanic black infants are ever breastfed as compared to non-Hispanic white infants and Hispanic infants. The agency also reported that infants who are eligible for and receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (also known as WIC) are less likely to ever be breastfed, and that young mothers (defined as aged 20 to 29 years) are less likely to ever breastfeed either.

Cultural norms, lack of family support, problems with lactation and latching, work policies that aren't supportive, lack of parental leave, and unsupportive hospital practices and policies are all reasons the CDC reported that mothers discontinue breastfeeding.

You may have noticed that most of those reasons involve not supporting moms, whether it's when they're in the hospital with their new baby, at home, or at work. And the reasons listed particularly intersect for black women — for example, they may be more likely to run into problems with latching because black women tend to receive the poorest postpartum support and health care, to the point that they have the highest rates of maternal mortality. Plus the wage gap is especially damaging to black women, and if they work jobs with lower wages, it's likely that those jobs don't offer paid leave.

The data is clear: black mothers have it harder when it comes to breastfeeding in the U.S. than other moms, and they need more support. It's well past time that we all get to work on combatting this issue, and on better supporting the breastfeeding efforts of all moms, but particularly those who we know need a little more help. Supportive policies we can all get behind include breastfeeding aid initiatives in hospitals, as well as worksite accommodation for breastfeeding, a federal paid leave law (the U.S. is the only developed nation that doesn't have one), and peer and professional support for the practice, which are all recommended by the CDC. We've got to start somewhere, or the problem will persist.