Booby Traps Series: Is there a “soft bigotry of low expectations” when it comes to breastfeeding?

This is the 29th post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

In my last post I wrote about cultural issues and breastfeeding support in the hospital.  Today I’m pleased to share a post asking the question:  Is there a racial Booby Trap?

You may know that there are significant disparities in breastfeeding rates among racial and ethnic groups in the U.S.  Probably the clearest example of this is the breastfeeding initiation rate of African American moms, which in 2007 was 60%, compared to the overall U.S. rate of 75%.

There are a number of reasons why the rates are different, and I explored some of them in this interview with Kathi Barber, founder of the African American Breastfeeding Alliance.

One reason we didn’t discuss, but which I’ve heard a number of times, is an assumption among health care providers that African American moms don’t plan on breastfeeding.  The result of this expectation is that moms sometimes get poor or no support in the hospital at getting breastfeeding off to a good start.

So, is there a “soft bigotry of low expectations” when it comes to breastfeeding support?  I certainly hear stories reflecting that, like this one in which a mother who is committed to breastfeeding gets no help (but plenty of formula samples) from her postpartum nurse, who “seemed surprised to find [her] breastfeeding.”

But I’ve been wondering whether any research might bear that out, so I spent some time looking at the limited literature on this topic, and I think the studies below add up to a “yes.”

Here’s what I found:

– One study examined racial disparities according to women’s self-report of advice received from health care providers during pregnancy about breast-feeding, among other topics.  It found that “the difference [in advice] between Blacks and Whites…approached significance for breast-feeding.”  Another study concluded that “the prenatal period may be a critical time to influence a prospective black mother’s decision to breastfeed.”

– One recent study of WIC breastfeeding support in North Carolina found that “those with higher African American populations were significantly less likely to offer clinic-based breastfeeding support services and trended toward fewer services in general” and found that “differences in the availability of breastfeeding support services were associated with the racial/ethnic composition of the catchment area.”

– A study using older data found that “being African American was associated with less likelihood of breastfeeding advice and greater likelihood of bottlefeeding advice from WIC nutrition counselors.”

– A small interview-based study of African American women and breastfeeding found that “support and advice about infant feeding from the health care system were uneven.”

Why is strong provider support important?  Because study after study has found that when African American women (and all women, for that matter) are given good advice and support, breastfeeding rates go up and up.

Take for example, Boston Medical Center, which became a Baby Friendly Hospital in 1999.  The rate of breastfeeding among African American women went from 34% in 1995 to 74% in 1999.

Another study found that Baby Friendly Hospitals, whether they serve high or low proportions of African American mothers, all had similarly high breastfeeding rates.  In other words: disparity, what disparity?

Is there good news to share on the disparity front?  Yes.  The gap between black and other mothers’ breastfeeding rates is closing at a strong rate, declining from a gap of 19% down to 15% in just seven years (20002007).

This is a real achievement, and something to celebrate.  But I would hope that continued progress occurs with the full support of our health care providers.

Do you think your race had any impact on your providers’ assumptions about whether you would breastfeed?  Have you experienced a Booby Trap based on your race?

Image credit:  Indiana Black Breastfeeding Coalition

10 thoughts on “Booby Traps Series: Is there a “soft bigotry of low expectations” when it comes to breastfeeding?

  1. I didn’t know it at the time with my first but reading this now yes they offered no support to me I kinda just had to learn thank god I had my mother and grandmother visit the two days after when we’re still in the hospital they both breastfeed and were able to help me. Also thank god for my husband who was the one that pushed me to look in to it and is the reason I breastfeed in first place. With out the three of them I wouldn’t have been able to do it.


  2. I am in NC and I was a WIC Director/ Breastfeeding Manager. Unfortunately, my former County employer did not know the Law or Policy on Breastfeeding in NC. It is so sad that statistics wind up like this, when Administration is the driving force behind what employees can and cannot do. I loved my job and the people I assisted. But the result was ….one mans personal choice. I was told to tell women in a Public Health Department “Tell them to go somewhere else,when you see them feeding their babies.” ” Help them find another place to go”. “Needless to say, I explained the law, clearly and professionally. Of course, I am not breaking the law for anybody. So, I did what could to protect myself and reported the situation to a level higher than me. The rest is obvious…the man, goes on to a bigger city near you!! Making more money, making bigger, affecting more people, making bigger decisions. I am not the town hero for standing up for the Breastfeeding Rights of the women and babies in that WIC office. But I am so happy to know I can make a difference. Everyday I am so motivated to teach and advocate for the Rights of Childbearing Women.


  3. This is excellent, Tanya. Thank you for putting on the table an issue that is so important. In addition to improving healthcare provider knowledge and support for breastfeeding (across the board but especially for providers who serve the underserved), community strength and support for breastfeeding is vital. The WIC peer counselor program is one effort that is making a significant stride against that gap of disparity; additional community-based (churches, schools, workplaces) initiatives will continue to close the gap. Many argue that, because of their higher rate of postpartum return to work/school, black and Latina moms and babies need more, stronger support for breastfeeding since the health risks of not breastfeeding are even higher than for babies who are able to stay home with their mothers. Great topic — thanks for starting the conversation!


  4. Race plays a big role in what many healthcare providers will tell you about breastfeeding and how they tell it. My second baby went to the NICU and i clearly indicated she was to he breastfed only. Well about 2 hrs after she was born i walked down to the NICU to feed my baby and there is the NICU staff, shocked to see me, giving my baby a bottle of formula. We have severe milk allergies in my family. No amount of formula is ever ok as it can provoke a life threatening reaction. The staff then tried to chastise me saying I should have mentioned the high risk of allergies. When I told them to check her chart it was in there ,no one had bothered to look.
    I had to beg for a pump and then pester someone to show me how to use it. And they didn’t put ke on the breastfeeding menu which has more calories. Overall the staff was unsupportive and in general tried to sabotage our breastfeeding. She and I persevered and nursed for 18 months.


  5. Thanks for this post, it rings true. Could you address the needs of teen moms as well sometime? People don’t expect them to bf either and many fall to the wayside because of outside pressures despite their wishes.


    1. Absolutely! I think that teen moms are also caught in this trap of low expectations. Will definitely write about it – thanks for the nudge!


  6. I am pregnant with what will be my 5th breastfeed baby. Yesterday, a friend who has known me 18 1/2 years offered me a can of formula. It seems there is always this underlying expectation of failure. I was blessed to have an extremely supportive mother when I was a teen parent, a supportive husband who stood up to those who tried to criticize, and a rebellious streak that gave me the strength to buck expectations. My goal is to be a LC and work with WIC to increase breastfeeding rates.


  7. I gave birth last year in a baby-friendly hospital. I was always planning to breastfeed, but (as it later turned out) my son had an unusual kind of tongue tie, so breastfeeding was painful and difficult. I knew to keep on bf no matter what, but it was great to have lactation consultants on hand to support that decision. I have cousins whose husbands encouraged them to stop breastfeeding because it hurt so much. Professional support makes all the difference: at least you have someone telling you it’s not supposed to hurt, and if it hurts, there’s a problem that can be fixed with better technique or, if there’s a tie, a small snip. If the same thing had happened to a less-educated mom who was less committed to breastfeeding, and the hospital had offered her formula, surely there’d have been one less bf baby.


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