August 25, 2025
The lack of institutional support is not merely incidental; it is a manifestation of a deeper, societal issue where the historical trauma of slavery and wet-nursing has created a powerful and haunting historical association with breastfeeding.
The “breast is best” axiom has long been the cornerstone of infant health, championed for providing physiological, psychological, and immunological benefits to both parent and child. Despite these well-documented benefits, a recent study conducted reveals a deep and uncomfortable truth: the biological promise of breastfeeding is rendered tragically inert for many Black mothers by the compounding effects of social determinants.
The research found that while breastfeeding appeared protective for some, its benefits did not extend to infants of color, regardless of their family’s socioeconomic standing.
Historical Context and Systemic Barriers
For more than 400 years, breastfeeding disparities and inequities have persisted in Black communities in the United States, rooted in the legacy of chattel enslavement and the subsequent commodification of Black women’s bodies and their milk. Today, systemic racism and inequitable access to resources and support remain the primary drivers of these disparities.
Research has made it clear that Black women and birthing people face more systemic and structural barriers during the perinatal period than other populations. In-hospital providers are less likely to discuss breastfeeding with Black women, and formula feeding is nine times higher for Black infants immediately after birth compared to their white counterparts. These challenges, along with disparate care in neonatal intensive care unit (NICU) settings, contribute to a reality where Black women and birthing people experience significant obstacles in meeting their infant feeding goals.
The Faltering Panacea: Study Findings
The 2023 study’s findings present a stark, clinical manifestation of these systemic issues. While a greater duration of breastfeeding in the overall population was associated with a reduced incidence of respiratory illnesses, examining the data by race and socioeconomic status revealed a critical flaw in the “breast is best” narrative. High-socioeconomic status (SES) white patients saw a significant decrease in illnesses like ear infections, eczema, and gastrointestinal issues when they breastfed for more extended periods.
In contrast, the study found no such benefits for high-SES Black and Hispanic patients. In fact, for infants of color, breastfeeding was linked to an increased occurrence of eczema, and it did not seem to offer any protection against other illnesses.
These findings suggest that the benefits of breastfeeding are not inherent but are instead dependent on a foundation of systemic privilege and access to resources that extend far beyond a family’s financial means. The physiological stress caused by racial discrimination, the lack of support in workplaces, and living in food deserts are all constant, low-grade sources of attrition that a single biological intervention cannot possibly overcome.
Systemic and Societal Barriers to Lactation
The challenges facing Black mothers in their lactation journey are further exacerbated by the economic realities they navigate. Black women, with a labor participation rate of 60.2%, are disproportionately shouldering the dual mantle of caregiver and primary financial support, with an astounding 70.7% of Black mothers serving as sole breadwinners.
This economic imperative often precipitates an earlier return to the workforce and a truncated maternity leave, an institutional disadvantage compounded by the fact that Black workers are less likely to hold positions that offer flexible schedules or robust benefits like paid family leave. Furthermore, even where legal protections exist, such as the Affordable Care Act’s mandate for break time and private space for nursing, many employers—particularly in the low-wage sector—fail to comply.
The fear of penalties for pursuing a fundamental right—including job loss, demotion, and harassment—weighs heavily on many Black workers, making the exercise of that right a perilous and often untenable option.
Beyond the workplace, systemic inequities in healthcare access and societal stigma create additional, formidable hurdles. Despite the ACA’s requirement for insurance coverage of lactation support and breast pumps, these vital services remain out of reach for many in the 14 states that have not expanded Medicaid, many of which have large Black populations. This structural inequity is mirrored in the hospital setting itself, where forty-five percent of Baby-Friendly hospitals—a designation for facilities that actively promote breastfeeding—are concentrated in areas where Black people comprise 3 percent or less of the population.
The lack of institutional support is not merely incidental; it is a manifestation of a deeper, societal issue where the historical trauma of slavery and wet-nursing has created a powerful and haunting historical association with breastfeeding. This legacy, coupled with the contemporary over-sexualization of Black bodies, perpetuates a stigma that compounds the public health messaging, making a seemingly simple act a complex negotiation with centuries of systemic prejudice.
Recent Trends: Progress Amid Persistence
While inequities persist, recent data sets reveal promising trends in breastfeeding rates for Black women. According to the 2020 CDC Breastfeeding Report Card for infants born in 2017, 74% of U.S.-born Black infants had ever been breastfed, a notable increase from 63% in 2010. The rate of continued breastfeeding also saw gains: 48% of Black infants were still breastfeeding at 6 months, and 26% at 12 months, up from 36% and 16% respectively in 2010. The number of Black women providing human milk exclusively to their infants at 3 and 6 months also increased to 39% and 21% respectively, from 27% and 13% in 2010. These trends are a testament to ongoing advocacy and grassroots efforts, yet they do not erase the fundamental systemic barriers that remain.
The conclusion is inescapable: we cannot continue to discuss racial inequities in breastfeeding without acknowledging the historical, sociocultural, political, and economic contexts that support them. A public health strategy that ignores the lived reality of its target population is, at best, incomplete.
We cannot tell a mother to “do better” when her very environment is working against her. The health of a child is not merely determined by the food it eats but by the world in which it is born.
For Black women, the fight to nourish their children is not just a personal choice—it is a struggle against a system that has long denied them the very foundation of wellness. Future research, policy, and advocacy must recognize and address this significant and persistent reality.
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