AAP Voices Blog

In a seminal study conducted over a century ago, African American sociologist W. E. B. Du Bois stated the following regarding the condition of 40,000 or more people of “Negro blood” living in Philadelphia in 1896: “The most difficult social problem in the matter of Negro health is the peculiar attitude of the nation toward the well-being of the race. There have ... been few other cases in the history of civilized peoples where human suffering has been viewed with such peculiar indifference.”

His words were a reference to the lack of attention being given to addressing disparities in health that plagued the African American community and resulted in human suffering. Unfortunately, little progress has been made in reducing these health disparities in the century since these remarks were made.  

This year’s theme for World Breastfeeding Week was Protect Breastfeeding: A Shared Responsibility. During National Breastfeeding Month and Black Breastfeeding Week, pediatricians must no longer be “peculiarly indifferent” to the breastfeeding disparities in the Black community and commit to doing our part in this shared responsibility to protect Black breastfeeding.

There is a growing body of evidence demonstrating that a person’s experience of racism either in health care or in life is associated with various racial and ethnic differences in health outcomes and health-related behaviors. The persistent disparities in breastfeeding rates among racialized groups is one such example.

It has clearly been demonstrated that race is a social construct rather than a genetic or biologic difference, and, therefore, we must recognize that racial disparities in breastfeeding are a shared, social problem with important health consequences — for which we must all take responsibility.  Until and unless we move beyond acknowledging to developing practical solutions to remedy institutional, cultural, and systemic racism as the root cause of such disparities, we will likely not be successful in decreasing disparities in breastfeeding.

For those of you reading this who are not Black, we urge you all to grow in your role as allies to the Black community every day. It cannot be left to individuals or groups of minoritized and marginalized people themselves to push society forward. Pediatricians bear witness to the daily struggles of families of various races, ethnicities, and life situations.

Especially in this unprecedented pandemic, pediatricians have grown in an understanding of how crucial it is to bring empathy and kindness to our work. As President Theodore Roosevelt once said, “People don't care how much you know until they know how much you care.”

“We need to be comfortable with being uncomfortable and take responsibility for implicit biases that exist.”

We need to be comfortable with being uncomfortable and take responsibility for implicit biases that exist. It is crucial to partner with the Black community to improve access for maternal child health around issues of maternal and infant morbidity and mortality. The focus needs to be on mental health support from pregnancy, birth, and throughout the perinatal period.

As a foundation to addressing health disparities and reducing inequities in breastfeeding for Black families, paid family and medical leave policies must be advanced. Although increasing numbers of states have passed laws, federal legislation would diminish inequity gaps that exist currently for the low-income and racialized families with children who, disproportionately, work in smaller businesses where paid leave has not been a universally accessible benefit.

Evidence shows that time with baby increases the odds of breastfeeding exclusivity and duration for working mothers.

It is in our hands to:

• Recognize that the solutions for protecting Black breastfeeding lie within the community and partner with the Black community to lend your expertise and support to their cause. The Black community needs partners, not heroes.
• Familiarize yourself with and make yourself known to local, state/territorial, and national organizations that are lead, organized and/or trusted by the Black community and are working to address breastfeeding disparities among racialized people. These organizations, such as Reaching Our Sisters Everywhere, the National Association of Professional and Peer Lactation Supporters of Color, Black Mothers Breastfeeding Association, and Breastfeeding Sisters That Are Receiving Support, are a vital part of the village that will be required to decrease and eliminate these disparities.
• Make local workplace environments a haven where diversity, equity, and inclusion struggles can be reported, discussed, and addressed openly. We would like to see reporting of microaggressions and concerns in the realm of DEI as a similar process as when clinical errors are reported in hospitals.
• Frame this diversity, equity, and inclusion work as a professional responsibility. We would like to make learning and participation in diversity and equity activities part of required CME for established clinicians, student/trainees’ curricula, and evaluations in all our health care systems. These are skills that need constant attention and cultivation and are another aspect of lifelong learning in medicine.