Here’s How Lactation Experts Are Working To Redefine and Decolonize Breastfeeding

In the 19th century, Native American children were often separated from their families and sent to boarding schools, a practice that triggered the downward trend of Native nursing practices.

In the 19th century, Native American children were often separated from their families and sent to boarding schools, a practice that triggered the downward trend of Native nursing practices. But the problem didn’t start there. Before the boarding-school era, “we had 300 years of war, famine, and occupation,” that disrupted the family unit and Indigenous customs, says Camie Goldhammer, MSW, LICSW, IBCLC, who is Sisseton-Wahpeton and the program manager, lactation consultant, and doula for Daybreak Star Doulas, which serves Native families in the Seattle area. Feeding a baby requires community support and generational knowledge, two important resources that were lost during this boarding-school period.

“For many Native parents, there’s a subconscious fear of losing our kids, no matter how well or stable we are. In every generation before us—whether it’s from boarding school, drugs or alcohol, or missing and murdered Indigenous women—they’re wondering if they’re going to be taken away from their babies,” Goldhammer says. “When we breastfeed our babies, we make a promise that we’re going to be there for them,” she adds. And many Indigenous people are still forced to break that promise through no fault of their own.

Black parents know this struggle as well. The Black community has had to endure the intergenerational weight of slavery and everything associated with it, including the practice of wet nursing white babies instead of their own. “It can be easy to overlook the historical trauma embedded in breastfeeding initiation and duration, but I think that is where we have to start. For years, Black women were forcibly used as wet nurses, making breastfeeding an act of labor, a far cry from the nurturing messages we have about breastfeeding today,” says Qu’Nesha Sawyer, PhD, a therapist and birth doula who leads mental health support groups for Black women through the startup Sesh.

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Later on in history, formula feeding became the norm and access to formula was both an economic challenge for Black families, and a physical challenge for the majority of Black parents, who worked outside the home, Dr. Sawyer explains. Even after the majority of non-Black parents migrated back to nursing because it was seen as healthier, formula was deliberately marketed toward Black communities as a symbol of “good parenting” and “upward mobility”—if parents could afford it.

Today, the assumption that Black parents are less likely to nurse persists. According to a study published in the journal Pediatrics, hospital staff are more likely to introduce Black babies to formula, an act associated with shorter breastfeeding duration. “There has not been enough positive messaging about breastfeeding to undo the years of poor imagery and negative connotations related to breastfeeding as a Black person,” Dr. Sawyer says. (This is one reason why initiatives like Normalize Breastfeeding, founded by photographer and lactation educator Vanessa Simmons, are so vital.)

"For years, Black women were forcibly used as wet nurses, making breastfeeding an act of labor, a far cry from the nurturing messages we have about breastfeeding today"—Qu’Nesha Sawyer, PhD

Lactation support for Black and brown families has been even more of a challenge during the pandemic, given that the virus has taken a larger toll on these communities. Hospitals may separate Covid-positive parents from their babies, per CDC guidelines, and that could leave the families without adequate, hands-on practice and guidance from a lactation professional. Outside of that hospital assistance, parents are often on their own, which presents an additional challenge for some BIPOC parents whose families may have only used formula.

It’s also worth noting that just under 75 percent of certified lactation counselors are white-identifying, and they may not be well-versed in the historical inequities BIPOC parents face. “Breastfeeding and chestfeeding practices and education must be rooted in birth and reproductive justice,” says Angela Aina, MPH, executive director of the Black Mamas Matter Alliance, which recently partnered with FemTech company Elvie to raise awareness about disparities in infant feeding. “This is why we continue to advocate for holistic maternity care services, full spectrum doula care, and culturally congruent lactation support for Black mamas, so that they have the rights, respect and resources to thrive before, during, and after pregnancy,” Aina says.

In providing that full spectrum care, it’s crucial for lactation consultants to take an individual’s cultural background into account. When Kim Moore-Salas, IBCLC, a Navajo citizen, lactation consultant at Valleywise Health Medical Center, in Phoenix, and owner of Indigenous Breastfeeding AZ and Tribal Indemnity, works with Native families who give birth, she believes it is ceremony. She recently started offering cedar bead bracelets to Native families to symbolize protection: Native American people use cedar medicinally to fight inflammation, she explains, but also to ward off negative energy and spirits, which is especially important when families are not able to have a traditional home birth or birthing on their homelands.

Moore-Salas and Goldhammer travel to Native communities across North America to train community members to become Indigenous Breastfeeding Counselors. They say it’s a major contrast from the white-centered lactation education they both received. “When we serve our own community, there is an unspoken language among each other. We can be ourselves; we understand we come from the same history that hurt us, so we feel safe,” Moore-Salas says. “This allows us to still heal and not feel judged.”

The B.L.A.C.K. (Birth, Lactation, Accommodation, Culture, and Kinship) course, launching virtually in January 2021, intends to function in a similar way, bringing historical-trauma-informed education to Black lactation providers and lactation providers who support Black parents. Led by lactation specialists and activists Felisha Floyd, Lydia O. Boyd, Ngozi D. Walker-Tibbs, and TaNefer Camara, the course not only instructs lactation counselors in a way that honors Black bodies, it advocates for the counselors to have the same work opportunities and equivalent pay that non-Black care providers might have.

Language that lactation professionals use is also key in helping their clients feel understood. For example, there’s consistently been a gap in non-English speaking lactation providers due in part to systemic racism and discrimination in language access. Brenda Reyes, RN, CLC, a program specialist lead of peer lactation services at Health Connect One, is working to rectify that. She helps train other breastfeeding peer counselors in Spanish, so they can provide lactation support to Latinx communities in their native language. Although Latinx communities have some of the highest rates of breastfeeding in the U.S, studies have found that Latinx parents are most likely to supplement feeding with formula earlier than any other racial or ethnic group, presumably because of the economic pressure to work outside the home. On top of that, paid parental leave and breastfeeding support from employers is lacking, Reyes adds.

Throughout history, many Latinx families in America have kept up their family traditions of starting bodyfeeding at birth, but research shows that the longer Latinx people remain in the U.S. and become accustomed to U.S. culture, the less likely they are to keep breastfeeding. However, it’s important to realize that Latinx parents in the U.S. come from a variety of cultural backgrounds. “We are not homogenous and our experiences vary,” Reyes points out. Some Latinx parents may not have a network of family support, and it can be much more difficult to find a lactation provider that is going to speak their language and understand their culture.

Inclusivity and understanding matters in the queer community as well. Historically, it’s been a challenge for people who identify as LGBTQ+ to become parents in the first place: It wasn’t until 1979 that a queer couple was able to legally adopt a child and it wasn’t until 1999 that the first birth to a transmasculine person was recorded. It’s also common for medical institutions to discriminate against the queer and trans community, often disrespecting parents’ chosen names, pronouns, and prefixes. According to the Journal of Human Lactation, the medical literature and imagery used to instruct lactation consultants (a profession that was only officially established in 1985) has been inherently heteronormative and cisnormative since the beginning. LGBTQ+ parents may not identify as a “mother” or “father,” may have a partner who’s also lactating, or may not be able to bodyfeed at all, and their lactation specialist should be well-versed in the appropriate language and pronouns to use.

The ultimate goal is to make sure the parents are as safe as the baby, even if that means choosing not to nurse. “Bodyfeeding is the healthiest option if it’s safe for [the parent], but if bodyfeeding is going to cause any pain or trauma, it’s not the healthiest option,” says Morgane Richardson, doula and co-creator of Woven Bodies, which provides digital parenting support to queer families and their healthcare providers and allies.

For Black and Indigenous individuals, bodyfeeding can be seen as “an act of resistance to a system that hasn’t worked for us for so long,” according to Moore-Salas. While it’s a powerful experience for some, it’s simply not going to be possible for every parent who is queer or living in a BIPOC body. “We’ve pushed the movement forward, and simplified this ‘breast is best’ mentality—but it’s much larger than that. We have to look at the intersections of race and class, and identity,” Richardson says.