By Perspective by Amanda J. Calhoun
The shortage of infant formula plaguing American families has precipitated calls for mothers who formula-feed to “just breast-feed”.
But even as women face this pressure, black women receive counterpressure not to breast-feed – and face obstacles to breast-feeding that most white women do not.
This situation is a legacy of slavery, when enslaved black women were denied control over their own bodies and forced to breast-feed their white enslavers’ babies to the detriment of their own.
The long-term consequence of this coercive practice – along with racist tropes and intentional economic oppression – was racial disparities in breast-feeding rates. Black women are less likely to initiate breast-feeding compared with Asian, white and Hispanic women.
The prevalence of breast-feeding is close to 85% across the nation, but for black women, it is around 75%.
While many posit that this gap stems from cultural preferences, individual choice, a lack of education or lower socio-economic status, this narrative obscures the centuries of oppressive laws, policies and behaviours that drive the disparity.
Before the Civil War, white female enslavers commonly found breast-feeding to be unfashionable and inconvenient. Instead, they preferred to have black enslaved wet nurses breast-feed their babies.
These wet nurses were a valuable commodity. In 1850, 20% of white enslavers (about 70 000) relied on them to breast-feed their children. While wet nursing was a global and ancient practice, for enslaved African women, it was dehumanising and traumatic, stripping them of autonomy over their own breasts.
This cruel practice also had devastating effects on the health of enslaved children. Black mothers were physically separated from their own newborns to breast-feed their enslavers’ babies – sometimes, their own babies were taken from them permanently.
To help justify separating enslaved babies from their mothers, white society created the racist caricature of the “mammy” – a black enslaved woman who was devoted to mothering white children but neglected her own.
The babies of enslaved wet nurses were bottle-fed a concoction of dry milk and dirty water that was not a healthy alternative to breast-feeding.
As a result, many black babies died during slavery. Forced wet nursing also disrupted the relationship between enslaved mothers and their infants during a crucial bonding time, causing significant maternal distress.
Even enslaved black women who were not wet nurses breast-fed their babies for shorter periods than counterparts in Africa (one year compared with two or three years), because their enslavers forced them to return to labour as soon as possible.
After slavery ended, some black women continued to serve as wet nurses for white families, exposing them to further exploitation.
Black families also faced major economic barriers from centuries of exploitation and discriminatory laws, which forced black women back to work after giving birth – often making breast-feeding impossible.
Overall, black women breast-fed less – which served white interests by freeing up the women to do more exploitative labour, including the nursing of white babies.
When infant formula based on evaporated milk became widely endorsed by both parents and physicians in the 1940s, white interests remained the priority.
Formula companies targeted black women in their ads, leading to enormous profits for the white-run industry.
The first black children shown in infant formula advertisements were the Fultz quadruplets, black-Cherokee sisters born in 1946, who quickly became famous as the first recorded African-American identical quadruplets.
A white doctor, Fred Klenner, delivered them and quickly moved to capitalise on their fame for his own benefit. Among other things, he signed them on as poster children for the St Louis Pet Milk company. Kenner’s exploitation resulted in a chain of events that cost the Fultz parents custody of the quadruplets, who went on to face poverty, isolation and early deaths.
While formula companies targeted black women with ads featuring black children, the 1950s marked a surge in the popularity of breast-feeding among privileged white women with the rise of breast-feeding organisations, such as La Leche League, founded in 1956.
These white-led organisations centred their advocacy for breast-feeding on white women, largely excluding black women.
Alongside this white-centred breast-feeding movement, popular media began to portray predominantly white women breast-feeding in humanising images, helping to normalise white mothers breast-feeding.
Images of black women breast-feeding, by contrast, were virtually non-existent – except for condescending images of African tribal women in “National Geographic”.
This difference in portrayals was built on racist ideas about mothers that dated to the idea of the “mammy”.
After slavery, the “mammy” character evolved to take many forms from Aunt Jemima, a dehumanising mascot for syrup that was recently discontinued, to the Welfare Queen, furthered by Ronald Reagan, of a promiscuous black mother who Reagan asserted reproduced only to “game the system” by deriving more government benefits.
Popular movies and television shows also perpetuated these racist stereotypes of the “Bad Black Mother” – helping to push black mothers away from breast-feeding, because society associated the practice with “Good White Mothers”. Some black mothers could not help but internalise this stereotype.
In addition to media influence, several key pieces of legislation also pressured black women to formula-feed. First, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) launched in 1974.
Black women were less likely to receive breast-feeding support from WIC compared with white women – implying that WIC staff assumed black women would formula-feed.
All the while, the programme also offered free formula to low-income women, further incentivising its adoption.
Second, the US did not sign on to the World Health Organization’s (WHO) International Code of Marketing Breast Milk Substitutes in 1981 because of concerns about the WHO becoming involved in US commercial marketing.
This refusal enabled formula companies to continue printing and airing unrestricted advertisements – often targeted at black communities – despite evidence that it hurt women and babies by encouraging mothers to formula-feed (sometimes offering free samples) when they could not afford it long-term.
This led to some mothers feeding their babies inadequate amounts of milk because of lack of funds.
Third, the 1996 changes to welfare – fuelled by long-standing racist conceptions about welfare – forced new mothers out of the home to work at a time when workplaces largely lacked breastfeeding accommodation laws.
The new law disproportionately affected black mothers. Black female welfare recipients were less likely to receive benefits under the new law than their white counterparts and more likely to receive poor treatment from welfare agencies.
An urgent need to work encouraged black mothers to abandon breast-feeding to avoid the difficulties and work-related problems it caused.
In 1991, the WHO launched the Baby-Friendly Hospital Initiative to support hospitals in giving new mothers the necessary care and assistance to breast-feed their newborns.
But medical officials prioritised hospitals in white neighbourhoods for adopting baby-friendly practices, while largely bypassing hospitals in black neighbourhoods. Instead, they pushed black women to breast-feed less.
Even today, black newborns are nine times as likely to get formula in hospitals compared with white babies, and health-care providers are less likely to discuss breastfeeding with black mothers during pregnancy.
Even for black mothers who do decide to breast-feed, lactation consultants are more likely to spend less time helping black women with breast-feeding concerns than white women because of the racist – and false – belief that black women do not breast-feed.
The racist legacy of coercive wet nursing during slavery has shaped every aspect of this landscape. It has fuelled a combination of laws and racist stereotypes that pushed black mothers away from breast-feeding while glorifying breastfeeding white mothers.
The racial wealth gap, which is inextricably intertwined with the economic oppression of black Americans through laws and policies, forces new black mothers back to work earlier, making it harder for them to breast-feed because of inadequate support from employers.
And the psychological trauma of breast-feeding for enslaved black women endures to this day. Some black women see breast-feeding as a way to take back the nutrients that were stolen from black women to feed black babies, but others refuse to breast-feed as a rejection of racist re-enslavement.
Ironically then, even as mothers come under pressure to breast-feed in the face of the formula shortages, black mothers who desire to do so must battle pervasive racist ideas embedded in hospital policies, formula advertising, behaviours among lactation consultants and more.
Breast-feeding disparities are not the mere result of cultural preferences that education will dismantle. Instead, the racial gap in breast-feeding rates reflects white supremacy – long-standing laws, policies and oppressive behaviours created to intentionally uplift white mothers and babies while harming black mothers and babies.
Amanda J Calhoun is an adult/child psychiatry resident at Yale Child Study Center/Yale School of Medicine. She is also a public voices fellow of the OpEd Project at Yale University.