Maria Stant breastfed her first three children, but she found nursing her babies was a challenge once she went back to work. She worked as a server at a pizza place and then at another restaurant, and she could only afford to take a few weeks of unpaid leave after childbirth – four weeks for her first two children, and two for her third.
It left little time to establish a breastfeeding routine, which can take several weeks. And once she returned to work, it was nearly impossible to find the time and the privacy to pump breast milk to feed her children and maintain her supply.
One employer told her to pump in her car, and another told her to pump in the public bathroom of a hotel, denying her request to use a locked manager’s office, she said. When she headed to the car or the bathroom, customers sometimes made appalling comments: “You want some help?”
Stand, who lives in Milford, Delaware, says she “toughed it out” for as long as she could, but she wishes she had more support to meet her breastfeeding goals.
As the US faces an unprecedented shortage in infant formula after the closure of the country’s biggest factory over contamination concerns, some pundits and parents are weighing the benefits of breastfeeding.
Exclusive breastfeeding is recommended for the first six months of life by medical entities like the World Health Organization, giving rise to the saying “breast is best”.
But not for everyone can breastfeed and there are immense structural impediments to breastfeeding, especially among low-income families and in communities of color that have long been marginalized in the medical system, with long histories of discrimination around infant feeding and caregiving.
More than 84% of parents in the US start breastfeeding, which means the vast majority want to try it. But only 58% are still breastfeeding at six months.
“They leave the hospital and our numbers plummet,” said Camie Goldhammer, a Native American lactation consultant, social worker and full-spectrum doula.
A little less than three-quarters of Black American and 76% of Native American and Alaska Native mothers initiate breastfeeding – rates lower than the national average.
The reasons are complex, ranging from a lack of support from the beginning of a pregnancy to the effects of generations-long trauma from medical and lactation-related racism that persists today, experts say.
Less than one-quarter of babies are born in hospitals designated as “baby friendly” for their breastfeeding support policies, and those hospitals tend to cluster in more affluent regions. Even in baby-friendly hospitals, parents of color report a lack of support.
Where you live can also play a role, with 94.8% of parents in Oregon and 64.7% in Mississippi initiating breastfeeding.
And income is another contributor to whether one breastfeeds, with parents of lower socioeconomic backgrounds less likely to breastfeed. Mothers with higher household incomes are more likely to nurse their babies, frequently because of longer family leave time and enough time and space to pump once they return to work.
These issues have only been exacerbated by the pandemic, said Lourdes Santaballa, executive director of Alimentación Segura Infantil (ASI) in Puerto Rico, an organization focused on safe infant feeding that began during the food insecurity crisis after Hurricane Maria.
“Many hospitals where babies are being born are limiting the help that can be provided to families,” Santaballa said. That makes it difficult to get breastfeeding started in the critical early days after birth.
Racism is another significant barrier to accessing breastfeeding support.
For generations under slavery, Black American mothers who had recently given birth were frequently forced to serve as wet nurses for their oppressors’ families, which meant their own children often went hungry. The legacy of that horrifying history is still present in Black communities today.
“We have long had an aversion to nursing because of wet nursing during slavery,” said Crystal Saiyge, a parent and DEI consultant in Hyattsville, Maryland. “Even though slavery itself ended, oppression never did, and the things that racism created in this country are still ongoing,” said Sahira Long, a pediatrician and medical director of the Children’s National East of the River Lactation Support Center in Washington, DC.
Ana Rodney, who runs MOMCares, a Baltimore organization that provides baby supplies and support to new mothers in the city’s Black community, said the formula shortage has hit many families hard. Black women don’t get breastfeeding encouragement or support from the white medical community, Rodney said.
Breastfeeding requires time, “being able to sit with your baby, being able to bond with your baby and working on your milk supply, not being able to go back to work”, she said. “It’s not that easy for some of us, even if we want to.”
Native communities’ long history of racism and oppression, starting from the first contact with European settlers, has inhibited breastfeeding among Indigenous mothers today, Goldhammer said. “It was mothers and children that were separated, whether that was as a result of genocide, removal, relocation,” she said, and breastfeeding was just one of the vital traditions lost in that time.
When Goldhammer had her baby 13 years ago, “there was a fair amount of breastfeeding support out there, but not necessarily for Native moms – it was always very white-centered,” she said. Goldhammer soon became a board-certified lactation consultant who offers culturally competent care and training for peer breastfeeding supporters in Native communities.
“Lactation consultants are overwhelmingly white women, and that is why it has been white women who have seen the increases in breastfeeding … because that’s who the support was geared toward,” she said.
“Our moms of color were not given those same encouragements, were not talked to about breastfeeding. And then, of course, we have the marketing of formula to our communities that has been very intentional – whether that was through large formula companies or through programs like Wic,” the federal nutrition program for mothers and children.
Many people of color and low-income people also live in food deserts, Saiyge pointed out, “so this run-around-town-looking-for-formula is 10 times worse for us, and we are very quickly turning to these homemade formulas,” which can be extremely dangerous for young infants.
This is not the first shortage of infant formula in the pandemic, as early panic buying reduced supply, leaving those unable to travel far facing the worst shortages.
As Morgan Fabry drives around Chicago looking for baby formula, she can’t help but be bothered by comments from people who don’t understand why she can’t breastfeed. “The bottom line is, fed is best,” said Fabry, 34. “I’m getting triggered by people who say, ‘Oh, just breastfeed.’”
Maria Stant’s fourth child is nine months old, and she isn’t able to breastfeed because of the medication she takes.
Stant relies on Wic for most of her daughter’s formula, and she budgets for off-brand cans for the rest of the month – but that has grown increasingly difficult to find. “Even before this shortage, this formula was already becoming scarce,” she said.
“I haven’t been able to find any off-brand in about two months. When I did finally find some two weeks ago, it was the last can on the shelf. With tears in my eyes I looked up and thanked God in the aisle,” she said.
Parents around the country are facing empty shelves with a growing sense of dread. They deserve support and empathy, Santaballa said – and the acknowledgment that breastfeeding is far more complicated than it may seem.
“If a family isn’t breastfeeding now, and they’re formula feeding, we can’t expect solutions overnight,” she said. “If we treat them with dignity and kindness, and help them navigate the formula shortage, focusing on what their baby needs, maybe they will approach us for help with breastfeeding – but definitely they won’t if they remember us as being these judgy, shaming, elitist sorts of people.”