Counting the Cost: Bias in Breastfeeding Support Hurts Us All

As a Latina, I know all too well how stereotypes and bias can impact the care we receive. When I was delivering my first child, I was subjected to all sorts of assumptions about my marital status, income, education and breastfeeding knowledge. And we don’t need to go far into current events to be awakened to the realities of the strong undercurrents of racism and biased thinking that still permeates America. It’s also a mindset that permeates health professionals, from physicians to nurses, at times unintentionally impacting the care they give and, at other times, their best intentions block our efforts to support our families.


What we also know is that my experience is not unique. In fact, far too many Latinas report that they experienced a form of racism or bias during birth or with breastfeeding support. Our recent landmark findings in our Latino Best Start program, surveying almost 800 Latina mothers, found far too many participants reporting unjust treatment from health care personnel. Often that includes a dangerous thinking that all Latinos are the same, assumptions about education and English proficiency, and use of language such as “them/us” —all of which shows the subtleties of how bias impacts Latinas. We cannot shift Latino health outcomes until there is broad recognition among health care professionals that Latinos are not a homogenous group. Recognizing differences among Latino subgroups is important to understanding their unique health characteristics and developing programs that address their health needs.


When it comes to breastfeeding, Latinas have one of the highest initiation rates in the U.S. Yet, while over 80% of Latinas initiate breastfeeding, only 16% continue to exclusively breastfeed for 6 months. That’s a tremendous drop off. Among Latino groups, breastfeeding initiation and duration rates are lower among Puerto Rican mothers living in the United States in comparison with other U.S. Latina mothers. Puerto Ricans have a 6-month exclusivity rate of 14.4%. As our research showed, Latinas know that breastfeeding is the healthiest food for their babies—but something gets in the way to stunt that commitment. Our report found racism and discrimination around health care to be significant obstacles. Lack of community support and lack of employer support were also reported as key challenges. 


In addition, the “Las Dos Cosas” (both things) phenomenon—Latina women feeding both breastmilk and using formula— is also important. The reasons behind “Las dos” are not fully understood but includes a thinking that formula has additional vitamins that will add to a chubbier baby, which is desirable. However, the “Las dos” trend causes many health care professionals to assume Latina moms will not exclusively breastfeed and therefore they may not receive the information or support resources to exclusively breastfeed longer, which turns “las dos” into a self-fulfilling prophecy - a very dangerous one. Latino infants who experience suboptimal breastfeeding are twice as likely to experience necrotizing enterocolitis, 1.4 times as likely to die from SIDS and 1.4 times as likely to suffer a gastrointestinal infection that leads to hospitalization.


More Latinas won’t exclusively breastfeed if we don’t learn more to address the root causes instead of viewing it as a fait accompli. More Latinas won’t exclusively breastfeed if we don’t build more culturally sensitive lactation support that allows women to explore the cultural nuances of infant feeding decision-making in safe environments. Perpetuating the belief of mixed feeding only benefits the multibillion dollar infant formula industry, who would love to ensure that the fast-growing Latino consumer base become loyal customers.  As a community and family we need to support mothers where they are.  Mothers want the best for their babies and we should provide positive, assuring reinforcement and not guilt and condemnation.


As Breastfeeding Awareness Month comes to a close with the celebration of Black Breastfeeding Week, this August 25-31, we stand with our black sisters to end stereotyping and bias in maternity care and breastfeeding support practices.


To help build agency among black and brown women, we created Latino Best Start as culturally relevant, grounded in the core values of Latino families and designed to create and amplify local champions. We know this can be a model for all communities of color. 


With the anticipated continued rapid growth of the U.S. Latino population, the younger than national average age of the population, and the high birth rate among Latinas, it is clear that the health trajectory of Latinas are inextricably linked to the health trajectory of the United States at large. As Latinas spend more time in the United States and experience increased and prolonged exposure to chronic stress in the form of racism, both interpersonal and structural, their birth outcomes and those of their offspring could be even more negatively impacted.  We can’t afford to allow racism and bias to continue its brutal attack on the health of women of color and their infants, which is an attack on all families.


Please feel free to continue the conversation and share your thoughts and breastfeeding stories with us at our Facebook page


Diana N. Derige, DrPH National Director of Health Initiatives

 Diana leads Urban Strategies’ national health strategy development, program implementation and evaluation of the organization’s broad health equity agenda.  She is also co-director of the Center for Latina Maternal and Family Health Research at the University of Houston. Dr. Derige is responsible for leadership and vision in program conceptualization, design, planning, management, coordination, communication, evaluation, policy and learning of Urban Strategies’ national health portfolio.  She is the proud mother of four girls and one fur baby with her partner Luis. With two toddlers at home she continues to learn about the joys and challenges of being a working mother.

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