Enter Demetra Seriki’s office at A Mother’s Choice in Colorado Springs, and you’ll see portraits of stunning, empowering, life-giving work: black and brown bodies breastfeeding.
Seriki, a Certified Professional Midwife (CPM), promotes representation in breastfeeding education and imagery. Still, she cautions her clients, who are mostly black, against over-romanticizing the snapshots.
“Breastfeeding is hard work. When you see these beautiful images, these people have had to work hard for this,” says Seriki. “If we can get you to day 14, you are going to be able to successfully breast or chest feed. That’s the turning point. Prior to that, it’s sore nipples, it’s curling of the toes, there are a lot of tears, but we can love you through.”
That kind of communal approach to maternal care was a central theme in the Black Health Summit: Black Breastfeeding: Past, Present, and Future which convened July 17, hosted by The Center for African American Health. Beyond mechanical challenges many breastfeeding parents face, such as low milk supply and improper latching, discussion centered around biases and systemic racism woven into the Black birthing experience; thus the need for Black Breastfeeding Week at the end of August, which is Breastfeeding Awareness Month.
A Deep-Rooted Divide
According to the CDC, breastfeeding reduces infants’ risk for infections and other illnesses such as asthma, diabetes, and mortality. Breastfeeding mothers also benefit, with a lower risk for type 2 diabetes, hypertension, and breast and ovarian cancers. It’s recommended to breastfeed for at least six months. Colorado’s rates showed just 22.4 percent exclusive breastfeeding at six months and 63.9 percent some breastfeeding at six months in 2018. The CDC notes a lower percentage of breastfeeding initiation, duration, and exclusivity (between 10–20 percentage points difference) among Black infants compared to white infants nationally.
“We breastfed the nation, and we nourished the nation,” says Felisha Floyd, an International Board Certified Lactation Consultant (IBCLC) also known as the Blactavist: Black lactation activist. During the Black Health Summit, she pointed to enslaved women who endured wet nursing, being forced to breastfeed a plantation owner’s child, and sometimes being raped in order to coordinate lactation.
Seriki calls back to a midwife inspiration, Dr. Justina Ford, Denver’s first female Black doctor, and further back to midwives before the 1900s who would travel between plantations to assist birthing. As medicine became more institutionalized and served wealthier individuals, midwifery in poor and particularly Black communities was considered “incompetent, unworthy, lacking in ability and skill,” says Seriki, whose job as a home birth midwife didn’t become legal in Colorado until 1993.
Medicalized racism threads through the story of obstetrics in the United States, with the “father of gynecology” James Marion Sims conducting experiments on enslaved bodies without pain management. As recently as the 1970s, writes Dorothy Roberts, author of Killing the Black Body: Race, Reproduction and the Meaning of Liberty, poor Black women were coerced into being sterilized.
“The historical trauma and the impact of race-related micro-stressors on a person over time become compounded in birth,” says Dr. Sayida Peprah, a birth doula and a psychologist who specializes in maternal mental health. Peprah’s keynote topic during the Black Health Summit focused on the relationship between stress and negative birthing outcomes such as preterm or low birthweight, making breastfeeding a more complex process.
The narrative continues with myths and stigmas. Poor women breastfed and wealthy women could afford formula, is one stigma birthwork activist China Tolliver has noted. Or it’s about access; full-time working parents have to use formula. Another one Seriki has heard in her work: “Your breasts are too big to breastfeed,” along with swift prescriptions of formula when babies struggle to gain weight.
“It tells that Black body that they are not capable,” says Seriki. “Then when we get them in our care, we’re spending a lot of time saying, ‘No, you are capable, you just didn’t have the tools in your toolbox, so let’s get things moving.’”
When Paul DePriest, a Montbello-based father of two, and his wife had their children, they connected with Families Forward Resource Center, through which they received supplies and breastfeeding education. DePriest credits the center, family, and friend support for successful breastfeeding experiences despite late nights, judgmental looks in public, and occasional need for supplemental formula. DePriest, now co-chair of Today’s Fathers Program at Families Forward and a rare male Certified Lactation Educator through the Center for African American Health, encourages fathers in his community to invalidate the narrative that Black fathers are physically or emotionally absent, or can’t be invested in the breastfeeding process.
“It’s extremely humbling for me to feel like I’m doing the right thing and I’m being involved in something that every male should experience,” he says.
Families Forward, along with Colorado School of Public Health and other health agencies, created a Community Action Network to address disparities in care. Their 2019 goals included tracking clinic activities and increasing family-friendly policies to build trust and cultural competency.
According to Seriki, clarifying questions that acknowledge patient stress or circumstances could build trust, avoid mismanaged care, promote patient-centered decisions, and ultimately save lives. If a provider makes a race-related assumption, for example, or lets racial biases/fear get in the way of complete dialogue, Dr. Peprah suggests they back up with something like, “It seems like I said something that offended you, I just want to see if that’s true,” or, “How does what I’m saying land for you? Do you disagree?”
Floyd also challenges care facilities and programs to bring people from the community in to talk about birthing and lactation and make sure the culture of their organizations is diverse.
In Seriki’s experience, however, some of these calls to action and invitations are more tokenizing than transformative; she refers to photo-ops, unpaid labor, non-inclusive language, and breakdowns between mission and actual care.
“When that happens, the best interest isn’t in the community members, it’s in the interest of the organization,” says Seriki. “I had to learn how to work outside the systems and structures in place in order to best serve these families.”
Investment in the Community
Denver’s Soul2Soul Sisters Sacred Seeds Black Doula Collective supports continuous, culturally congruent breast/chestfeeding care for entire families. Rocky Mountain Doula and The Mama ‘Hood offer partial scholarships for doula training and internships for women of color, respectively. The National Association of Professional and Peer Lactation Supporters of Color (NAPPLSC) is making its own support by empowering Black, Indigenous, People of Color (BIPOC) providers to incorporate multicultural practices. The Healthy Children Project and Center for Breastfeeding have started scholarships for BIPOC folks to take the Lactation Counselor Training Course.
Direct investment in community-based doula programs, Medicaid reimbursement for doula and midwife use, and training a diverse workforce are foundations for achieving reproductive justice, according to a Black Mamas Matter report.
Earlier this year, Representative Lauren Underwood (D-IL), Representative Alma Adams (D-NC), Senator Kamala Harris (D-CA), and members of the Black Maternal Health Caucus introduced the Black Maternal Health Omnibus Act to help diversity the perinatal workforce and address community social determinants of health.
Expansion of paid family and medical leave has also been a central goal for postpartum improvements, particularly for Black mothers who are more likely to have less access or ability to take unpaid leave. According to a state-commissioned review in Colorado, there’s strong evidence that paid leave decreases infant mortality and increases the rate of exclusive breastfeeding at six months. On July 31, Colorado Families First delivered more than 205,000 signatures, petitioning for Initiative #283 to appear on the November ballot. The initiative would set up the FAMLI Fund to support paid leave using 0.9 percent of wages split by employers and employees.
Seriki views pregnancy and birth as the most sacred process in life. The intricate process of meeting needs to support parent and child nourishment—and thus community health— is precious and unique to each family.
“Nobody can duplicate that experience or take it away from you,” says Seriki. “It is one of those rare life moments that you can say, ‘This is mine. I made this. This was made for me, by me, through me.”
Celebrate and learn with these events:
- Black Breastfeeding Week, August 25-31, 2020, returns for its seventh annual gathering, this time online. The theme is “Revive. Restore. Reclaim.” Find online events from organizations across the country.
- Black & Latina Breastfeeding Week, Denver will offer prints from the past several years’ photo shoot events during August. See the event’s Facebook for updates.