1. Spatz, Diane L. PhD, RN-BC, FAAN

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Without question, all of us have probably been affected by the COVID-19 pandemic and civil unrest in the United States. In response, we have experienced protests and a call to action to decrease racial disparities and fight systemic racism. The Black Lives Matter campaign has been covered in all media outlets (Black Lives Matter, n.d.). Let us consider this campaign as it relates to use of human milk and breastfeeding.


The Centers for Disease Control and Prevention (2018) reports higher than ever breastfeeding initiation and continuation rates, yet despite these increases, tremendous disparities in breastfeeding initiation, exclusivity, and duration persist related to racial and ethnic background and income levels. Data from the National Immunization Survey-Child (n = 167,843) report that non-Hispanic Black infants continue to have lower breastfeeding rates than White infants (Li et al., 2019). From 2009 to 2015, breastfeeding initiation rates increased by 7.1%, exclusivity rates increased by 9.2%, and breastfeeding duration increased by 11.3% (Li et al.). The largest increase in breastfeeding rates is among White infants and the smallest was among Black infants (Li et al.).


These disparities are further underscored when examining use of human milk and pasteurized donor human milk (PDHM) for infants admitted to Neonatal Intensive Care Units. For hospitals located in postal codes with higher percentages of Black residents, use of mother's own human milk and PDHM were lower (Boundy et al., 2017). Differences in use of human milk and PDHM could be affected by a lack of healthcare provider support, hospital practices and policies, parents' knowledge and exposure to breastfeeding, and community-level support for breastfeeding (Boundy et al.).


We should use momentum from the Black Lives Matter campaign to elevate the critical role of human milk and breastfeeding for Black families. Although we can't change the historical antecedents that have influenced breastfeeding among Black women (Louis-Jacques et al., 2020), we could change the current paradigm to ensure that all families have equal access to evidence-based lactation information, care, and support. Attention to the matter must begin prior to conception and during prenatal care to change the current paradigm.


Black women are more likely to die in childbirth, have more chronic health conditions, and have higher rates of low birthweight infants (Boundy et al., 2017; Petersen et al., 2019). The low rates of human milk and breastfeeding among Black mothers have had an intergenerational impact on the health outcomes of black communities.


Systemic change is warranted. We all have a role in examining our current practice paradigm, the organizations we work for, the health care we deliver, and the communities in which we live. As nurses, let's use the current events as a call to action to ensure that we improve our communities and tailor our care so that Black families have the opportunity to make informed feeding decisions and reach their personal breastfeeding goals.




Black Lives Matter. Retrieved July 1, 2020, from


Boundy E. O., Perrine C. G., Nelson J. M., Hamner H. C. (2017). Disparities in hospital-reported breast milk use in Neonatal Intensive Care Units - United States, 2015. MMWR. Morbidity and Mortality Weekly Report, 66(48), 1313-1317.[Context Link]


Centers for Disease Control and Prevention. (2018). Breastfeeding Report Card United States, 2018.[Context Link]


Li R., Perrine C. G., Anstey E. H., Chen J., MacGowan C. A., Elam-Evans L. D. (2019). Breastfeeding trends by race/ethnicity among US children born from 2009 to 2015. JAMA Pediatrics, 173(12), e193319.[Context Link]


Louis-Jacques A. F., Marhefka S. L., Brumley J., Schafer E. J., Taylor T. I., Brown A. J., Livingston T. A., Spatz D. L., Miller E. M. (2020). Historical antecedents of breastfeeding for African American women: From the pre-colonial period to the mid-twentieth century. Journal of Racial and Ethnic Health Disparities.[Context Link]


Petersen E. E., Davis N. L., Goodman D., Cox S., Syverson C., Seed K., Shapiro-Mendoza C., Callaghan W. M., Barfield W. (2019). Racial/ethnic disparities in pregnancy-related deaths - United States, 2007-2016. MMWR. Morbidity and Mortality Weekly Report, 68(35), 762-765.[Context Link]