When my 3-week-old grandson started to lose weight, I could not help but be concerned. Ultimately, it turned out that my daughter's breast milk wasn't providing enough nutrients, and so the pediatrician instructed her to supplement her breastfeeding with formula. Unfortunately, shelves at the local supermarkets were empty. Online suppliers were back ordered. Supply chain issues resulting from COVID-19 had turned baby formula into a hot commodity. She and I immediately contacted friends and extended family, and deliveries of formula quickly began to arrive from across the US. My daughter and I were grateful and relieved, and my grandson soon started gaining weight. As an adult and pediatric DNP-prepared NP, my concern turned to other Black mothers who inherently make up a vulnerable population. Breastfeeding came to mind immediately and the literature confirmed what I already knew: Breastfeeding is recommended-especially during the first months of life-and disparity in breastfeeding is evident among Black women.1,2
The multiple facets of breastfeeding
The issue is complex, and the effect of racism, bias, and discrimination on rates of breastfeeding is not well understood.3
Breastfeeding is beneficial to mother and baby. Yet Woollard questions the presentation of breastfeeding as the "best" option, as this language strays from the idea that breastfeeding is the norm and may inadvertently set up a benefit/risk dichotomy that may precipitate feelings of guilt around breastfeeding decisions.4
Studies have shown that Black women face "historical, cultural, social, economic, political, and psychosocial barriers" to breastfeeding.5 Yet statistics show that rates vary from state to state, suggesting that these barriers are not consistently evident across geographic locations.2
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides support for breastfeeding mothers, yet Black women are less likely to have access to this type of supportive information and to feel that breastfeeding is culturally acceptable.4,6
NPs are ideally situated to encourage pregnant women and new mothers to breastfeed, leading the charge as breastfeeding champions.
Creating breastfeeding champions
How do we create breastfeeding champions, and what exactly should these champions do? I can answer the first question: Speak up and start the discussion. Only one voice is needed to engage and interest others, one voice to kindle the spirit of others and initiate action. I would be naive to think I have the answer to the second question. The CDC suggests populations with low rates of breastfeeding can benefit from targeted breastfeeding promotion programs.2 The challenge, however, is to determine what "targeted" looks like in any given community and then to grow programs of support that not only fill the needs of the community but are feasible to implement. That task is too much for one or two individuals. We must grow our number of breastfeeding champions and take advantage of the window of opportunity COVID-19 and the formula shortage have provided to increase the numbers of Black women who breastfeed their infants.
The most important step is the first one. Let the discussions begin.
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