Lactation as Social Justice: Why Social Workers Should Care About Breastfeeding

By Kristin Cole Cavuto, MSW, LCSW, IBCLC

“Disparities in breastfeeding initiation and duration due to racism and other forms of oppression mean that the children who need human milk feeding the most are the least likely to receive it.” health, development, and prevention of disease throughout the lifespan. Breastfed infants have reduced risk for ear, respiratory, and gastrointestinal infections and might be less likely to develop asthma and diabetes. 1 For mothers, breastfeeding is associated with a reduction in risk of breast cancer, ovarian cancer, metabolic syndrome, hypertension, type 2 diabetes mellitus, and cardiovascular disease. On a population level, the impact of these associations is substantial. Cost analysis found that, compared with optimal rates of breastfeeding— defined as 90% of mothers exclusively breast feeding each child for 6 months and continuing through 12 months— suboptimal rates were associated with an excess of 2,619 premature maternal deaths and 721 child deaths, as well as $3 billion in medical costs and $1.2 billion in nonmedical costs. 2

In the US, Black babies have twice the infant mortality rate as non-Hispanic white babies. In New Jersey, it is even worse, with Black infants 3.8 times more likely than white infants to die before their first birthday. 3 The CDC states that increased breastfeeding rates in Black birthing parents would cut this number in half. Unfortunately, disparities in breastfeeding initiation and duration due to racism and other forms of oppression mean that the children who need human milk feeding the most are the least likely to receive it. Black infants in America have a significantly lower rate of receiving human milk than white infants (58% vs 73%). This puts Black mothers and their babies at higher risk for poor postnatal outcomes and may be a substantial contributor to the origins of health disparities among African Americans across the lifetime. 4

When discussing health outcomes among marginalized groups, it is important to remember that disparities come from the experience of oppression, not from any inherent factor in the group itself. The weathering concept tells us that Black women in particular experience both physical and mental health complications due to the toxic stress of everyday racism and sexism. 5 The provision of human milk/breastfeeding is an evidence-based intervention that holds potential to mitigate the effects of toxic stress from the moment of birth. 6

As a profession, social work has recognized human milk feeding as a social justice issue. “Because breastfeeding is a critical component of maternal and child health, persistent racial and socioeconomic breastfeeding inequality is a social justice issue in need of social work commitment.” 7 So, how can social workers in New Jersey help to protect and promote this crucial factor is social justice? How can we support our breastfeeding clients on both macro and micro levels?

On a macro level, we must advocate for policies and laws that support human milk feeding. These include paid parental leave, expansion of Medicaid, subsidized daycare, licensure of lactation consultants, Baby Friendly Hospital Initiatives, and all laws that decrease everyday experiences of oppression for marginalized groups.

On a micro level, many of us have work to do on our own biases about breastfeeding before we can effectively help clients. We may feel defensive or angry about our own experiences of being failed by our medical providers and support systems when we had our children. Until we resolve that personal trauma and accept the facts about the importance of human milk feeding, we will contribute to our client’s health disparities rather than abate them.

We can support clients in meeting their breastfeeding goals by providing evidenced based treatment for perinatal mental illness. Lactation provides protection from postpartum depression and increases self-efficacy. It increases the amount of sleep new parents get. It diminishes cortisol levels and reduces stress. 8 Many social workers advise clients to wean their babies in order to receive antidepressant or anti-anxiety medication. This is absolutely unnecessary and causes harm. Women who discontinue antidepressants during or after pregnancy are three times more likely to develop another episode of depression when compared with women who continued to use antidepressants throughout the perinatal period. 9

By supporting our clients in meeting their breastfeeding goals, we are providing evidence based care. When we support our marginalized clients to meet these goals, we are helping to reduce health disparities.

I encourage all social workers in New Jersey to learn more about maternal and infant health disparities and how human milk is a key to eliminating them. As social workers, it is our duty to advocate for social justice issues on all levels. Promoting, protecting, and advocating for human milk feeding does that. I hope that this year’s World Breastfeeding Week will inspire you to join in this crucial social justice movement.

References:

1. Beauregard, J. L. (2019, August 30). Racial Disparities in Breastfeeding Initiation and Duration Among... CDC. Retrieved July 17, 2023, from https://www.cdc.gov/mmwr/ volumes/68/wr/mm6834a3.htm

2. Louis-Jacques, Racial and ethnic disparities in US breastfeeding and implications for maternal and child health outcomes. Seminars in Perinatology, 41(5), 2017

3. New Jersey Breastfeeding Landscape Study. (n.d.). The Burke Foundation. Retrieved July, 2023, from https://burkefoundation.org/burke-portfolio/research/new-jersey-breastfeedinglandscape-study/

4. Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions. (n.d.). NCBI. Retrieved July 17, 2023, from https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4307211/

5. Keough, D. (2023, March 2). Experiencing racism increases black women’s heart disease risk. Retrieved July 17, 2023, from https://www.eurekalert.org/news-releases/981483

6. Hallowell, S. (n.d.). Human Milk and breastfeeding:An Intervention to mitigate toxic stress. Nursing Outlook, 65(1), 58-67.

7. Hurst, C. (2018). Committing to Breastfeeding in Social Work. Social Work, 63(3), 252-260.

8. O'Malley, C. (2022, September 15). Mental Health Benefits of Breastfeeding: A Literature Review. NCBI. Retrieved July 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC9572809/

9. Antidepressant Use While Breastfeeding: What should I know? (n.d.). InfantRisk Center. Retrieved July 17, 2023, from https://www.infantrisk.com/content/antidepressant-use-whilebreastfeeding-what-should-i-know

About the Author:

Kristin Cavuto, MSW, LCSW, IBCLC is a Licensed Clinical Social Worker and International Board Certified Lactation Consultant in private practice in central NJ. Her practice specialties are low supply, parental and infant mental health, ethical non monogamy, and LGBTQ+ issues. She has spoken on various lactation, mental health, and equity topics for many regional, national, and international conferences and organizations. She serves as a legal advocate and expert witness for cases involving lactation and child welfare. Learn more at www.kristincavutoconsulting.com