In Pursuit of Equitable Breastfeeding Support

Eva Williams, North Oxfordshire, Great Britain

Republished with permission from La Leche League Great Britain. The original article can be found on their website: https://www.laleche.org.uk/in-pursuit-of-equitable-breastfeeding-support/

 La Leche League Great Britain (LLLGB) is committed to becoming a fully inclusive organisation able to offer equitable breastfeeding support to families of all backgrounds and skin colours. In this report, we provide a comprehensive list of resources to help all Leaders inform themselves of the barriers faced by Women of Colour and how to be antiracist.

Racial disparities in healthcare are evident in the United Kingdom (UK), and the world of breastfeeding support is sadly no stranger to systemic racism. Not only are maternal and infant mortality rates in this country shockingly higher among Women of Colour than among White women, but there are also structural barriers preventing Black and Brown families from accessing breastfeeding information and support.

According to the 2019 MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) report, Black women in the UK are five times more likely to die as a result of pregnancy complications than White women, while women of mixed ethnicity and Asian women are respectively three times and twice more likely.[1] Infant mortality statistics are equally shocking: 2013 data collected by the UK Office for National Statistics shows that Pakistani, Black Caribbean and Black African babies had the highest infant mortality rates (6.7, 6.6 and 6.3 deaths per 1,000 live births respectively) compared to White British and White Other babies (3.3 and 2.6 deaths per 1,000 live births).[2]

According to the UK Infant Feeding Survey 2010,[3] Black mothers actually have higher breastfeeding initiation rates than White mothers (96% vs. 79%), as well as higher breastfeeding rates at six weeks and six months (89% vs. 65% and 64% vs. 40% respectively). However, being able to access adequate breastfeeding support could further improve these rates, resulting in better short- and long-term health outcomes for Black mothers and babies. Breastfeeding could help save babies’ lives,[4] and this is why it is so important that the support offered by breastfeeding organisations like LLLGB is accessible, inclusive, equitable and culturally relevant.

We are acutely aware that our lack of racial diversity and insufficient attention to cultural sensitivity may have created an unwelcoming environment for Women of Colour in need of breastfeeding support. We also know that socio-economic factors can have an impact on the ability of families to access our services and that Black and Brown women are often disproportionately affected. Our failure to understand this in the past has contributed to perpetuating systems that discriminate against People of Colour and, as an organisation, we stand accountable for that.

We are actively working to instigate change such as ensuring that all skin descriptions on our website are representative and not excluding, and supporting local Groups to remove barriers that might prevent mothers from attending our meetings. One of our recent National Workshop sessions (“Who’s not in the room?”) considered the reasons that might prevent families from seeking our support in the first place. It included the importance of carefully examining the content and tone of meeting announcements, and whether venue choice might be off-putting to those who do not normally attend Group meetings. We are also exploring training options for all Leaders in Great Britain and sharing ideas to help us actively make change. LLLGB recognises that we have a lot more work to do to fully address these issues. However we are taking our pursuit of antiracism very seriously and we are committed to becoming a genuinely inclusive organisation able to offer culturally sensitive breastfeeding support to families of all backgrounds and skin colours.

You can access LLLGB’s Equity and Representation Policy here https://www.laleche.org.uk/equity-and-representation-policy/

Eva Williams lives in North Oxfordshire, England, with her husband and four children, aged ten, eight, seven and one. She has been a Leader in Great Britain for five years, and is currently LLLGB’s Publications Director. She acts as Editorial Consultant, making sure that LLLGB’s publications and external communications are accurate and unbiased, and she is a member of Breastfeeding Today’s Editorial Review Board. She also previously served as Editor of Breastfeeding Matters, LLLGB’s bimonthly publication for members.

Resources

Podcasts/Presentations

Conversations with Nova Reid: More than just birth, Black maternal mortality, toxic kindness and uncovering medical racism with Mars Lord https://podcasts.apple.com/gb/podcast/4-more-than-just-birth-black-maternal-mortality-toxic/id1506584414?i=1000471862805

Kimberley Seals Allers: The Lived Experience of BAME Women in Birth and Breastfeeding – UNICEF Baby Friendly 2019 Annual Conference Presentation https://www.unicef.org.uk/babyfriendly/bame-women-in-birth-and-breastfeeding/

Ruth Dennison: Breastfeeding in the Black Community: Pregnancy, Birth and Beyond https://www.youtube.com/watch?v=m5nxfK0YeFc

Nekisha Killings: How Did I Miss That?: Breast Assessment and Non-White Skin Tones https://www.goldlearning.com/ce-library/all-lectures/breast-assessment-and-non-white-skin-tones-detail

Good Ancestor Podcast by Layla Saad: Candice Brathwaite on Being a Black British Mother http://laylafsaad.com/good-ancestor-podcast/ep028-candice-brathwaite

Ibram X Kendi: The difference between being “not racist” and antiracist – TED 2020 https://www.ted.com/talks/ibram_x_kendi_the_difference_between_being_not_racist_and_antiracist?

Nova Reid: Not all superheroes wear capes – how you have the power to change the world – TED 2020 https://www.ted.com/talks/nova_reid_not_all_superheroes_wear_capes_how_you_have_the_power_to_change_the_world?language=en

About Race with Reni Eddo-Lodge https://www.aboutracepodcast.com

Talking Race with Young Children – NPR podcast https://www.npr.org/2019/04/24/716700866/talking-race-with-young-children?t=1594761427154&t=1605270230307

Dope Black Mums: The Mixed Race Experience https://podcasts.apple.com/gb/podcast/9-the-mixed-race-experience/id1503347953?i=1000468782963

Breastfeeding as food justice – Black Breastfeeding Week UK https://www.youtube.com/watch?v=3AaHjaiVoLE

Reports/Articles/Guides

MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. November 2019. https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf

Ingram, J. et al. Exploring the Barriers to Exclusive Breastfeeding in Black and Minority Ethnic Groups and Young Mothers in the UK. Maternal Child Nutrition, 2008; 4(3): 171-80. https://pubmed.ncbi.nlm.nih.gov/18582351/

Griffiths, l.J. and Tate, A.R. The contribution of parental and community ethnicity to breastfeeding practices: evidence from the Millennium Cohort Study. International Journal of Epidemiology, 2005; 34 (6): 1378–1386 https://academic.oup.com/ije/article/34/6/1378/707404

McFadden, A. et al. Does cultural context make a difference to women’s experiences of maternity care? A qualitative study comparing the perspectives of breast‐feeding women of Bangladeshi origin and health practitioners. Health Expectations, 2013; 16 (4): e124-e135. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1369-7625.2012.00770.x

Anekwe, L. Ethnic disparities in maternal care. BMJ, 2020. https://www.bmj.com/content/368/bmj.m442.full

Oakley, L.L. et al. Factors associated with breastfeeding in England: an analysis by primary care trust. BMJ, 2013; 3 (6). https://bmjopen.bmj.com/content/3/6/e002765

Kelly, Y.J. et al. Racial/Ethnic Differences in Breastfeeding Initiation and Continuation in the United Kingdom and Comparison With Findings in the United States. Pediatrics, 2006; 118 (5): e1428-35. https://pubmed.ncbi.nlm.nih.gov/17079543/

Kimberley Seals Allers: Top Five Reasons We Need A Black Breastfeeding Week http://blackbreastfeedingweek.org/why-we-need-black-breastfeeding-week/

Ruth Dennison: Why Black Breastfeeding Week? https://www.121doula.co.uk/breastfeeding/why-black-breastfeeding-week-2/

Alicia Burnett: ’We Need to Talk about Race’: A reflection on the RCOG’s International Women’s Day conference https://www.all4maternity.com/we-need-to-talk-about-race/

La Leche League International: Black Breastfeeding Week Celebrations. Breastfeeding Today, October 2019. https://llli.org/black-breastfeeding-week-celebrations/

Zeenath Uddin: As a midwife I see racism towards BAME mothers and NHS workers alike – enough is enough https://metro.co.uk/2020/06/22/bame-midwife-racism-nhs-race-matters-12879872/

Child of our Time: Breastfeeding and Ethnicity http://childofourtimeblog.org.uk/2015/04/breastfeeding-and-ethnicity/

Boujie Media Blog: What is White Privilege https://www.boujiemedia.co.uk/blog/

Nova Reid Free Anti-racism Guide https://novareid.com/free-anti-racism-guide/

Guide to Allyship https://guidetoallyship.com

National Museum of African American History & Culture: Talking About Race https://nmaahc.si.edu/learn/talking-about-race

Faima Bakar Metro article: The way you define racism may stop you from seeing it – so what definition do you hold? https://metro.co.uk/2020/02/28/way-define-racism-may-stop-seeing-definition-hold-12287889/

Skin Deep https://dftbskindeep.com

Breastfeeding as a Black woman in modern day UK https://abm.me.uk/breastfeeding-information/breastfeeding-as-a-black-woman/

Black Women Do Breastfeed https://blackwomendobreastfeed.org

Books

How to Be an Antiracist by Ibram X Kendi

Me & White Supremacy by Layla Saad

Why I’m No Longer Talking to White People About Race by Reni Eddo-Lodge

I Am Not Your Baby Mother by Candice Brathwaite

So You Want to Talk About Race by Ijeoma Oluo

Black and British: A Forgotten History by David Olusoga

Natives by Akala

The Good Immigrant by Nikesh Shukla

This Book is Anti-Racist: 20 Lessons on How to Wake Up, Take Action, and Do the Work by Tiffany Jewell

Reproductive Injustice: Racism, Pregnancy, and Premature Birth by Dána-Ain Davis

Free to Breastfeed: Voices of Black Mothers by Jeanine Logan and Anayah Sangodele-Ayoka

Stamped: Racism, Antiracism, and You by Jason Reynolds and Ibram X Kendi

Anti-Racist Baby by Ibram X Kendi

List of books to facilitate conversation around race with children by Dope Black Mums (https://www.dopeblackmums.co.uk/lets-talk-about-race)

References

[1] MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. November 2019. https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf

[2] UK Office for National Statistics. Pregnancy and ethnic factors influencing births and infant mortality: 2013. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/pregnancyandethnicfactorsinfluencingbirthsandinfantmortality/2015-10-14

[3] Health and Social Care Information Centre, IFF Research. Infant Feeding Survey 2010. https://sp.ukdataservice.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf

[4] Victora C.G. et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90.