An African American grandmother’s journey to support breastfeeding during the Lenten season, amid COVID-19 restrictions
By Altrena G. Mukuria – Maryland, USA
On Wednesday, March 18, 2020, my daughter gave birth to my first grandchild. I was on my way from Maryland to Texas, USA, amid the COVID-19 shutdown. Nonetheless, I was overcome by joy and excitement! I was becoming a grandmother, and my daughter was becoming a mother. Even better, it was happening during this season of Lent — 40 days before Easter — a season so special to my family. Nothing was going to stop me from getting to Texas. I did not want my daughter and her husband to start this journey without my support. It takes a village to raise a mother.
My American origins
I was born in Philadelphia, Pennsylvania, and come from parents raised in rural North Carolina, who migrated north for better opportunities. They wanted a modern urban lifestyle, but they brought their own traditions. In the late 1950s, my mother breastfed me for nine months and my younger brother for six months. I saw my older sister comfortably nurse her babies modestly at home with company around. I knew I would breastfeed my children also when I had them. After graduate school, I moved to Nairobi, Kenya, to work in global nutrition. I married and settled there. After my first two children were born, I enrolled in a public health doctoral program. My dissertation was on the topic of exclusive breastfeeding and social support. Exclusive breastfeeding helps protect against common childhood diseases, particularly for children under five years old in low income countries. However, I discovered that to study breastfeeding academically was one thing; to practice and support it was another.
My other life in Kenya
Born in Africa of a Kenyan father and African American mother, my daughter, Nyam, spent her first 12 years living an urban African life. In Kenya, my daughter saw everyone breastfeed; 98% of infants are breastfed there.  In 1994, 70% of Kenyan hospitals were Baby-Friendly.  (For more information about the Baby-Friendly Hospital Initiative, click here: https://www.who.int/nutrition/bfhi/en/.)
It was commonplace in Kenya for women to breastfeed in public. In fact, we had a breastfeeding-only house. One day Nyam’s friend from nursery school came to visit, but seemed to be taking a long time to get out of the car. I went outside to see why.
Her mother said that her daughter was putting her doll’s bottle into the glove compartment because she knew she could not bring it into our house! I bent over laughing, but it was true. Later that day, my daughter and her friend breastfed their dolls.
Back to the USA, a new experience!
In 1997, our family migrated to Maryland, USA. Nyam and her siblings had to adjust to their American side of life. In the U.S. then, you rarely saw public displays of breastfeeding. Sadly, even now, only 44.7% of black infants are breastfed at six months of age, and there is a 14.7 percentage point difference in breastfeeding rates between black and white infants.  In Maryland, 18.2% of infants are born in Baby-Friendly facilities.  My daughter graduated from high school in Baltimore and went on to college and medical school in other states. As a practicing physician, she supports breastfeeding families. But what would she do as a mother? What support would she want from me? In Texas, only 20.1% of infants are born in Baby-Friendly facilities. 
As part of my doctoral research on breastfeeding in a low-income community of Nairobi, I learned that the baby’s grandmother and his father are the key to a new mother’s support. Following mothers from their last month of pregnancy until their babies were four months of age, I learned a lot about what supports they wanted and what they received from their networks. It turned out that they were not much different than mothers from higher-income areas. To care for their newborns, these mothers, like all mothers, had the same needs: financial health, laundry done, house cleaned, shopping accomplished, and informational and emotional support from someone outside themselves to build confidence. Although mothers from higher-income areas were more inclined to have the resources to pay someone to do or help with those tasks, neither area needed someone to feed the baby. This was a breastfeeding culture. Friends and neighbors celebrated every new baby into the community.
What I learned by supporting my daughter in her goal to breastfeed
Grandparents and a baby’s father are the key to a new mother’s support. But there are apps and websites, Instagram, Pinterest, Facebook, and so many other places to find information and build community. I was astounded by all the options. My daughter’s village was mostly found online, while friends on the phone and her doctors comprised the rest of her support network. Due to COVID-19 precautions and quarantine, there were no friends and neighbors visiting in-person to celebrate the new birth. Even though I had been in training to become an International Board Certified Lactation Consultant (IBCLC), I knew that since she is my daughter, it would feel different than working with a patient. Would she welcome my advice? Would she want to hear about my breastfeeding journey? I was delighted to learn, yes!
Since then, we have had long conversations about my breastfeeding joys and challenges. For example, my grandson developed a face rash during his third week at home. I told my daughter about her own rash that she had as a baby, which ended up being a reaction to my dairy intake, received by her via my breastmilk. She checked with her doctor to see if that was also the case for her own son. Indeed, my grandson’s rash turned out to be a reaction to dairy. Fortunately, after a couple of weeks it went away. My daughter was relieved that the cause of the rash was not because she was a bad mother or that she had done something wrong. I reassured her that she was an awesome mother.
Reflections on pumping, past and present
My husband and I fast throughout Lent, praying for our family. The homebound restrictions for us ended up having some benefits. My company gave me two weeks of grandparents’ leave. Thanks to the ability to work from home after that, my two-week visit to see my daughter and family turned into two months of cooking, laundry and grocery shopping to help my loved ones. So my daughter could take adequate time to rest when possible, breastfeed, and care for her baby, without feeling overloaded with household chores.
After six weeks of exclusive breastfeeding, Nyam started to get ready for returning to work. She passively expressed 3 ounces (oz) of milk using a silicone suction pump . Wow! Thirty-five years ago, I struggled to produce 10 milliliters (ml) with hand expressing, a manual bulb pump, and a pump resembling a sliding trombone. So much has changed since then. Nyam struck gold with the suction pump, the equivalent of about 90 ml (3 oz.)! Today, she started on the electric breast pump and produced 2 oz (about 60 ml) from just one breast.
I feel like my work is done. My daughter is stronger and fully recovered from childbirth. My grandson exclusively receives breastmilk, and has even learned how to take a bottle of pumped breastmilk from his dad when mom is away at work. My son-in-law is balancing his work from home and supporting his breastfeeding wife. My Lenten season prayers have been answered! This new family is well, and the new mother — my dear daughter — is secure and confident.
Altrena G. Mukuria, DrPH, CLS, has been a seasoned global health professional for 40 years, specializing in infant and young child nutrition. She is working to become an International Board Certified Lactation Consultant (IBCLC) as the next chapter in her life.
1. National Council for Population and Development (NCPD), Central Bureau of Statistics (CBS) (Office of the Vice President and Ministry of Planning and National Development) [Kenya], and Macro International Inc. (MI). Kenya Demographic and Health Survey 1998. Calverton, Maryland: NDPD, CBS, and MI. 1999. https://dhsprogram.com/pubs/pdf/FR102/FR102.pdf (accessed 15 May 2020).
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4. United Health Foundation, 2019 Health of Women and Children Report: Baby-Friendly Facility, 2020, https://www.americashealthrankings.org/learn/reports/2019-health-of-women-and-children-report/state-rankings-measures-policy-infants (accessed 15 May 2020).