Abstract
Alongside a novel coronavirus pandemic, 2020 has provided brutal reminders of the centuries-old pandemic of racism. The senseless deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery have prompted global outrage and demonstrated unequivocally that racism is a public health emergency.
Black indigenous people of color worldwide experience higher rates of maternal and infant mortality, shorter life expectancy, and a greater burden of chronic health conditions. These outcomes are the direct consequence of colonialism 1 and chattel slavery. 2 Their legacy persists today as structural and institutional racism, the “differential access to the goods, services, and opportunities of society by race.” 3
For the mothers and infants we care for, one of the many ways that systemic racism manifests is in lower rates of breastfeeding initiation and continuation, adversely impacting health across generations. As breastfeeding medicine physicians, we must commit to action to dismantle racism and antiblackness.
We might begin with the words of Ibram X. Kendi in his book, How to Be an Antiracist. Kendi writes, “The opposite of ‘racist’ isn't ‘not racist.’ It's ‘antiracist.’” If we are neutral, we are complicit.
To stem this public health pandemic, we must dedicate ourselves to the principles of reproductive justice. Reproductive justice
4
was first defined by Women of African Decent for Reproductive Justice in Chicago in 1994, and it comprises three core rights:
The right not to have a child The right to have a child The right to parent children in safe and healthy environments.
Fundamental to the right to parent children in safe and health environments is the right to breastfeed.
To engage in this work we can begin by educating ourselves about the myriad ways that white supremacy and colonialism have stripped black indigenous people of color of traditional practices and healers 5 and forcibly separated mothers from their children.6,7 In the United States, enslaved women were forced to breastfeed the children of their enslavers, leading to stigma that persists today. 8 Among indigenous populations, historical trauma and mistrust of the health care system are barriers to breastfeeding. 9 This history, coupled with policies that have deprived marginalized populations of wealth and health, is a key driver of lower rates of breastfeeding initiation and continuation among black indigenous people of color.
This history, combined with lived experiences of discrimination, causes many black indigenous people of color to distrust the health care system. It is incumbent upon us as physicians to offer respectful and culturally humble care that can earn the trust of the communities we serve.
As Karen Scott, Stephanie Bray, Ifeyinwa Asiodu, and Monica McLemore have written, “…there is no answer to solving this crisis that Black women do not already know. It is in their lived experiences and resilience that drives innovation and belonging—and we as stakeholders should take heed.” 10 To advance reproductive justice, we must engage with the communities we serve to cocreate and implement novel solutions that are designed by and for black indigenous people of color.
We must also take steps to dismantle racism in clinical care. A systematic review of studies in the United States found that black mothers received inadequate or inaccurate information on breastfeeding from health care providers. 11 The same review noted the benefits of peer support from culturally aligned breastfeeding counselors; however, in one state, offices of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) that served populations with >75% African American clients had no lactation support providers. This differential access to services is systemic racism, and it is unacceptable.
We must also demand basic economic protections for growing families, including universal implementation of the International Labour Organization's Maternity Protection Convention. 12 The convention mandates 14 weeks of paid maternity leave, as well as paid breaks for breastfeeding or expression of milk. Globally, too many women are forced to choose between breastfeeding their babies and supporting their families. When economic constraints disrupt breastfeeding, optimal infant feeding is not choice, but a privilege.
Central to reproductive justice is the concept that human rights include both negative rights and positive rights. Negative rights protect the autonomy of individuals from interference; positive rights are the obligation “to ensure that people can exercise their freedoms and enjoy the benefits of society.” 4
As breastfeeding medicine physicians, we are uniquely positioned to promote, protect, and support reproductive justice. Let us get to work.