First Food Justice = Food Justice = Environmental Justice: A Call to Address Infant Feeding Disparities and the First Food System

Injustices in the American First Food System

Breast milk ² and formula ³ are intended to be the sole sources of nutrition, energy, and sustenance for infants. Nonetheless, all major public health organizations ⁴ agree that babies should consume breast milk exclusively for 6 months and then continue this feeding along with appropriate complementary foods for 2 years or more, thereby skipping formula consumption altogether. Breast milk is viewed as the best food for babies because as Perdue et al. ⁵ point out:

“It meets all their specific nutrition needs with the right amount of fatty acids, lactose, water, and amino acids necessary for growth and vitality. Breast milk also protects babies from illness, as eighty percent of cells in breast milk are macrophages, cells that kill viruses, bacteria, and fungi. Mothers also produce antibodies to diseases present in their specific environment and pass these on to their babies.”

In addition, breast milk is comparatively more healthful than U.S. formula, which frequently includes sugars banned in other countries due to concerns about overfeeding and obesity ⁶ and oils linked to decreased bone density in children ⁷ , among other issues. Babies who consume breast milk in the United States are consequently 21% less likely to suffer postneonatal infant mortality and appear to experience a decreased incidence of many infectious diseases and type 1 and 2 diabetes, obesity, and asthma later in life when compared to those who do not breastfeed. ⁸ In addition, consuming breast milk over formula precludes the need for the latter's environmentally intensive processing, packaging, marketing, and distribution. Moreover, it can foster physical and mental health benefits in nursing mothers ⁹ and economic benefits to society. ^{10 , 11}

All infants do not have equal access to breast milk, however. This is especially so because all mothers do not have an equal ability to provide it. A seemingly endless amount of structural and cultural forces constrain women from effectively breastfeeding, often disproportionately impacting women of color and those of lower socioeconomic status. These forces include a lack of cultural and concrete support for nursing mothers. For instance, less than half of Americans believe women should have the right to breastfeed in public (a notion often linked to the sexualization of breasts in the U.S. society). ¹² Over 20% of U.S. women return to work just 10 days after giving birth (often not even having a full week with their babies once their breast milk comes in); nonetheless, employers frequently do not accommodate the pumping and storing of breast milk. ¹³ Even women who do have accommodating workplace policies may then find that their childcare centers do not allow staff to administer expressed milk to infants under their supervision. Meanwhile, caregivers who are unable to lactate often cannot provide their babies with donor breast milk because poor oversight and lacking federal regulations severely limit this access.

Breastfeeding initiation is relatively high in the United States, at around 80%, suggesting that most mothers and babies do have the capacity and desire to breastfeed. Yet, given the injustices briefly described above, breastfeeding cessation rates are also quite high and, today, most American infants consume formula. Indeed, women tend to end exclusive breastfeeding within the first 2 weeks to 3 months of an infant's life. Less than 20% of American infants subsequently have exclusive access to breast milk at the recommended age of 6 months and instead are consuming formula by this age. ¹⁴ Moreover, “unacceptable disparities” characterize infant breast milk consumption. For instance, breastfeeding rates for African American infants are consistently around 20% lower than those for white infants at birth and 6 months even when controlling for the family's income and education. ¹⁵ Directly linked to this, black babies are 2.4 times as likely to die before their first birthday than their white counterparts. ¹⁶ Indigenous and lower income communities too face consistently poorer breastfeeding and infant health outcomes when compared with their white and wealthier counterparts. ¹⁷

An authentic and equitable food and environmental justice discourse must address the abovementioned issues and other first food system dynamics. Considerations around gender, race, and class disparities vis-à-vis the first food system mirror and connect to themes central to food and environmental justice research. So do the first food system's links to health (including infant, maternal, and environmental) and workers rights (particularly in the context of mothers but also parents and caregivers more generally). Environmental justice scholars may be particularly keen to note that industrial water and soil contaminants, including PCBs, DDT, and HCBs, move up through the food chain into maternal bodies. These contaminants resist being broken down and are instead passed to the next generation of humans during pregnancy and breast milk consumption. ¹⁸ In regarding the first food system, we can better capture how each of us, as well as our succeeding generations, inherits a burden of toxic contaminants. Consider also the intersections between first foods and natural disasters. After Hurricane Katrina hit, for example, many formula-feeding babies lost access to their food supply among severe food shortages. The Flint Water Crisis too underscored many overlapping considerations with regard to first foods and natural disasters, including raising questions about the relative safety of consuming potentially contaminated breast milk or formula prepared with a compromised water supply.

When Gottlieb ¹⁹ made a case in this journal for greater attention to food systems and food justice, he highlighted how “the food justice agenda also sheds light on how environmental justice enters into the equation and, as a consequence, helps establish its capacity to function as rooted in daily life, yet universal in its aspirations.” Similar is true of the first food system and first food justice. For example, first food justice = ecological sustainability = environmental justice. Improving breast milk access will decrease the need for formula and its environmentally intensive production and distribution. In addition, first food justice = community health = environmental justice. First food justice can help prevent disease, improve food ways among adults, and augment both mothers' and children's well-being. And first food justice = livability and the built environment = environmental justice. Where we live, including our hospitals' Baby-Friendly ²⁰ status and public spaces that are breastfeeding inclusive, impacts how we feed and what we eat; this also shapes the toxins that accumulate in breast milk and are thus central food and environmental justice issues.

Addressing injustices: the first food justice movement

Incorporating the first food system into food and environmental justice agendas requires not only focusing on this system's disparities but also efforts to ameliorate them. Indeed, just as many work to alleviate food and environmental inequities in the United States, so too are there ongoing efforts to combat the first food system's injustices. This includes the courageous, innovative, and impactful work of what I term the “first food justice movement.” The first food justice movement consists of loosely connected endeavors to improve breastfeeding rates especially in underserved areas. Movement members include grassroots organizations such as the Navajo Nation Breastfeeding Coalition, ²¹ whose mission is to “improve the nutritional status and overall health of families on the Navajo Nation” through the promotion of infant access to breast milk, and the Black Mothers Breastfeeding Association, which addresses racial disparities in breastfeeding success. It involves funders such as the Kellogg Foundation ²² that has launched a first food strategy aiming to “accelerate a cultural shift in the acceptance of breastfeeding … [through] supporting community-based approaches to supporting breastfeeding … in vulnerable communities.” It also includes a variety of additional individuals and groups who have—through social media, sister circles, and other creative spaces—found ways to defy the patriarchal, white supremacist, and classist ideologies that currently shape much of the first food system toward improving breast milk provision and access for all.

The first food justice movement is courageous, in part, because women of color command it. This requires some of the most marginalized actors in our country—those who experience not only “double” but often “triple” jeopardy (gender, racial, and economic discrimination)—to confront institutions fostering their oppression. Consider the movement's black and indigenous leaders. They must overcome not only persistent political, economic, and social barriers to providing infants with breast milk but also historical trauma. This trauma includes the denial of black women's very role as mothers when they were separated from their infants as slaves and indigenous peoples' similar disavowal as their children were taken in mandated assimilation attempts. It also stems from their servitude as wet-nurses to white peoples' children, a forced practice especially widespread among black female slaves. Many “free” black and indigenous women have thus been hesitant to breastfeed, as it conjures up incredibly painful associations and is particularly challenging due to the erasure of lived lactation knowledge in their communities. Combined with the contemporary stressors many of these women disproportionately face—including poverty, family substance abuse, and violence—black and indigenous women experience an allostatic load ²² that all but requires them to provide their babies with formula. That some of these women are overcoming these obstacles to improve breast milk access not only for their own children but also others' is remarkable and in many ways the epitome of the brave resistance to food and environmental injustice many scholars aim to support.

The first food justice movement is also innovative in its strategies to improve breast milk provision and access. For instance, movement actors regularly deploy what I term “field bridging”: uniting two or more ideologically congruent but structurally unconnected fields to address a particular issue or problem. Field bridging occurred in the mid-2000s when alternative food movement participants united food systems and public health discourses to develop the notion of “food deserts.” While now problematized in some ways, ²³ food deserts as a concept helped (re)focus Americans' attention away from individual behaviors to the broader forces shaping nutrition-related health disparities in this country. Now, members of the first food justice movement are deploying similar efforts, this time merging public health and food justice discourses to better address infant feeding disparities. This has contributed to the notion of “first food deserts,” defined as geographic areas that have low breastfeeding rates, high infant mortality, and systematically lack breastfeeding support (including no Baby-Friendly hospital existing within a 35-minute commute, 60% or more of employers not having a breastfeeding policy, 30% or more of childcare facilities untrained to handle expressed milk, and 50% or more of the public feeling uncomfortable when seeing a woman breastfeed). ²⁴ This and other gains made through field bridging have helped the first food justice movement (re)direct dialogues about infant feeding away from mothers alone toward their broader communities of support and the historic and ongoing social, political, economic, cultural, and environmental factors that constrain and enable infant food access.

First food justice movement actors are also innovative in deploying what I term “counter-hegemonic appropriation,” which includes colonized actors selecting out and leveraging aspects of colonial rule to fuel their own empowerment. Consider black women's use of social media to promote breastfeeding in their communities. On the Facebook page “Black Women Do Breastfeed,” for instance, women of color post pictures of themselves nursing, share success stories, and offer advice and encouragement often accompanied by the solidarity-affirming hash-tags “We Do This” and “Black Women Do Breastfeed.” Through such efforts, first food justice movement participants have thereby helped address the lack of positive media messaging around black breastfeeding by seizing the media itself. ²⁵ Furthermore, via these practices, black women have (re)generated some of the lived lactation knowledge and moral support needed for breastfeeding success yet historically stripped away from their communities. Forms of counter-hegemonic appropriation that may seem as simple as Facebook posting thus in fact suggest the potential for a radical reclaiming and reconstructing of what bell hooks ²⁶ terms the “homeplace”: a safe space (black) women make to affirm one another, be objects rather than subjects, and build meaningful resistance in white supremacist societies.

Finally, although nascent, the first food justice movement's efforts already appear impactful. By the close of 2014, for instance, every Indian Health Service birthing hospital in the United States achieved Baby-Friendly designation. Around this same time, black women in Detroit successfully blocked Medolac from obtaining their breast milk to sell to hospitals, a corporate attempt that was widely viewed as exploiting marginalized mothers, infants, and biological resources. In addition, in 2015, the International Lactation Consultant Association established diversity and equity as core values. The Association is now adjusting many of its practices, from implementing more gender-inclusive language to addressing how the lactation profession itself benefits those who already hold privilege (e.g., through the profession's educational, financial, and clinical requirements). Finally, disparities in breastfeeding initiation and duration are making modest reductions, including among some of the United States' most disenfranchised communities. On the Navajo Nation, where the first food justice movement is quite active, for example, 80% of Women, Infants, and Children (WIC) participants now breastfeed—that exceeds the national average across all WIC participants by 10%. ²⁷ Also, since 2000, the gap between white and black breastfeeding narrowed significantly while both groups achieved overall improvements in breastfeeding rates. ²⁸