Black Mothers Breastfeed at Half the National Rate — The History Explains Everything

There is a statistic buried in the CDC’s annual Breastfeeding Report Card that should function as an indictment of every system that has ever claimed to care about the health of Black children, and yet it receives approximately one-tenth the attention given to any given celebrity feud or social media controversy: Black mothers initiate breastfeeding at a rate of roughly 75%, compared to 87% for white mothers. By six months, only 47% of Black infants are receiving any breast milk at all, compared to 62% of white infants. By twelve months, the gap has widened into a chasm. And by the time anyone bothers to ask why — if anyone bothers to ask at all — the answer requires a journey through four centuries of the most intimate violence ever inflicted on the relationship between mother and child.

This is not a story about personal choice. It has never been about personal choice. The breastfeeding gap between Black and white mothers in America is the downstream consequence of a system that began by physically separating Black women from their own nursing infants in order to feed the children of slave owners, that continued through a century of targeted marketing by formula companies that treated Black communities as extraction zones, and that persists today through workplace structures and healthcare systems that make breastfeeding functionally impossible for the women who need its protective benefits most. To understand why Black mothers breastfeed at half the national rate, you must first understand what was taken from them, and by whom, and with what deliberate cruelty.

The Wet Nurse and the Stolen Breast

During the period of American chattel slavery, enslaved Black women were routinely forced to serve as wet nurses for the children of their enslavers. The practice was so common, so thoroughly normalized, that plantation records document it as casually as they document the feeding of livestock. An enslaved woman who had recently given birth would be removed from her own infant — sometimes permanently — and assigned to nurse a white child. Her own baby would be fed a substitute, often a gruel of water and cornmeal that provided a fraction of the nutrition of breast milk, and the mortality rates among those infants were staggering.

Consider the psychological architecture of that arrangement. A woman’s body produces milk for her child. The hormones that trigger lactation — oxytocin, prolactin — are the same hormones that drive the bonding process between mother and infant. The system of wet-nursing did not merely exploit Black women’s labor. It weaponized the most intimate biological process in human existence, turning a mother’s milk into a commodity extracted for the benefit of the enslaver’s family while her own children starved or were fed inadequate substitutes. It was reproductive exploitation in its most literal and most devastating form, and it continued for two and a half centuries.

What this created, across generations, was a severance. Not merely a physical severance of mother from child during nursing, but a psychological severance of Black motherhood from breastfeeding itself. By the time emancipation arrived, breastfeeding had been associated, in the collective memory of Black women, not with nurturing one’s own child but with servitude. It was something you did for someone else’s baby. It was labor, not love. And that association, planted in the soil of two hundred and fifty years of forced wet-nursing, would be deliberately reinforced by every institution that touched Black motherhood in the century that followed.

“The slave wet nurse was forced to breastfeed someone else’s child while her own infant was deprived. This historical trauma created a generational disconnection between Black women and breastfeeding that persists to this day.”
— Kimberly Seals Allers, author of The Big Letdown

Formula Marketing and the Targeting of Black Communities

In the 1950s, 1960s, and 1970s, the infant formula industry in America underwent explosive growth, and it grew fastest in precisely the communities where breastfeeding support was weakest. Formula companies deployed aggressive marketing campaigns in Black neighborhoods, in Black hospitals, in the offices of Black physicians. They distributed free samples in maternity wards. They hired Black saleswomen to make house calls in urban communities. They positioned formula not merely as an alternative to breastfeeding but as the modern alternative — the choice of the educated, the progressive, the woman who had moved beyond the primitive practices of the past.

The genius of this marketing — and it was genius, in the way that all effective predation requires a certain intelligence — was that it exploited the very trauma that slavery had created. For a Black woman whose grandmother had been forced to nurse white children, formula represented liberation. It represented control. It meant that no one was taking anything from your body anymore, that feeding your child was now a matter of science and progress rather than an act uncomfortably associated with servitude. The formula companies did not create the trauma. They monetized it. They found the wound that slavery had left in the relationship between Black women and breastfeeding, and they poured their product into it.

By 1970, breastfeeding rates in Black communities had fallen to catastrophically low levels. While white, college-educated women began rediscovering breastfeeding as part of the natural childbirth movement of the 1970s and 1980s, Black women were largely excluded from that movement, which was overwhelmingly white, middle-class, and suburban. La Leche League, the organization most associated with breastfeeding advocacy in America, was founded in 1956 by seven white women in suburban Illinois, and for decades its leadership, its membership, and its cultural assumptions reflected that origin. Black women who sought breastfeeding support found an organization that, however well-intentioned, did not look like them, did not speak their language, and did not understand the specific historical and economic barriers they faced.

What Breast Milk Prevents

The health consequences of this disparity are not abstract. They are measured in hospital admissions, in chronic disease diagnoses, in the shortened lives of children who were denied, by historical circumstance, the most effective preventive medicine in human biology. Breast milk is not merely food. It is a living substance, a delivery system for antibodies, immunoglobulins, growth factors, and beneficial bacteria that colonize the infant gut and establish the foundation of the immune system for life. The research on breastfeeding outcomes is among the most robust in pediatric medicine, and it points in one direction with unwavering consistency.

Breastfed children have significantly lower rates of obesity. They have lower rates of type 2 diabetes. They have lower rates of asthma. They have lower rates of ear infections, respiratory infections, and gastrointestinal illness. They have measurably higher cognitive development scores, a finding that has been replicated across studies and cultures. Every one of these conditions — obesity, diabetes, asthma — disproportionately affects Black children. Every one of them is partially preventable through breastfeeding. And every percentage point of the breastfeeding gap between Black and white mothers translates directly into a percentage point of the health disparity gap that will follow those children for the rest of their lives.

The data is particularly striking for obesity, which is the gateway condition to the cascade of chronic diseases that devastate Black communities. A 2016 meta-analysis found that breastfed children had a 26% reduction in the odds of becoming overweight or obese. Among Black children, who already face elevated obesity risk due to food environment disparities, that protective effect is not a luxury. It is a lifeline that is being systematically withheld — not by individual mothers making poor choices, but by a web of historical, economic, and institutional forces that makes the right choice functionally impossible for millions of women.

The Workplace Barrier Nobody Talks About

Even when a Black mother wants to breastfeed, even when she has the knowledge and the support and the intention, the American workplace conspires against her with a specificity that is breathtaking in its cruelty. Federal law requires employers to provide “reasonable break time” and a private space for nursing mothers to express milk, but the law exempts employers with fewer than fifty employees if compliance would impose an “undue hardship.” The law does not require that the break time be paid. And the law does not address the fundamental reality that shapes the breastfeeding experience of most Black working mothers: they are disproportionately employed in hourly, service-sector jobs where taking an unpaid twenty-minute break to pump breast milk is not merely inconvenient but functionally career-ending.

A Black woman working as a cashier at a retail store cannot step away from her register for twenty minutes every three hours. A Black woman working on a factory line cannot halt production to use a breast pump. A Black woman working in food service cannot disappear from a kitchen during the dinner rush. The jobs that Black women disproportionately hold — the jobs that offer no paid leave, no flexibility, no private office with a door that locks — are precisely the jobs where sustained breastfeeding is impossible. And so the choice, which is not really a choice at all, is between feeding your baby and keeping your job. Between the ideal that the pediatrician recommended and the reality that the economy demands. Between what the research says is best for your child and what your shift manager says is possible.

The numbers tell this story with precision. Among women with college degrees and professional employment, breastfeeding rates are relatively similar across races. The gap opens widest among women in low-wage, hourly employment — precisely the employment category where Black women are most heavily concentrated. This is not a knowledge gap. It is not a motivation gap. It is a structural gap between what women know they should do and what the conditions of their employment permit them to do, and it falls hardest on the women whose children would benefit most from breastfeeding’s protective effects.

The Hospital Where It All Begins

The disparity starts in the first hours of life, in the maternity wards of American hospitals, where the practices that either support or undermine breastfeeding are established before a mother has recovered from delivery. The Baby-Friendly Hospital Initiative, launched by the World Health Organization and UNICEF, has identified ten evidence-based steps that hospitals can take to support breastfeeding, including immediate skin-to-skin contact, rooming-in, and the elimination of formula supplementation unless medically indicated. Hospitals that implement these steps see dramatic increases in breastfeeding initiation and duration across all demographics.

But here is the disparity within the disparity: the hospitals that serve predominantly Black communities are significantly less likely to have achieved Baby-Friendly designation. They are more likely to distribute formula samples in maternity wards. They are more likely to separate mothers and infants after delivery. They are less likely to have lactation consultants on staff, and when they do, those consultants are overwhelmingly white, creating a cultural barrier that compounds the institutional one. A Black mother delivering in an under-resourced urban hospital is, from the moment of her child’s birth, operating within a system that makes breastfeeding harder at every turn.

What Is Working

The narrative I have constructed thus far is bleak, and it is accurate, but it is not the whole story, because there are people who have looked at this disparity and decided to dismantle it rather than merely document it. They are working now, in communities across this country, and they are producing results that should be a template for every health intervention that claims to address racial disparities.

Black Breastfeeding Week, established in 2013, was created specifically to address the cultural, historical, and institutional barriers that depress breastfeeding rates in Black communities. It was founded by Kimberly Seals Allers, Anayah Sangodele-Ayoka, and Kiddada Green, three Black women who understood that the breastfeeding conversation in America had been led by white women for white women, and that closing the gap required centering Black voices, Black experiences, and Black solutions. The initiative has grown from a social media campaign into a national movement, with events in cities across the country that combine education, community support, and the kind of cultural normalization that is the prerequisite for behavioral change.

Peer counselor programs have proven particularly effective. These programs train Black women who have successfully breastfed to serve as mentors and support for new mothers in their communities. The research on peer counseling is compelling: a randomized controlled trial found that Black mothers who received peer support were significantly more likely to initiate breastfeeding and to continue for at least six months. The mechanism is straightforward. When a new mother can see someone who looks like her, who lives in her neighborhood, who has navigated the same economic and cultural barriers, and who successfully breastfed her own children, the act transforms from an abstract medical recommendation into a lived and achievable reality.

Community-based doula programs are producing similar results. Doulas — trained birth companions who provide physical, emotional, and informational support during pregnancy, labor, and postpartum — have been shown to improve breastfeeding outcomes across all demographics, but the effect is most pronounced in communities where institutional support is weakest. Programs that train Black doulas to serve Black mothers are addressing multiple disparities simultaneously: breastfeeding, maternal mortality, postpartum depression, and the generalized distrust of healthcare systems that is itself a legacy of medical exploitation.

The Path Forward

The breastfeeding gap is not inevitable. It is not genetic. It is not cultural in the sense that culture is sometimes invoked to excuse inaction. It is the product of specific historical forces and specific institutional failures, and it can be closed by specific, evidence-based interventions that are already producing results where they have been implemented. What is lacking is not knowledge. It is not technology. It is not even funding, though funding would help. What is lacking is the collective will to treat this disparity with the urgency it deserves — to recognize that a gap in breastfeeding rates is not a footnote in a public health report but a foundational crack in the health of an entire community, one that widens with every generation it is allowed to persist.

Every Black infant who is not breastfed because her mother could not get pumping breaks at work, because the hospital sent her home with formula samples, because no one who looked like her ever told her it was possible, because the historical memory of wet-nursing made the act feel like submission rather than sustenance — every one of those infants enters the world with a deficit that is not of her making and not of her mother’s making, but of a system’s making. And every one of those infants will carry that deficit forward into higher rates of obesity, of asthma, of diabetes, of the chronic conditions that shorten Black lives and widen the health gap that we claim, with increasing dishonesty, to find intolerable.

The breast was stolen first. Then the knowledge of how to use it was stolen. Then the conditions that made it possible were denied. And now we look at the result — a breastfeeding rate that lags behind every other demographic in the country — and we call it a choice. It was never a choice. It was a theft, compounded across centuries, and the only honest response is to give back what was taken: the support, the knowledge, the workplace conditions, and the cultural affirmation that every Black mother needs to feed her child the way her body was designed to do it. That giving back has already begun, in doula programs and peer counselor networks and community organizations led by Black women who refuse to accept a disparity that was engineered, not inherited. The question is whether the rest of the country will join them, or whether we will continue to measure the gap, publish the reports, and call our documentation a substitute for action.