Sharing the Table: Racial Inequalities and Breastfeeding

Thought and observations by Dr. Anne Merewood


I guess I’ll start this post by sharing one of the proudest moments of my career – in July 2021, ROSE (Reaching Our Sisters Everywhere) honored me with an Ally Award – designated “for those who are not Black that have done amazing work to further, highlight, promote and protect justice and equity for the African American MCH community.” The other high point, a few years ago, was when the Health Director of the Northern Cheyenne commissioned our team to perform a Community Health Assessment for the tribe, and drove me around their sovereign land to interview elders for the assessment.


I treasure such milestones, rather than traditional career markers, because, for a white woman working in health equity – the position from which I write – there is no greater honor than to earn the trust of the community one serves. Trust, collaboration, and a meaningful, outcome-driven course of effective hard work is what those of us benefitting from white privilege must pursue. Without this, the work is useless.


"At your next management meeting, roundtable, or team meeting, whatever form that takes, look around the table. Do the faces represent the faces of the people this entity serves, or should serve? "

It is a long journey, to grasp, accept, and understand how to make the biggest difference for those with the worst deal. It’s easy to say, “But I’m not racist! I’m nice to everyone!”


Unfortunately, we all have prejudice to grapple with, and being nice is not enough. Racial inequities in breastfeeding will only decrease through proactive dedication to a course of action for change. The good news is it begins with the personal, so everyone can act. We work mostly in Mississippi these days, and here’s one thing I have tried: At your next management meeting, roundtable, or team meeting, whatever form that takes, look around the table. Do the faces represent the faces of the people this entity serves, or should serve? If not, and if you’re a non-representative face, imagine you are the only face of your color or race at the table (and, huge waves of respect and honor, to the many of you in that position already). How would you feel? Would you listen to the advice or solutions proffered by those around you? Would you believe they knew enough to give you meaningful support?


In the CHAMPS program, we work with hospitals pursuing Baby-Friendly designation. Repeatedly, inevitably, exhaustingly, white lactation consultants — and the data shows that in the US, most are white — tell me, “I can’t get ‘them’ to breastfeed" or “They do both*, how can I change that?” I used to talk about cultural competence, about ‘leveling the playing field’. Now I ask, “How many Black/Latina/American Indian lactation consultants work in your hospital?” Unfortunately, as we know, it’s likely few or none. And I am a realist, and we have to move ahead regardless. So while pushing the bigger picture to change I (and you) must make change in our sphere of influence. 


"If half the patient population, half the community, is African American, then half the lactation support staff, half the breastfeeding task force, half the people at the meeting (at least) need to be African American as well. Isn’t that a no brainer?"

One place to start is to bring those missing faces to the table. I use my white privilege —without actually announcing, “Hello hospital management, I am about to use my white privilege”—to set up hospital management meetings that include WIC breastfeeding peer counselors (an idea suggested by my friend and colleague, Tawanda Logan-Hurt, of the Mississippi WIC). It’s amazing how few maternity units know their WIC breastfeeding peer counselors. It’s less amazing, how many WIC peer counselors know more about breastfeeding than the doctors. And, because I hold a privileged (if overrated) consultant position, I take responsibility for ensuring their voices are heard, because if you don’t proactively mediate, everybody else talks all the time. Bringing people to the table doesn’t work if a token person sits there in silence, because they can’t manipulate their space in the meeting. But use your white privilege to ensure they speak, and they nail it, every time.Racial inequities in breastfeeding won’t go away until those of us in the dominant culture internalize that we can’t tell others what to do. If half the patient population, half the community, is African American, then half the lactation support staff, half the breastfeeding task force, half the people at the meeting (at least) need to be African American as well. Isn’t that a no brainer?


Looking around at our CHAMPS conferences, I do believe that at least half the attendees are non white. This makes us white attendees uncomfortable. The ground has shifted. We’re used to running the show, the space, the meeting. We’re not sure where we stand any more (finally!) Some ask us to please make everyone feel comfortable. This amuses me. I believe this only worries people when discomfort impacts them. But we are not in this game to placate.


As a white person, I am honored beyond all written words to serve American Indian, African American, and most recently, refugee populations in the breastfeeding field; to have their support and proactive presence in my work, to allow our orbits to intercept, to feel, even, a bond. Lord knows, historically, my race does not deserve it. I doubt that I would have such grace. I can only honor them, and battle on.


Find out more about Dr. Merewood.


*BabyFriendly hospitals strive for exclusive breast milk without any supplements.