When Whites Just Don’t Get It: Breastfeeding is not a “personal behavior”
By Alison Stuebe
In this aside about infant feeding, Kristof misses the crucial role of structural barriers that prevent women from breastfeeding – barriers that affect all families, but are especially severe for women of color. Contrary to popular belief, breastfeeding is not simply a “personal behavior” – it is constrained by the life circumstances and support (or lack thereof) that a woman receives from her family, her community, her employer, and her health care providers.
For example, maternity care is a major predictor of whether women achieve their infant feeding goals. Yet while suburban hospitals that serve insured women are adopting the Ten Steps, a set of evidence-based guidelines that enable women to achieve their infant feeding goals, safety net hospitals that serve Women of color are less likely to implement the Ten Steps. Indeed, as the Center for Social Inclusion reports, as of May 2015:
Forty-five percent of hospitals designated as Baby-Friendly are located in communities where the Black population is three percent or less.
Almost one-fifth of Black people live in states without a single Baby-Friendly hospital.
Structural barriers are not limited maternity hospitals; while the ACA requires private insurers to cover the cost of lactation care, Medicaid policy does not require such coverage, limiting access to breastfeeding support for low-income women.