How Science and Socioeconomics Impacts a Mother’s “Choice” to Breastfeed
By Lauren Montgomery, MA (Program Coordinator, APA Office on Socioeconomic Status)
I did whatever I thought would provide the best start for my daughter and cement me as a “good mom”. And as a young 21-year-old, unmarried, Black mother I felt even more pressure to prove this to others since I knew my age, amongst other things, unfortunately said otherwise to some people. Absent the knowledge and support of any family or friends that breastfed their children, I did my research and decided to breastfeed my daughter and enrolled in WIC (Special Supplemental Nutrition Program for Women, infants, and Children). I was doing what I was thought was best for my daughter while simultaneously, purposefully performing an act that I thought would shatter anyone’s doubt that I could be a good, competent parent.
A mother’s milk currently reigns supreme in the ebb and flow of what is the scientifically-supported, publicly favored infant feeding practice in our country. “Breast is best” is the ubiquitous chant that joins the chorus of physiological benefits supported by the American Academy of Pediatrics (2018). Bolstering previous findings, recent psychological evidence suggests a positive correlation (consistent and statistically significant, though of substantively minor impact) between being breastfed during the first six months of life and higher levels of intelligence (Boutwell, Meldrum, & Young, 2018). Other psychological research highlights the bond and enduring responsiveness past infancy of mothers toward children they have breastfed for an average of 17 weeks (Weaver, Schofield, & Papp, 2018).
A woman’s choice to breastfeed can be seen as a protective factor for her baby with the potential to give her child a leg up in life. However, a woman’s ‘choice’ to breastfeed isn’t solely predicated on the current science, best practice or publicly favored ideals. Rather, it is made possible by multiple factors including the resources she has available to her. If a woman does not have the resources, her lack of breastfeeding is less likely a choice than the result of a lack of practical, viable options.
A woman’s education, occupation and income dramatically impact her ability to breastfeed. There are programs that are designed to help ease, though not completely address, the tangible monetary burden for directly providing what your baby will eat such as WIC or the Affordable Care Act’s (ACA) mandated provision for insurers to cover breast pumps for breastfeeding mothers. But the intangibles are just as important.
Time, one of the most important resources when breastfeeding a child, is costly. However, if you enjoy a certain level of education or income that is correlated with job schedule flexibility, supportive nursing mother policies and better benefits including paid leave, your employer can essentially absorb some of this cost. If you are not fortunate to have such a job, the cost of the time it takes to breastfeed your child manifests itself in ways such as:
lost wages due to breaks to pump milk when you return to work
lost wages due to time needed away from the job to support breastfeeding, or
a loss of an entire income if your occupational prospects don’t support what is required of you to breastfeed
I went back to school full-time three weeks after giving birth so I could graduate with my undergraduate degree on time. Transitioning back to school and later into inflexible, entry-level jobs during the almost two years I breastfed my daughter was difficult. Finding places to pump, being able to pump on a regular schedule to keep my breast milk supply steady and knowing what resources were at my disposal was a constant struggle.
Lacking resources due to socioeconomics is just one of the categories of inequities affecting a woman’s ability to breastfeed in this country. We have to consider how a woman’s lower socioeconomic status intersects with any other marginalized identities that are accompanied by their own social norms (Hohl et al, 2016). Communities of marginalized women experience enduring legacies of socially promoted negative beliefs toward breastfeeding that have starved them of supportive knowledge (Dailey, 2014). Racial minority women also must contend with the systemic inequalities that leave communities without appropriate levels of medical care and advice– including breastfeeding consultation, support and education (Lind et al, 2014).
We need to equitably distribute the resources that allow for breastfeeding in our country as much as we need to promote and distribute the knowledge that supports it. Giving a mother the conditions, resources, and autonomy to make sense of her options is the only way her eventual decision on how best to feed her infant can really amount to a true choice. I know first-hand the hurdles of breastfeeding while trying to climb the socioeconomic ladder, the societal pressures to breastfeed and the social and systemic failures of supporting those of us that do. It really shouldn’t have to be that hard.
What can you do to support the equitable opportunity to breastfeed? A few ideas on how you can be an ally:
Support universal paid family leave policies
If you are an employer or an employee, advocate to make the burden easier. Ensure that your organization is following the ACA’s requirement for what is considered required breast pumping breaks and a dignified place to pump (here are some examples of space solutions)
Have you successfully breastfed your baby? Become a peer breastfeeding consultant through your local WIC office or your state’s Department of Health. Bring some of that knowledge and support to lower-income mothers who are breastfeeding.
Lauren Montgomery is the Program Coordinator in the Office on Socioeconomic Status and helps to facilitate and promote psychology’s contribution to the understanding of SES. Lauren received her bachelor’s in Psychology from Old Dominion University and her masters in Near Eastern Languages and Civilizations from the University of Washington.
American Academy of Pediatrics. (2018). Benefits of Breastfeeding. . Source: Author. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/Benefits-of-Breastfeeding.aspx
Boutwell, B. B., Young, J. T. N., & Meldrum, R. C. (2018). On the positive relationship between breastfeeding & intelligence. Developmental Psychology, 54(8), 1426-1433. http://dx.doi.org/10.1037/dev0000537
Breastfeeding Benefits. Retrieved from https://www.healthcare.gov/coverage/breast-feeding-benefits/
Dailey, Kate. (2014). Who, what, why: Why do African-American women breastfeed less? Retrieved from https://www.bbc.com/news/blogs-magazine-monitor-27744391
Hohl, S., Thompson, B., Escareño, M., & Duggan, C. (2016). Cultural norms in conflict: Breastfeeding among Hispanic immigrants in rural Washington State. Maternal and Child Health Journal, 20(7), 1549-1557. http://dx.doi.org/10.1007/s10995-016-1954-8
Lind, J.N., Perrine, C.G., Li, R., Scanlon, K.S., Grummer-Strawn, L.M. (2014, August 22). Racial Disparities in Access to Maternity Care Practices That Support Breastfeeding – United States, 2011. Morbidity and Mortality Weekly Report. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6333a2.htm
Weaver, J. M., Schofield, T. J., & Papp, L. M. (2018). Breastfeeding duration predicts greater maternal sensitivity over the next decade. Developmental Psychology, 54(2), 220-227. http://dx.doi.org/10.1037/dev0000425