August was Breastfeeding Awareness Month. But as Chidera Anthony-Wise discusses below, this issue is critical year-round.
by Chidera Anthony-Wise*
Introduction
The first food countless infants receive upon arrival into the world is breast milk. The health benefits of breastfeeding are remarkable for babies and mothers. Breast milk strengthens nervous system development and ocular ability of infants. Through breastfeeding, antibodies are introduced to infant immune systems, combatting various diseases. Conditions such as asthma, cardiovascular disease, obesity, type 1 diabetes, and sudden infant death syndrome (SIDS) are less likely among babies that are breastfed. Similarly, lactation is associated with a reduced risk in ovarian and breast cancers and type 2 diabetes in nursing mothers. According to the World Health Organization (WHO), it is strongly recommended to exclusively breastfeed babies for the first 6 months of life and subsequently accompany solid foods with breastmilk for up to 2 years or beyond. Still, there are a plethora of challenges that hinder the adherence to this expert advice.
Breast milk offers all the nutrients, proteins, and hydration a baby needs for those first 6 months. The release of breast milk is through a “supply and demand” mechanism. If a nursing mother does not have preexisting health conditions that would limit milk production, a full supply of breast milk is dependent on feeding frequency. The provision of formula milk can decrease breast milk supply due to reduced breastfeeding sessions. Despite the WHO recommendation, 2.7 million of the 3.6 million infants born annually in the United States consume formula milk by the age of three months.
This discrepancy is a result of political and systemic barriers related to breastfeeding. Such hindrances disproportionately affect people of color, especially the Black community. For example, there is a lack of initiatives that effectively teach mothers of color about breastfeeding matters. Baby-Friendly hospitals are institutions that aim to provide breastfeeding educational support; however, 45% of these hospitals are located in U.S. cities with Black individuals making up to no more than 3% of the population. In regards to employment, there is minimal time granted for unpaid parental leave, let alone paid. The Family and Medical Leave Act (FMLA) is a federal law that grants employees up to 12 weeks of unpaid leave per year. Under the Act, employers are unable to discriminate or retaliate against employees who chose to take the leave. However, the eligibility requirements of the FMLA are strict, excluding about 50% of U.S. employees, including two-thirds of low-income workers. This restriction on approved work leave forces mothers to switch to formula milk earlier than advised, lessening the health benefits of breast milk for growing babies.
Historical Injustices related to Breastfeeding
Born on May 23rd, 1946, the Fultz sisters were the first Black quadruplets recorded in American history. The girls were instant celebrities, piquing the interest of many formula companies for promotional purposes. Their parents were James Fultz, a low-income sharecropper, and Annie Mae Fultz, a Black-Cherokee woman who was unable to hear or speak since childhood due to meningitis. Despite Annie Mae’s selection of names, the babies’ White doctor, Fred Klennner, assumed the right to name the baby phenomenons after his own family members. Their names ultimately were Mary Louise, Mary Ann, Mary Alice, and Mary Catherine. Dr. Klenner unofficially adopted them, taking control over their promotion and seeking which formula company had the highest bid. Among competitors such as Borden and Carnation, Pet Milk won. The company wanted to use the quadruplets to advertise milk formula to the Black community. It was negotiated that the babies would star in Pet Milk ad campaigns in return for paid medical expenses, food, farm land, a house, and a live-in nurse. Once agreed upon, the babies were taken off of breastmilk and only fed Pet Milk, showcased as the reason behind the girls’ wellbeing. Dr. Kleener even permitted public visits to the Fultz home to view the babies on display behind glass. In the name of “health”, he also injected the girls with Vitamin C which is known to support the immune system—a benefit that is provided through breast milk.
From modeling engagements to Presidential meetings, the Fultz sisters had a unique childhood that seemingly implied the acquisition of wealth. However, as Pet Milk and Dr. Kleener profited from the exploitation of the quadruplets, the Fultz family did not see the fruits of their labor. The family’s gifted farm land was barren and the sisters were granted only $350 per month, which was barely enough to not qualify for welfare. On the contrary, Pet Milk’s plan was a success. Formula milk became largely used in the Black community, reducing breastfeeding rates and having resounding impacts even to the present-day. Once the quadruplets became adults, the ad campaigns ceased. Unfortunately, all sisters died of breast cancer, three passing before the age of 55. Although the link between their lack of breast milk and cancer is not confirmed, essential nourishment and immune protection were withheld from the young babies during their critical development. Skimmed by Andrea Freeman recounts the story of the Fultz quadruplets, unpacking the social, legal, and cultural inequalities they faced. Freeman highlights how the situation created the modern public health crisis regarding breastfeeding challenges in the Black community.
There are external factors beyond the control of Black mothers that have decreased their breastfeeding rates. Yet, Tabitha Walrond, a 19-year-old Black mother from New York, was not exempted from villainization for not providing sufficient breast milk to her late son, Tyler Isaac Walrond. Pediatric checkups after delivery are covered under Medicaid; however, Tatiana was unable to enroll Tyler in the insurance plan due to bureaucratic and computer complications, despite tireless efforts to do so, starting four months before he was born. Legally, Tyler was supposed to be an immediate recipient of Medicaid from birth due to his mother’s enrollment. Technically, however, a caseworker must approve of the baby’s coverage. This process was delayed, as Tabitha was a high school student and dependent on her mother’s insurance plan. Each attempt to schedule a checkup appointment for Tyler ended with Tabitha being turned away because Tyler did not have a Medicaid number. The lack of professional evaluation depleted the baby’s health. Tyler’s father was alarmed by his son’s significant weight loss, pressuring Tabitha to give him formula milk. Even though Tabitha had an estranged relationship with Tyler’s father, she desired to exclusively breastfeed and believed Tyler to be healthy. In 1997, Tabitha was accused of second-degree murder when 7-week-old Tyler died from malnutrition. Media outlets depicted Tabitha to be a inconsiderate mother, employing dehumanizing stereotypes about Black mothers created during slavery. Black women were typecast as “bad” mothers to justify stripping them away from their own babies and forcing them to breastfeed white babies. With intense public opposition and legal prosecution, Tabitha did not have much vindication. Nevertheless, insight about baby weight from lactation experts and a powerfully supportive campaign, led by the local chapter of the National Organization of Women, resulted in Tabitha being convicted of a smaller charge: criminally negligent homicide. She was sentenced to five years of probation. New York has a history of failing to support poor mothers in need of essential services such as healthcare. Federal investigations and court rulings indicate that city policies attempt to lessen access to welfare among low-income mothers by forcing them to be employed. It is likely that most mothers will work low-paying jobs, emphasizing their need for welfare. Yet, their employment complicates Medicaid enrollment. In Tabitha’s case, rigid procedures were shown to be ineffective in providing urgent support to her, a mother who likely needed educational and donor milk resources due to her insufficient breast milk supplies, and Tyler, a malnourished baby. Thus, governmental bodies need to ensure that welfare-related policies truly value the wellbeing of individuals, instead of preserving counterproductive systems.
Breastfeeding Policies and Laws to Generate Change
There have been major efforts to establish greater breastfeeding equity. In 2023, Pennsylvania Governor Josh Shapiro signed Senate Bill 500 into law which increases accessibility to donor breast milk for mothers that are unable to produce sufficient supplies, such as Tabitha Walrond. This Bill directly broadens the health conditions that qualify for Medicaid coverage. Donor milk can only be acquired from hospitals that are in compliance with the Keystone Mother’s Milk Bank Act (2020), which set the standard for donor milk in Pennsylvania. Moreover, the bill requires the Department of Health and Department of Human Services to make the availability of human donor milk public information. Accessibility to donor milk can greatly assist mothers who cannot breastfeed. This is a reality for many women due to surgery, substance use, radiation therapy, bearing a premature baby, among other aspects. Donor milk can give mothers the option to not feed their babies formula milk. The manifestations of such legislation can also mitigate health issues seen in clinically feeble infants. Furthemore, the UNICEF International Code of Marketing of Breast-Milk Substitutes (“the Code”) plays a key role in discouraging the premature provision of formula milk. “The Code” instituted restrictions on breast milk advertisements. UNICEF’s global goals are to implement “the Code” into national law or integrate principles of the code into current policies. It has proven effective, as Sierra Leone passed “the Code” into its country legislation and exclusive breastfeeding increased from 32% in 2013 to 51% by 2021. In regards to the exclusion of certain employees under the FMLA, Representative Lauren Underwood (D-IL) and Senator Tina Smith (D-MN) have championed the Job Protection Act which would reform the eligibility details to be more inclusive of different types of employees. Furthemore, 13 states including California, Maryland, New York, among others have passed paid medical, parental, caregiving, and deployment-related leave laws which will incentivize families to remain at home for longer, extending the length of breastfeeding. Multiple organizations advocate for economic support towards breastfeeding as well, namely the U.S. Breastfeeding Committee (USBC). The USBC sent a budget request to the head of the Office on Management of Budget, urging the upcoming President’s 2025 Fiscal Year budget to dedicate $20 million to the CDC Hospital Promoting Breastfeeding program to support baby-friendly hospitals and $70 million for the Racial and Ethnic Approach to Community Health (REACH) program plus $1.5 million for paid leave research and analysis. In addition to other components, the financial appeal summed up to be $209.5 million. These initiatives directly strive to promote infant and maternal health, addressing the disparities created from unjust structures.
Breastfeeding can organically present many complexities. Social inequities exacerbate matters. However, nuanced, justice-driven systems can facilitate the delivery of “the first food” from mother to child.
*Chidera Anthony-Wise is a Spring 2024 graduate of UCLA, earning a degree in Human Biology and Society. She is passionate about healthcare equity for low-income communities of color through fortified legislation and policy.
On Food Law 