Breastfeeding seminars

Formula crisis highlights barriers to breastfeeding in southern states

Despite the efforts made in recent weeks by the federal government to resolve the shortage of infant formulaparents still struggle to find formula.

The Food and Drug Administration announcement this week that nearly two million boxes of infant formula from a UK-based company would arrive in the US in the coming days. Abbott Laboratories – the Illinois-based company whose alleged unsanitary conditions led to a voluntary infant formula recall, the deaths of two infants and the closure of a major infant formula manufacturing plant in Michigan, triggering the crisis – announced that it will release about 300,000 cans of EleCare infant formula which will undergo extensive testing before being distributed nationwide, according to the FDA.

The shortage of formulas in the United States has been blamed on supply chain disruptions related to the pandemic and a market with limited competition, exclusive contracts and few major suppliers. Earlier this month infant formula producers were allowed to speed up the manufacturing processand the Biden administration has called on state attorneys general to crack down on price gouging for the formula, according to a White House statement.

In response to the formula shortage, some experts advised mothers to breastfeed In place. But this advice, well-intentioned as it is, not only ignores medical realities but structural barriers to breastfeeding. These barriers are particularly high in the black community and in southern states, where breastfeeding rates are lower.

“Breastfeeding is about reproductive choice,” said Kimaire Bugg, founder and CEO of Reaching Our Sisters Everywhere (ROSE), a Georgia-based national organization that aims to reduce racial disparities in breastfeeding. “We know there are long-term health benefits to a mother, child, family and society if a woman breastfeeds successfully.”

Blacks have the lowest rates of breastfeeding initiation among all racial groups in the United States, according to a 2015 study study. Those who breastfeed less tend to be young, low-income, black, single, and recipients of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Andrea Freeman, author of the 2019 book “Skimmed: Breastfeeding, Race, and Injustice,” says another factor driving racial disparity is a cultural stigma attached to breastfeeding that is rooted in slavery, associated with a concerted push to market baby formula to blacks in the mid-twentieth century.

There is also a geographic disparity, as southern states overall have a lower breastfeeding rate than the nation as a whole. According to the latest CDC report breastfeeding newsletter as of 2020, 84.1% of U.S. infants born in 2017 were breastfed, compared to just 76.2% of infants in Southern states. Nationally, the rate is lowest in Louisiana, at just 66.2%. Among the southern states, only Texas and Virginia had breastfeeding initiation rates above the national average.

A report from the Centers for Disease Control and Prevention published in 2019 found that better maternal health care, as well as increased work and family support, could reduce racial and geographic gaps in breastfeeding. According to the CDC, sociocultural norms, concerns about milk supply, income, and lack of accurate information are among the factors that affect a person’s decision to breastfeed.

The American Academy of Pediatrics recommended exclusive breastfeeding for the first six months of an infant’s life, noting that this leads to better health outcomes for both parent and infant. Maternal benefits include a decreased risk of diabetes and hypertension, while benefits for infants include better dental health and neurodevelopmental outcomes, the AAP said. It advises against breastfeeding only for people with HIV infection and infants with classic galactosemia, a rare genetic disease.

Facing South spoke with Bugg and other experts about what could be done to increase breastfeeding rates in the South.

Lactation care under Medicaid

Expanding Medicaid coverage to include breastfeeding services — think breastfeeding classes or lactation consultants — could be a solution to racial and geographic disparities in breastfeeding rates.

Nationwide, only one-third of state Medicaid programs cover breastfeeding education or lactation consultation services, depending on a Kaiser Family Foundation Report released this month. Nine states nationwide do not cover any of these services under Medicaid, and seven are in the South: Arkansas, Florida, Kentucky, Louisiana, Mississippi, Tennessee and Texas.

In the South, the states with the highest breastfeeding initiation rates are Georgia, South Carolina, North Carolina, Texas and Virginia, according to federal data. Four of these states — Georgia, North Carolina, Caroline from the southand Virginia — cover certain forms of lactation care under Medicaid. Generally, parents can get free breast pumps in southern states through WIC or Medicaid.

Greater racial diversity in the field of lactation consultants could be a solution to racial disparities in breastfeeding, according to Bugg, an early pioneer in lactation advocacy among black communities. “Here in Georgia, we want to make sure mothers are comfortable and that the care they receive is culturally appropriate,” she said. “We do a lot of SEO, based on their specific needs.”

ROSE organizes support groups dealing with the complexities of breastfeeding in black communities. The group also sued Georgia for a 2016 requirement that those who want to teach women how to breastfeed obtain the equivalent of an advanced degree; in March of this year, the courts ruled the requirement to be unconstitutional. Bugg said the legal victory ensured lactation consultants would be available to rural parents and not just those concentrated in the Atlanta metro area.

Whereas South Carolina Medicaid does not pay for breast pumpsthe state Department of Health and Environmental Control notes that the WIC program has lactation counselors, support groups, and food parcels for people who exclusively breastfeed, according to the DHEC website. WIC offices in all states also have lactation consultants on staff.

But more could be done in South Carolina as well as other states, according to Tisha Felder, a behavioral scientist at the University of South Carolina’s College of Nursing. Felder co-founded Mocha Mama’s Milk, a virtual breastfeeding support group for South Carolinians that launched this spring.

“If we want to see change, we need to invest in these maternal and child health policies,” including paid family leave and the WIC’s breastfeeding program, Felder said.