Reimagining Racial Trauma as a Barrier to Breastfeeding Versus Childhood Trauma and Depression Among African American Mothers

Abstract

Objective: Although breastfeeding provides benefits for mothers and infants, multiple factors prevent women from breastfeeding. This article aims to explore the role of mothers' personal and contextual risk factors to breastfeeding rates with a special emphasis on understanding breastfeeding among African American mothers at 6 months postpartum. Design: This secondary analysis was capitalizing on previously collected postpartum data from a longitudinal cohort study on the consequences of maternal childhood trauma on mother and infant outcomes. Postpartum mothers (n = 188) completed questionnaires on demographics, childhood trauma history, postpartum depression, social support, and breastfeeding status at 6 months postpartum. Results: All risk factors (i.e., demographic and social support risk, childhood trauma history, and postpartum depression) were associated with lower breastfeeding at 6 months postpartum. When risk factors were examined in a single comprehensive model, only cumulative demographic risk emerged as significant. When partialingout by race, being African American was the only variable associated with lower breastfeeding at 6 months postpartum. Conclusions: Our study confirms that African American mothers report lower breastfeeding rates at 6 months postpartum than non-African American mothers. This association held even when controlling for demographic and social support risk, childhood trauma history, and postpartum depression. We discuss our findings from an intergenerational and historical trauma, racism, chronic discrimination perspective that considers the multifactorial nature of past and current impacts on breastfeeding among African American women in the United States.

Trauma and US Minority Children and Youth

“…The historical context of enslaved Black mothers being separated from their infants and being forced to breastfeed their owners’ children is a contributing factor for present day Black women’s decision to not breastfeed their babies [ 20 ]. This remains a significant finding even after controlling for demographic and social support risk [ 21 ]. Structural racism (a system in which public policies and institutional practices reinforce racial inequities) and historical marginalization are among several reasons that African American children are overrepresented by 2–3 times in the foster care system [ 22 ] and are more likely to have been exposed to a greater number of trauma types and community violence than White children [ 23 ].…”

Centering Our Voices: Experiences of Violence Among Homeless African American Women

“…African American women disproportionately experience various forms of violence across the lifespan (West, 2002(West, , 2004. Several factors compound the experiences of violence in the lives of African American women, among them multiple and intersecting forms of oppression, historical trauma, systemic racism (Hampton et al, 2008;Johnson et al, 2021) sexism, classism, and poverty-related challenges (Crenshaw, 2019;Roschelle, 2017;Watson-Singleton et al, 2020). Women's lifetime subjection to violence can lead to a myriad of physical and mental health concerns (Liu et al, 2016;Wong & Mellor, 2014), while evidence shows that violence has both short-and longterm effects on the physical, mental, and social health of affected individuals (Miller & McCaw, 2019).…”

“…Experiences of violence represent a serious public health concern in the United States, especially among women who experience homelessness. As homelessness, violence, and substance misuse often co-occur, shelter programs designed to accommodate these intersecting health risks are crucial (Martin et al, 2008).…”

“…Shelter programs not only save lives but also aid violence survivors in overcoming trauma, especially when experiencing homelessness and uncertainty. Shelters provide physical safety as well as psychological support, crisis aid, and connections to legal, educational, and employment opportunities (Hawkins et al, 2017; Martin et al, 2008). However, few shelters serving women with children experiencing homelessness are equipped with long-term residential support for women facing intersecting challenges such as violence and substance abuse.…”

“…Improving self-efficacy, which Sullivan (2018) noted as culturally and socially situated, enhancing social support, and regaining a sense of hopefulness, reduces negative outcomes associated with violence. Moreover, because most programs that exist are run by non-profit organizations (Sullivan, 2018), programs may vary greatly, from serving several clients a year to others serving thousands (Martin et al, 2008). There are even fewer evaluations of such programs (Hughes, 2020).…”