How Breastfeeding Might Look Different for Black Families
Published Date:August 26, 2026
By Ali Weatherford
For anyone who doesn’t work in the field of maternal health, it might be hard to understand why and how there are disparities in outcomes for black families, but it’s a very real crisis. The start of the path to where we are now was etched a very long time ago.
A History
This is very hard to think about and write about, but there are some very real and disturbing historical facts about the medical treatment of black women in the United States in the field of obstetrics and gynecology (OBGYN). This is not a hidden or fringe conspiracy theory. This fact is well acknowledged by the OBGYN field.
This statement released collectively by 19 OBGYN professional organizations that includes the American College of Obstetricians and Gynecologists (ACOG) acknowledged “the injustices inextricably linked to the field of obstetrics and gynecology [and the need to] recognize all the contributions made both willingly and unwillingly by oppressed and marginalized persons.”
It is a fact that enslaved black women were used “unwillingly” for research and experimentation in the OBGYN field. J. Marion Sims is the most notable historical figure. He was a physician who performed experimental gynecological surgeries on enslaved women in the mid-1800s in Alabama. This was particularly unethical because the surgeries were performed without proper anesthesia and presumed without informed consent. He was not the only one, and the abuses did not stop there.
More than 100 years later into the 1970s, forced sterilization of marginalized people was still happening and is another sad chapter in our country’s OBGYN history. Sterilization was often viewed as a “benefit” and even covered by Medicaid in some situations. Surgical sterilization can be a voluntary and reasonable contraceptive method for those who do not want to have more children. Unfortunately, it is also true that certain women were targeted for sterilization because the doctors deemed them inferior or at risk. It was decided for them that they would be better off not having more children. They may not have wanted to become permanently infertile and may not have understood the procedure when giving consent, or did not give consent at all. Many of those women were black. According to physician Helen Rodriguez-Trias, “In 1970, it was found that 43% of the women sterilized in federally-financed family planning programs were black, although they represented only one-third of the patient population” (Rodriguez-Trias, 1976).
Implications of this History
Learning about our history is important, because it can help us understand why black families are experiencing worse outcomes . Black women die and are seriously injured due to pregnancy and birth complications at a much higher rate. The reasons this is happening can be traced back to the historical treatment of black women related to obstetric care. People who experienced abuse and enforced sterilization would understandably be very suspicious of medical care providers and resistant to accessing care. This is especially true when the providers are mainly white men. White men, historically, were the perpetrators of the medical abuse, and therefore difficult to trust. Unfortunately, there were not many alternatives. Very few women, black men, and even fewer black women were working in the field of obstetrics until more recently. Understandably, mothers and grandmothers may have cautioned their daughters and grandchildren about the medical care field. This, in addition to issues of economics and access, led to lower levels of medical care for black families. They are less likely to access good prenatal care because of their distrust of the system, and because of limited access in their communities. Even now, I have many times heard directly from black birthing people that they are afraid to see certain providers or go to certain hospitals.
What Can Be Done?
Ultimately, we need to provide more avenues to access good care, and more culturally congruent care. Culturally congruent care means that black families can find a provider who looks like them and has a shared understanding of their history and fears. They are more likely to access care with a provider they trust and who can understand their needs. To make this happen, many schools and organizations provide scholarships and extra opportunities to encourage black women to enter the OBGYN field. The field of midwifery is expanding as more people access that kind of pregnancy and birth care. With an increase in demand and a better awareness of the great outcomes with midwifery care, insurance companies are beginning to provide benefits and more hospitals are hiring midwives as hospitalists. Midwives are most often women, and a position traditionally held by black women. There is a new interest in the midwifery field across all ethnicities, and a stream of consciousness to resuscitate the midwifery profession in the black community. Before the age of obstetrics, there were black midwives. The profession was nearly eradicated when birth moved from home to hospital, and sexism and racism meant that women were not offered a seat at the table for medicalized birth.
More and more black women are entering the fields of midwifery and obstetrics. Over time, this can help rebuild trust in the maternal health care system with black families. When black women can feel safe accessing care, outcomes will improve. When black families can get care that centers them and their needs, outcomes will improve. When the medical model can make room for the type of care that black women can see and trust, outcomes will improve. We are on that path, but there is so much work left to do.
What About Breastfeeding?
Like in all of our communities, black communities have lost much of the wisdom for breastfeeding. But it’s been harder for black families to regain the skills to breastfeed. because they are experiencing birth injuries and trauma at a higher rate, making breastfeeding a secondary concern.
Also, the field of lactation is not immune from disparities in care. Lactation consulting has traditionally been a service that only wealthier, and usually white, families could access. It was not affordable for many people, and only available or visible in certain exclusive communities. At Breastfeeding Success, we see the problems, and are working to overcome the inequities.
When the Affordable Care Act made lactation care a required covered benefit for most insurance companies, we moved into the realm of insurance billing. It has been a struggle to become an in-network provider and do what it takes to wrestle with insurance companies for payment, but we now have a large and hard-working billing team that do just that every day. We want to make sure that everyone who wants the care can get it covered at no, or very little, out of pocket expense. We are successful almost 100% of the time. We see every family who is admitted to the hospitals we work in. If a family is uninsured or has a Medicaid plan, we cover the cost.
We had a big win in Texas in 2025 with House Bill 136. The bill was passed that will require Medicaid to cover lactation care with an IBCLC, and now the big job is to put that new legislation to work in the real world. We’re not there yet, but we’re advocating and participating in all of the planning sessions so that this bill can become a reality for families.
Our lactation team is International Board Certified Lactation Consultants (IBCLCs). This is the highest level of certification in the field, and is a growing and fulfilling profession. We are possibly the only organization in the U.S. that has a paid internship program for aspiring IBCLCs. To become fully certified, an IBCLC has to take a lot of classes and then complete 300+ hours of clinical training hours. This has always been the most difficult part of the process. It can be very difficult to even find an IBCLC to take on the mentoring role for this. And then, you might only get experience in outpatient care, but not in the hospital or NICU setting. It can also take a very long time to accumulate the hours needed at a very small organization of just one or a few IBCLCs. Most of these apprenticeships are unpaid, and there are even cases where an aspiring IBCLC is asked to PAY to be mentored.
We hope that by making entry into the field of lactation more accessible, we will attract people of more diverse ethnicities and races into the profession. Because when we can provide culturally congruent lactation care, we hope that more black families will access the support.
References
Obstetrics and Gynecology and Reparations: The Debt We Owe (and Continue to Accumulate) – PMC
Forced Sterilization and the Racial Politics of “Choice”
Forced sterilization of women as discrimination | Public Health Reviews | Springer Nature Link
Sterilization in the United States: The Dark Side of Contraception
The Reid Lectureship: Two lectures by Helen Rodriguez-Trias, M.D., 1976-1976 | Finding Aids
