by Kathleen Kendall-Tackett, PhD, IBCLC, RLC, FAPA
We are at a critical junction in the U.S. in our conversations about race and ethnicity. People are being shot by police, and others rise up to protest those shooting. We grieve those losses and hope that changes in our system will result. In the face of these violent events, is breastfeeding even relevant? The short answer is Yes. Breastfeeding can’t stop racism and discrimination, nor can it stop trauma and adversity, but it can protect new mothers from their effects. To understand why breastfeeding helps, I’ll use discrimination as an example. What happens physiologically when people are discriminated against? We happen to have some good science on this.
The Biology of Discrimination
A fascinating book called Social Pain summarizes many studies, and describes the neurobiology of social exclusion (Dickerson, 2011; Eisenberger, 2011). The basic premise is this: we are designed to be in relationships with others. It’s important for our survival. When we are not–when we are excluded–our stress response is triggered, including the inflammatory response system. These are our survival mechanisms. Social exclusion activates the same part of our brains as physical pain—the anterior cingulate cortex (ACC). The ACC is the same part that is activated for other mammals in the separation-distress response. The response to social exclusion is a hard-wired for all mammals, including human beings.
The act of discrimination says to the recipient, “You are not one of us. You are not part of our group.” These behaviors can be in the form threats of overt violence, or they can be in the form of microagressions. Some people dismiss microaggressions, saying that people are “too sensitive.” Sometimes, that can be the case. There could be misunderstandings. But what we need to keep in mind is how it affects the people who experience them. These often careless utterances still have a physiological effect on the person who hears them. Microaggressions tell people that they are being excluded from the group, and that is why it is important to be aware of them.
So what happens when people experience discrimination on an ongoing basis? You get a chronic activation of the stress response system, which increases chronic inflammation and disturbed sleep. Many researchers have studied this effect. One study asked a series of questions, such as “you get poorer service in restaurants or stores,” or “people think you are not smart.” The more of these questions that people said yes to, the higher their levels of inflammation (Lewis, Aiello, Leurgans, Kelly, & Barnes, 2010).
Inflammation and disturbed sleep are physiological time bombs and increase rates of heart disease, diabetes, and BMI >30—in other words, the exact pattern you see in many of our minority populations (Suarez & Goforth, 2010). The obesity statistics are particularly relevant. Consistently, what you see across countries, that marginalized populations tend to have higher BMIs. The more marginalized they are, the higher the percentage of people with a BMI >30. In the U.S. and UK, women of African descent have the highest rates. But other groups, such as American Indians and people from Southeast Asia, tend to also have a higher percentage of people with BMIs >30 than Whites. In the UK, Irish are split out as a separate group from British Whites. Interestingly, a similar pattern of higher BMIs emerges. Given the long history of marginalization of Irish people, this effect is consistent with other research. You also see a similar pattern for people who have lower-incomes (Goodman, McEwen, Huang, Dolan, & Adler, 2005).
The Critical Role of Breastfeeding
Exclusive breastfeeding acts as a powerful counter to these physiological effects (Groer & Kendall-Tackett, 2011). It is one of the mechanisms that downregulates, or turns off, the stress response. Baby at the breast actually lowers two important stress hormones in the short term: ACTH and cortisol. Further, when the researchers tried to stress the mothers in their study, they couldn’t because of the lovely little cloud floating around them (Heinrichs et al., 2001). In other words, it was a short-term lessening of the stress response. When mothers experience that day after day, it lowers lifetime risk of the Number One killers of women in the U.S.–heart disease and diabetes—in a study of 139,000 women with a mean age of 63 (Schwartz et al., 2009).
There is an important caveat to these findings: in most of these studies, exclusive breastfeeding lowered risk, partial breastfeeding did not. In our study of 6,410 new mothers, we found that exclusive breastfeeding improved mothers’ sleep, lowered their risk of depression, and had a dramatic effect on self-reported anxiety and anger (Kendall-Tackett, Cong, & Hale, 2011). This was even true when women had a history of sexual assault, which puts them at high risk for both sleep problems and depression. There was still an effect of the sexual assault, but it was significantly lower (Kendall-Tackett, Cong, & Hale, 2013).
I was honestly surprised that we found no significant difference between partial breastfeeding and exclusive formula-feeding. I thought we would see a dose-response effect: the more they breastfed, the better the response. Instead, we found a threshold effect: that exclusive breastfeeding is a very different physiological experience than partial breastfeeding. It is one more reason to continue to support exclusive breastfeeding wherever possible.
How Shall We Then Treat?
As individuals, and as a culture, we must continue to eliminate discrimination. One way for you to do that locally is to foster trust, and then have open discussions with the population you serve. How do they describe themselves? Is there any terminology that they find offensive? A Jewish friend once told me that the term “Nipple Nazi” was high offensive to her and asked that I not ever use it. I hate that expression too, so I was happy to comply with her request. Other terms may seem more benign to you, and you don’t understand why they are problems. The best strategy is to ask.
As a woman with a disability, I’ve been on the receiving end of many microaggressions. For example, I have a hard time with stairs, so a conference organizer once volunteered to “carry” me up the stairs—a very demeaning way to speak to me. I’m sure she was trying to help and had no idea how offensive that was. It took me a long time before I started speaking up, and it was only after I was actually injured at a conference because the organizers ignored my requests.
Sometimes these conversations can be uncomfortable and really tense. I’ve seen some ugly ones that were not at all productive. So it’s important to set some ground rules about communicating respectfully, even if frustrated. And you’ll probably make some mistakes along the way. But having these conversations will deepen your relationships within the community, and will make you even more effective in helping the women you serve.
In summary, breastfeeding can be a radical act that helps women who experience discrimination take back their health. American Indian lactation consultant and social worker, Camie Goldhammer, describes breastfeeding as “food sovereignty,” a powerful way to take back your culture. You can help women overcome the physical effects of discrimination, one woman at a time. By doing so, these women can become powerful agents for change the broader culture.
Thanks for all you do for mothers and babies. You make a radical difference.