Minority Health Month is a time to reflect on the systemic inequities that affect health outcomes in communities of color. One of the most pressing yet often overlooked aspects of maternal and infant health is the ability of parents to meet their infant feeding goals—whether through breastfeeding, combination feeding, or formula feeding. The disparities in lactation support for minority families are well documented, yet solutions remain underfunded and under-implemented within our healthcare system. As professionals working in this space, we know the reality: our work is critical, yet too often, we lack the resources, funding, and institutional support needed to sustain and expand our efforts.
Barriers to Breastfeeding and Infant Feeding for Minority Families
As a multiracial Black Cherokee woman who grew up in the South, these challenges are deeply personal to me. My own experiences reflect a broader narrative that many of us share. I was raised in a culture where the expectations around infant feeding were shaped by systemic influences that often discouraged breastfeeding. I remember flipping through Ebony and Jet magazines as a child, mesmerized by the images of elegant Black women, often holding bottles rather than breastfeeding their babies. The formula companies had poured millions into shaping our perception of what successful Black motherhood looked like, and it wasn’t one that included nursing at the breast.
For Indigenous families, the barriers are even more deeply rooted in history. My mixed-race Cherokee grandmother’s experiences were shaped by generations of forced assimilation, where Native parenting traditions were actively erased. The government-run boarding schools that stripped her and children like her of their culture also severed intergenerational knowledge about breastfeeding, replacing it with formula as the default. These historical traumas continue to echo today, as Indigenous communities still experience some of the lowest breastfeeding rates in our state.
The challenges don’t stop with history. They persist in the present. I have watched working mothers navigate inflexible jobs that failed to accommodate their pumping needs. And I have seen how systemic neglect leaves entire communities without adequate lactation support. For those of us implementing change, these challenges aren’t abstract. They are real, urgent, and deeply frustrating. We are constantly stretching ourselves thin, operating with minimal funding, and pushing forward despite the barriers. The reality is that the need far exceeds the resources available—but we persist because we know this work is essential.
Cultural Perspectives on Infant Feeding
Breastfeeding is highly normalized in some cultures but not in others. For example, in Brazil, firefighters are trained to transport human milk, reflecting a national commitment to breastfeeding. In contrast, in the United States, formula feeding has become the default in many communities due to aggressive marketing, inadequate maternity leave, and systemic failures in workplace support. Understanding these cultural differences is crucial in crafting policies that are inclusive and supportive of diverse parenting practices.
Yet, cultural competence is not always prioritized in lactation support. As professionals, we often find ourselves advocating not just for families but for the very existence of culturally responsive programs. We must keep pushing for funding and institutional recognition that respects the lived experiences of the families we serve.
The Intersection of Medical Complexity and Infant Feeding
Medically complex children—such as those with sensory processing disorders, low muscle tone, or oral-motor challenges—often struggle with traditional feeding methods. Babies are incredibly smart. They often know what they need, and sometimes interventions that seem necessary—may not be the best option for them. For those of us working in the field, the standard medical model often fails to account for the nuanced realities of infant feeding. We must continue to bridge these gaps by advocating for holistic, responsive care that prioritizes the parent-child relationship over rigid protocols.
Postpartum Support and the Role of Community Advocacy
For families of color, postpartum support can make the difference between meeting or not meeting their feeding goals. The Breastfeed Durham initiative is a model of how community-based support can bridge these gaps. Through peer-to-peer lactation support groups, culturally competent provider training, and resource hubs, initiatives like this are changing the landscape of infant feeding for minority families.
One of the simplest yet most impactful interventions is providing clear, accessible resources. A doctor or nurse working with a postpartum parent in Durham, for example, can direct them to Breastfeed Durham’s website, which lists lactation support groups by date and type, making it easy for families to find the help they need.
But we also know that these interventions require sustained effort. Many of us are doing this work without sufficient institutional backing, relying on community networks, volunteer labor, and patchwork funding. The reality is that while community-driven solutions are powerful, they should not have to function as a substitute for comprehensive policy and funding support.
The 10 Steps to a Breastfeeding Family Friendly Community: A Model for Systems Change
The 10 Steps to a Breastfeeding Family Friendly Community is the model we use to drive sustainable solutions. This framework has been instrumental in improving breastfeeding outcomes and closing racial health disparities in Durham and beyond. Yet, even with this proven roadmap, we continue to struggle with institutional buy-in from major healthcare systems, including Duke University Health System.
Despite individual providers and nurses implementing breastfeeding-friendly practices at the grassroots level, systemic change has yet to reach the highest levels of hospital administration. Duke’s labor and delivery nurses should receive at least three hours of lactation support training, but this remains inconsistent. Compliance with the World Health Organization’s guidelines on marketing breastmilk substitutes is another area where improvement is needed. Additionally, we have yet to see full implementation of all 14 American Academy of Pediatrics (AAP )recommendations on how to create Breastfeeding Friendly Clinics.
We know that healthcare workers—including many of our readers—are doing everything within their power to support lactation-friendly care. But until these policies are mandated at an institutional level, true systems change remains out of reach. This is not just about individual effort; it’s about leadership stepping up to make breastfeeding-friendly care the standard, not the exception.
Paid Family Leave: Necessary but Not Sufficient
Paid family leave is often touted as the solution to low breastfeeding rates, but it is only one piece of the puzzle. While leave provides parents with the time to establish lactation, it does not address broader systemic issues, such as lack of support in medical settings, workplace accommodations, and cultural attitudes toward breastfeeding. In many cases, even when parents have leave, they are expected to juggle multiple responsibilities at home, leaving little room for self-care and lactation support.
For those of us on the ground, the fight for paid leave is just one battle in a much larger struggle. We know that improving breastfeeding outcomes requires addressing everything from racial health disparities to workplace policies to childcare accessibility. And yet, securing funding for these efforts remains a constant challenge.
Moving Forward: Advocacy and Action
As we observe Minority Health Month, it is clear that achieving breastfeeding equity requires a multi-faceted approach. And it is equally clear that the work we do is undervalued and underfunded. We are not just implementing programs—we are pushing against systemic barriers, filling gaps in care, and fighting for recognition of the work we know is essential.
- Healthcare providers should receive training on cultural humility in lactation support.
- Community organizations must continue advocating for workplace accommodations and better postpartum care.
- Funders and policymakers need to recognize the value of lactation equity work and invest in sustainable solutions.
- Those of us doing this work must continue to support each other, sharing resources, strategies, and advocacy efforts.
Through continued advocacy, education, and policy change, we can create a future where all parents—regardless of race, income, or background—have the support they need to feed their babies in the way that works best for them.
By ensuring that all families have equitable access to breastfeeding support, we take an essential step toward improving minority health outcomes—one baby, one parent, and one community at a time. And for those of us in this field, we must continue pushing forward, knowing that even when our work feels invisible, it is deeply impactful.