May 20, 2021

Breastfeeding can lower infant and maternal mortality and reduce the likelihood of developing conditions like diabetes and certain cancers. This makes the practice a vital part of improving health equity for Black Americans, who are at disproportionately higher risk for conditions that breastfeeding can mitigate.

To improve breastfeeding rates among Black Americans, maternal and child health researchers at the UNC Gillings School of Global Public Health are encouraging public health professionals to consider the role intergenerational family support networks have in infant feeding practices. Understanding the value of family roles and their impact on communication about breastfeeding in Black families can help shape more empathetic and culturally mindful approaches to public health messaging.

Dr. Alexis Woods Barr

Dr. Alexis Woods Barr

Jacquana Smith

Jacquana Smith

Alexis Woods Barr, PhD, MS, and Jacquana Smith, MPH, IBCLC, maternal and child health researchers at the Gillings School’s Carolina Global Breastfeeding Institute, co-authored two recent studies on the sharing of information and values between families with two or three generations of mothers and how it affected the youngest generation’s breastfeeding experience.

“Black Feminist Thought informed and guided both studies,” said Barr. “This theoretical framework is concerned with empowerment, overcoming oppression, countering marginalization and changing the narrative of Black women. Through this lens, researchers can reflect on and consider the intersectional experiences of Black women to better understand how they interact with society. Essentially, this theory is designed to remind the researcher to center the lived experiences of Black women for the entirety of the study.”

Barr explained that research studies informed by Black Feminist Thought, from literature review through dissemination, may provide a unique focus for future intervention studies and steer evidenced-based practice toward Black woman-centered care that is nuanced, relevant and culturally responsive. This research process can lead to more equitable care for Black communities.

Generational communication matters

The first article, published in Breastfeeding Medicine, examined the communication dynamics of infant feeding information shared between Black American families in the Southeastern region of the United States. Families were grouped based on whether breastfeeding occurred among one, two or three generations of mothers. In particular, the infant feeding information shared across generations were categorized as guidance, encouragement, practical assistance, observational learning, reservations and perceived undermining. The authors also determined when the conversations took place and that each family’s feeding history may have influenced those intergenerational conversations.

Results of the study suggest that a family’s feeding history can shape family support dynamics and influence the content and the context of the feeding information they share between generations. One major finding demonstrated that families in the study used historical information about breastfeeding as a means of empowerment.

According to the research team, “African American women’s maternal experiences have been negatively affected by practices such as wet nursing, involuntary breeding and maternal vilification during chattel slavery, and the effects are still ongoing. Previous studies found this cultural memory and the enduring legacy of slavery and wet nursing continued to be passed down in African American families and negatively affect their breastfeeding behaviors. However, this study found that families used this historical knowledge to empower the youngest generation to change the breastfeeding narrative within their family.”

Another finding suggests that miscommunication may have occurred between generations because, when referring to the same conversations, older generations reported expressing concern about a topic of discussion, while the youngest generation perceived that older generations were undermining them. However, the team noted that reports of undermining and reservations decreased among families with each additional generation of breastfeeding experience.

Each generation plays a role

The second article, published in the Journal of Human Lactation, sought to understand the intergenerational roles of African American families in the Southeastern region of the U.S., and the value or meaning each generation associated with infant feeding communication. Participants in this study were classified based on whether they were among the older, middle or youngest generations in a family.

Participants in the older two generations often cited a moral responsibility to share information about infant feeding and beyond with their daughter and granddaughter, while middle generations reported that sharing information about breastfeeding with younger generations provided comfort and created a strong bond.

The younger generation reported that even if the information from the older generations was inaccurate, the fact that they chose to share infant feeding information with them demonstrated that older generations cared. Additionally, younger generations placed significant trust and value on the wisdom that older and middle generations provided.

“It really meant a lot to have somebody that cares,” said one participant in the study. “[N]ot that nurses don’t care…some of them do, but some of them will definitely rush you out. ‘Is the baby breathing? Are you breathing? Good.’ And they are gone out of the room…. [I]f I did not have [my mom] helping me with feeding the baby, I wouldn’t have known what to do…she just gave that personal touch.”

“A principal tenet of African American women’s motherwork, and an act of maternal love, has long been to use teachings as a form of protection for their children,” Barr said. “Lactational professionals should recognize the value of multigenerational oral traditions and consider including protection language, in addition to support language, when including elders into infant feeding conversations. Proper messaging is the crux of breastfeeding promotion, support, protection and re-normalization in the African American community.”

For public health professionals, understanding the nuances found in these study results is critical, as they have broad application potential for providers, communicators, educators and scholars who work with Black American families. By understanding the importance of oral tradition as a means of health communication and the value that intergenerational family roles provide, new opportunities arise to improve breastfeeding rates and increase health equity.

Contact the UNC Gillings School of Global Public Health communications team at

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