10 Doulas Seek to Improve Breastfeeding in Black Community as Lactation Consultants

Breastfeeding is an essential aspect of motherhood. It provides the child with crucial nutrients for growth and nurtures mother-baby bonding.

Yet, for many Black mothers, it's a journey fraught with systemic challenges and barriers.

Throughout pregnancy, childbirth, and postpartum, Black mothers often don't get the level of support and access to help that all mothers need to promote and protect healthy breastfeeding.

Recognizing this deficiency in support and access, two UC Berkeley Public Health students decided to do something about it. 

Rutendo Ajayi, a UC Berkeley Masters of Public Health candidate, and Renee Clarke, a Neonatal Intensive Care Unit (NICU) nurse for over ten years and a third-year Doctorate of Public Health candidate at UC Berkeley with a focus on Maternal and Child Health policy, applied for and were chosen to be a part of the UC Berkeley School of Public Health's Inaugural cohort for the Social Impact Innovation Grant changemakers. The program supports UC Berkeley students in developing and implementing community-based projects to improve health equity.

“This grant allows us to become change-makers now and not wait until we graduate to go into our communities and be the change we need to see,” said Ajayi.

Recognizing the value of breastfeeding as a linchpin to other aspects of public health, their initiative, "Black Lactation Matters," aims to increase breastfeeding rates within the Black community, particularly in Solano County.

The duo partnered with UC San Diego to use the grant money to provide ten Black doulas the opportunity to take the Division of Extended Studies Foundations of Lactation of Education Course free of tuition.

We spoke with Ajayi to learn more about the origins of the project, as well as the wider objectives and the urgent need for change for Black women around childbirth.

Tell us about ‘Black Lactation Matters’ and the goals of the project.

Ajayi: The goal of Black Lactation Matters is to increase the breastfeeding rate in the Black community and lower the maternal risk factors that contribute to Black maternal mortality and morbidity. These are challenges that have plagued our community for generations.

The first step is to fund the education of ten Black doulas to become Lactation Education Counselors (LECs). Our goal is that all ten of the first cohort will eventually become International Board-Certified Lactation Consultants (IBCLCs).

The value of breastfeeding goes beyond just healthy babies. Studies have shown that breastfeeding can lower the risk of breast and ovarian cancer, type 2 diabetes, high blood pressure, and heart disease for moms. Breastfeeding milk also has antibodies that protect infants and reduce the risk of many short-term and long-term health problems.

What was the inspiration behind this initiative?

Ajayi: As a Black woman, mother of two, and a full-spectrum doula, I had my own lived experience when my daughter was born. She was in the NICU, and I had to advocate for myself to request things such as a pump to be able to continue to breastfeed her.

Having had the experience of struggling with breastfeeding and helping my clients and other moms who are first-generation breastfeeding moms, I know how important and necessary access is for the community.

Motherhood is one of the most vulnerable and sacred journeys. My project partner and I, along with the ten Black doulas, have seen the effects of not having Black Lactation Education Counselors or IBCLCs in the community who can provide culturally appropriate and relevant support through the mother's breastfeeding journey. 

We truly believe that if you don't see it, be it. We say we're doing the walking so that the next generation of Black mothers can do the running. That's what we're working towards.

What are some of the challenges that might require the help of a Lactation Education Counselor?

Ajayi: A correct latch for the baby to the breast is essential for healthy direct nursing, yet this is something mothers often struggle with.

When you don't have the correct latch, it's extremely painful and discouraging for moms. 

Society has portrayed breastfeeding as something that is effortless. However, breastfeeding is a skill that you and your baby have to learn. Sometimes, you need somebody to guide, support, and encourage you on the journey. That's what a Lactation Education Counselor does.

What are some of the specific challenges for Black mothers with regard to childbirth and breastfeeding?

Ajayi: Breastfeeding for Black women has not always been felt as a loving, bonding experience between a mother and her baby.

Many of the challenges that Black mothers face is systemically rooted in history.

Many people don't know about the historical factors, such as wet nurses during slavery and predatory formula marketing, that have contributed to the low breastfeeding rates in the Black community. 

For enslaved Black women, breastfeeding was labor, horror, and exploitation because they were forced to nurse their white enslaver's child. At the same time, they were separated from and watched their own babies die because they were not allowed to nurse both a white and black baby on the same breast. So, within the Black community, women were taught to stop lactating due to this insidious history.

In more recent times, baby formula producers used aggressive marketing to communities of color to advance their interests at the expense of Black mothers and their children.  

All this transcended through generations to where most Black women don't have a history of mothers or grandmothers who breastfed. Many Black moms today are first-generation direct nursing or exclusively pumping moms.

In terms of the hospital system, this hasn't always been a safe space for Black moms to give birth either. There is already a sense of hesitation and lack of trust based on things that have happened in the care system in the past.

Because of history, breastfeeding is often not seen as the default perspective within the medical community for Black mothers and their infants either. Formula is the default. 

My project partner, Renee Clarke is a NICU nurse and a Black woman who has had to educate, encourage, and advocate for Black mothers so that they can exclusively pump while their baby is in the NICU or request human donor milk. This is a big reason why her public health research focuses on care after birth for Black birthing people in California to provide solutions and improve models of care delivery.

Lastly, representation matters.

If we look at the statistics for IBCLCs, there are less than 2% Black IBCLCs within the nation.

Having an IBCLC or a Lactation Education Counselor who looks like you, can relate to you, and understands you as a Black mother is important to helping mothers feel seen, safe, and supported within the current care system. 

Renee shares, "I am grateful to be a part of this transformational project and be amongst community. When we uplift and nourish those most in need, we uplift all."

What is the benefit of specifically working with doulas to be educated as Lactation Education Counselors? 

Ajayi: Having doulas who are also Lactation Education Counselors streamlines Black mothers' access to evidence-based, solution-focused education and support. 

As doulas, we establish trust and connection with our clients when we enter their most important space, their home. We often provide in-home services, and having Black doulas as LECs will better enable them to offer mothers care with breastfeeding in the comfort of their own homes.

Our role is to support, empower, advocate, and educate mothers throughout their journey to make informed decisions. We do not replace or provide medical advice.

What's the plan for after the first cohort graduates?

Ajayi: After the first cohort graduates, we will host a Black Breastfeeding Week Community Celebration in Solano County. We have partnered with Doula Doula (who referred the ten Black doulas from their organization), Solano Heals, and other community organizations. We will share a space dedicated to connection and education as we introduce the Solano County Doula Lactation Education Counselors, who are also all medi-CAL enrolled doulas. A majority of the doulas are mothers who have traveled their own journey into motherhood. One of our doulas is also a Black American Sign Language (ASL)  interpreter who will be able to serve our Black deaf community members better.

I'm forever grateful to UC San Diego Extended Studies for partnering with us. We could not have done this without them. There is strength in the community.

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More info about the UC San Diego Division of Extended Studies Foundations of Lactation Education Course and the full suite of Lactation & Perinatal Education Programs available can be found on the website.

To learn more about Black Lactation Matters, visit https://www.douladoula.org/.