Factors in Birthing Centers that Impede Exclusive Breastfeeding among Black Mothers: A Basic Qualitative Approach

Racism includes unfair attitudes and violent hostility against another ethnic group (United Nations Educational Scientific and Cultural Organization, 2019). While many Americans who are unaware of social inequities may argue that racism no longer exists in the United States, equality without equity is meaningless in a system founded on racism and discrimination (Kwate, 2014). Institutional racism refers to how institutions operate systematically, both overtly and inherently, via the reinforcement and adoption of racist policies, procedures, operations, and culture that exclude racial minorities or create barriers to access quality health and resources (American Academy of Family Physicians,2019; American Psychological Association, 2019). Race-based inequities against patients during care and the link to implicit bias are documented components of exclusive breastfeeding disparities (Thomas, 2018a). 

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Exclusive breastfeeding rates have been on the rise with the help of health communication campaigns triggered by the Surgeon's General Call to Action to support exclusive breastfeeding and the Healthy People 2020 Maternal, Infant, and Child Health goals (CDC, 2018c; Thomas, 2018a). Regrettably, the health gap-disparity between Black mothers and their white counterparts has not decreased regarding exclusive breastfeeding (CDC, 2018c; Thomas, 2018a). Therefore, the results of this study create social change by providing an insight into Black mothers' experiences individually, interpersonally, and within their community regarding exclusive breastfeeding. Furthermore, this study provides insight into the perception of implicit (unconscious) bias, racism, and discrimination within the institutional structure and existing policies of birthing centers that may influence the initiation and duration of exclusive breastfeeding among Black mothers.

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Due to structural racism woven into the United States' social and institutional structure, racial health disparities continue to impact people who self-identify as Black negatively. Therefore, this study also provides an understanding of how the individual, interpersonal, and community factors, as well as the organizational structures and existing policies within birthing centers, are perceived by Black mothers. In addition, the study provides more insight into how Black mothers identified and characterized these perceptions of racial discrimination after giving birth within a birthing center. As a result, this study can provide insight into (a) reducing exclusive breastfeeding disparities rates that are associated with race/ethnicity and (b) assist with developing best practices for the management of exclusive breastfeeding. Subsequently, leading to strategies that yield higher breastfeeding rates among Black mothers, which would significantly impact Black maternal and child health (McGuire, 2011; NCHEC, 2015; Office of the Surgeon General U.S. Department of Health & Human Services [HHS], 2011; Trent et al., 2019).