Breastfeeding and Racial Inequality – A Humble Look at this Healthcare Crisis
April 9, 2021
Breastfeeding and Racial Inequality

Hello. I’m Lynn Gerner.

In my professional circles, I’m frequently in the position to introduce myself and to find appropriate titles to define myself. I often use such words as “Doctor, Chiropractor, Pediatric specialist, Cranial Therapist, Teacher, Instructor, Business Owner, etc.  Sometimes, if the context is more personal, I’ll include the titles of wife, mother, daughter, sister or even Democrat.  All of these titles have been received mostly with respect and neutrality.  None of those terms or titles have ever caused me personal harm or brought about any visceral fear inside of me.  Prior to the last 2 years, I never really had to think too hard about any of the titles that do cause harm and fear to millions (or even billions) of people- black, brown, minority, gay, transgender, BIPOC, non-binary, etc. I have lived most of my life in the San Francisco greater bay area; not the South or the Midwest. I had a very loving mother who taught me to embrace other cultures and people. I have members of my immediate family who are also from other cultures and ethnic backgrounds. For the past 30 years, I’ve mingled with mostly highly educated, outwardly accepting and culturally diverse communities.  The world, as a whole, felt like it had progressed on racial issues and that (at least most of us) were one big happy family.

So… what changed?

Some of you are familiar with me from my course, “The Anatomy of Breastfeeding”. This is a continuing education workshop for professionals about breastfeeding as a whole and how cranial therapy fits into it.  What does that have to do with racial issues?  Well, part of creating that course included addressing World Health Issues and looking at disparities in breastfeeding, birth, and healthcare in general. Here’s what the research says…

Breastfeeding and Racial Inequality

Black women experience higher rates of poor birth outcomes, including higher rates of Cesarean, preterm birth, low birth weight, and infant death.  In addition to that, black parents continue to have the lowest rates of breastfeeding initiation (60%) and continuation at 6 months (28%) and 12 months (13%) compared with all other racial/ethnic groups in the United States.  They are 2.5 times less likely  to breastfeed than white women. Studies show that significant racial disparities (differences) in birth and breastfeeding outcomes continue to exist even after accounting for factors like the pregnant person’s income, education, marital status, tobacco/ alcohol use, and insurance coverage. In other words, health and social factors alone can’t explain the higher rates of poor birth outcomes among Black people. Then what does explain the health inequity? Researchers have proposed that African Americans are subjected to individual, institutional, and other forms of racism and bias throughout their lives; these experiences build on each other and are uniquely stressful; and the increased stress can negatively impact pregnancy outcome.

Through my own work, I am acutely aware that positive outcomes of birth and breastfeeding are determined by the parent’s access to care.  This starts during pregnancy with prenatal care, birth education, chiropractic and other complementary healthcare services.  A birthing parent’s preparations for birth, both physically and emotionally determine the success of her delivery.  The ideal care continues after birth, especially when there are difficulties in breastfeeding.  The ideal collaboration of care here includes the lactation consultant, chiropractor or cranial therapist, and often includes a ENT or dentist in the case of tethered oral tissues (tongue tie).  If these resources are not available to that parent and baby, then breastfeeding may fail causing a lifelong detriment of health for that child.  All of these services can be very expensive and out of the reach of many minority groups. Insurance plans available to the lower income population usually do not cover these specialty services.  In addition to financial limitations, often either inherent or implicit bias of the medical provider is a roadblock to even educating minority parents about these options.

Breastfeeding and Racial Inequality

I became aware that my own beloved Chiropractic profession DOES have an assumed stigma around the subject of inclusivity. Chiropractic care is still considered to be elective and complementary.  It is usually not part of paid healthcare for low-income populations (such as MediCal and Covered CA). It is usually only available to the higher income groups who can either pay out of pocket for care or who can afford the higher rates of better insurance plans (AND we chiropractors are in so much debt that we can’t work for free).  As a result- most lower income minority groups simply cannot afford Chiropractic care; leaving the predominantly white middle-high income demographic groups as our patients. Whites comprised 96% to 97% of chiropractic users, blacks 1% to 2%, and all other racial minorities 1% or less. The large majority of Chiropractors themselves are also White and middle-high income; perhaps due to the high cost of Chiropractic school and the lack of exposure of minorities to the profession.

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

-Martin Luther King, Jr.

                                                                                                                                      

Here are some enlightening highlight from an NCBI research article entitled, “Diversity in the Chiropractic Profession: Preparing for 2050”:

“As the diversity of the United States (US) population continues to change, concerns about minority health and health disparities grow. Health professions must evolve to meet the needs of the population… Surprisingly little has been published in the peer-reviewed literature on the topic of diversity in the chiropractic profession. For the variables available (sex and race), the data show that proportions in the US chiropractic profession do not match the population… The chiropractic profession in the United States currently does not represent the national population with regard to sex and race”.

Diversity in the Chiropractic Profession: Preparing for 2050. Claire D. Johnson, DC, MSEd and Bart N. Green, DC, MSEd, Editor-in-Chief. J Chiropr Educ. 2012 Spring; 26(1): 1–13.

To help set the stage even further, I’ll remind you that all of this was happening in the Fall of 2020.  That was obviously a heavy time for many reasons.  We were ALL affected by the Coronavirus Pandemic; both in our practices and our families.  Much of the world retreated indoors to quarantine and the buzz term “social distancing” is became too commonplace in our lives.  Much of the world became isolated, vulnerable, and unsteady about the future.  Many of us lost jobs, friends, and loved ones. Many of us lost what we thought we knew about security. 

This all happened in a time when political parties were at an unprecedented odds against each other. Unlike in times past when conservatives and liberals simply argued about trickledown economics and if climate change was real, this battle of the parties was much more emotional and personal. BIPOC (Black, Indigenous and People of Color) and LGTBQIA issues became the fuel on the flame.  People who previously hid their prejudices and bias in the name of social acceptance were now given a public voice. The Black Lives Matter movement is (fortunately) on center stage. At the same time, we saw evidence of racially motivated violence such as the death of George Floyd,  Breonna Taylor, and Ahmaud Arbery. Political divisions still exist that allow racism, homophobia, and general hatred to be falsely emboldened.  Even now, in 2021, the trial of Derek Chauvin has America waiting to see how we respond as a country to this injustice. 

Breastfeeding and Racial Inequality

So… who am I to say anything about it???  I’m no one.  That’s the point.  I think that I probably represent, the majority of those who are take my classes.  I am a part of the 2%.  I’m a white, straight, cis-gender upper middle-class woman who had the open door to get a higher education and; while I worked really hard to land on the other side, I certainly didn’t have any doors closed to me because of my race or identity.  I’m going to be super honest here, because, once again, I think that I am coming from a similar place as many of my colleagues.  Before creating this course and having to look harder at this topic, I was one of those people who said to myself, “Why we can’t I say that all lives matter?” I was a single mother for 12 years, all while I was going through Chiropractic college and worked nights bartending to make ends meet.  DON’T TELL ME that I’m entitled!  Now… in current conversations abound racism, I am sensitive to not throw that out there because I am aware now that this does not change who I am.  I’m just telling you where I was coming from.  I was also offended that, just because of the light color of my skin, that I was often automatically assumed to be part of the problem.  Are any of you identifying with this???

WELL… I WAS WRONG.

In doing my research into disparities in healthcare, though, I began to see the light.  Just because I don’t notice overt racism or social injustices in my little world, doesn’t mean they don’t exist elsewhere, even right around the corner.  I was not raised in a family that suffered an open wound caused by generations of abuse and neglect.  And… my biggest discovery was that it’s not about ME.  It’s about YOU- those of you who have been marginalized, ignored and outright ABUSED just on the basis of the color of your skin or your sexual identity.

The studies do not lie.  Women of color DO have much higher risk of birth trauma and neonatal death as well as much lower breastfeeding rates- across the board REGARDLESS of education or income level.  When I reached out the black community to find out why, I was humbled to hear their stories.  In addition to this, I read accounts of couples in the LGTBQIA communities who also, most definitely felt unsafe to find healthcare when starting their families.  UNSAFE- that is the actual a word used by a non- binary person I know about finding a doula for their pregnant partner.

I was shocked to realize that, while MANY other professions require extensive social sensitivity training, including the Western healthcare profession as a whole, we Chiropractors are not required to take even 1 unit.  In fact, it was hard to even find a chiropractic focused course on the subject.  Why is this???  I think this needs to change, especially in light of the current political and social unrest in our world.

Perhaps my all-time favorite leader, teacher, and spiritual advisor is Desmond Tutu.  If any one of you does not know who this man is, Google him.  Read his works.  Listen to his speeches.  He is an amazing human being.  Just one of the many things he said is-

“Differences are not intended to separate, to alienate. We are different precisely in order to realize our need of one another.”

As a result of all of this researching and soul-searching, I created just such a class called “Social Safety in Healthcare- Opening the Conversation around Race and Identity in the Chiropractic office”.  All chiropractors will be able to earn their 2 hours of yearly Ethics credit and learn about the beginnings of racism in the US, how it has affected our healthcare system as a whole (and the Chiropractic profession specifically), exactly why birth and breastfeeding rates among women of color are so challenged, and what we can do about it.  This article and the course are both merely an attempt to start the conversation and not an exhaustive view of the whole.  Efforts have been made to present a humble, respectful and real dialogue about this sensitive topic within a very short space allowed.  Real people from different racial and social backgrounds  were sought out, interviewed and listened to including an in-depth video interview with black breastfeeding professionals.  This topic represents generations of abuse and hurt as well as healing and joy.  Everyone has their own experience and interpretation.  I am not trying to speak for anyone, but to merely be the facilitator. ***Proceeds from this course will be donated to non-profit organizations supporting birth and breastfeeding with Women of Color.

As doctors and caregivers, we will have people of all races and identities walk into our practices. If we cause hurt or offense to anyone; however unintentionally or naively as it may happen, then someone will not receive the care that they need.  Someone may not have a safe birth. Someone may not be able to breastfeed. Someone may have to suffer the consequences of these things throughout their life or the life of their child.  It is my hope and prayer that we have an upmost desire, at least, to be nothing be loving and respectful to all.

Dr. Lynn Gerner, D.C., FICPA
Dr. Lynn Gerner, D.C., FICPA

Dr. Gerner is a Chiropractor and has been a Maternity and Pediatric Specialist in private practice for over 16 years with an additional focus on functional infant cranial work. She teaches other professionals to support breastfeeding across the USA and internationally. She is a graduate of Life Chiropractic College West in 2004. She is a Fellow with the International Chiropractic Pediatric Association (ICPA) and a trained doula. She is currently Post Graduate faculty at Life Chiropractic College, West. She is the founding partner of The Good Life Collective, Davis, CA and the creator of The Good Life Learning, LLC. She is a wife, mother of 3 grown children, and lives in Northern CA with her husband and their 2 rescued dogs.

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