Breastfeeding advocacy grows in Minnesota communities of color.

Shukri Jumale had worked closely with mothers and babies for four years as a bedside labor and delivery nurse before she became pregnant herself. By then, there was no doubt in her mind that she wanted to breastfeed her baby.

Convincing the rest of her Somali-American family that breastfeeding was a healthy and culturally acceptable choice, however, was another matter.

“It was really challenging,” said Shukri, who is now program manager of the Midwest Fetal Care Center, a collaboration between Allina Health and Children’s Minnesota, and a Minnesota Breastfeeding Coalition board member. “Family members would tell me I needed to bottle-feed or supplement, and there’s a belief we need to give babies water.”

Many immigrant communities and communities of color breastfeed at lower rates than white Minnesotans. Hmong, Native American, and Black infants are less likely to start out breastfeeding than East African, Hispanic, Asian (non-Hmong) and white infants. 

There are also income disparities: Breastfeeding rates are highest among older, highly educated Minnesotans who live in bigger cities, and lowest among low-income parents under age 20. 

These disparities in breastfeeding likely contribute to future health disparities, according to nurses who work with parents and infants. Breastfeeding confers advantages ranging from reduced risk of disease and illness for both mom and baby to financial savings, so it’s essential that all parents can access lactation resources, they said. Infants and mothers who are not involved in breastfeeding are at higher risk for poor health outcomes, according to the Minnesota Department of Health, because breast milk creates stronger immunity than formula. 

“Breastfeeding touches on every social determinant of health,” said Dr. LaVonne Moore, a doctor of nursing practice who specializes in obstetrics and gynecology. 

“It saves costs, parents are out sick less, children are out sick less—and children who are breastfed are more sociable and easier to parent,” she said. Breastfeeding even contributes to a lower carbon footprint and increased workforce, she said. 

Barriers to breastfeeding vary by community. In East African communities like Shukri’s, there’s often a lack of family, cultural, and religious support. In low-income communities, expenses for breastfeeding and newborn care classes (which often cost upwards of $150) can present hurdles. Many communities have historical trauma linked to breastfeeding, including the practice of African-American women used as wet nurses during slavery. In newer immigrant communities, there are language barriers. And lack of education is a problem across communities, Shukri said. 

“There’s an assumption that they don’t want to breastfeed,” Moore said, referring to African-American women, even though most women do desire education and breastfeeding support, she said. “Breastfeeding is natural, but it’s not always easy. We need to reclaim the cultural practice and normalize it.”

Education is the first piece of the puzzle, Shukri said. “I’ve seen moms coming in who have never even thought about what they’re going to do,” she said. 

New programs are starting to address these disparities. They include the Chocolate Milk Club, which Moore founded seven years ago as an extension of her Chosen Vessels Midwifery Services.

“I felt breastfeeding was an overlooked tool to address health disparities in the Black community,” said Moore, who also practices at NorthPoint Health and Wellness Center. “It’s a tool that could improve our health and the health of our children. And it’s something I could do to address what I was seeing in practice.” Club members get support via FaceBook and at monthly in-person meetings.

Other initiatives include:

• The Minnesota Breastfeeding Coalition recently helped organize a fatwa, or religious clarification, on Islamic women using donor breast milk. Islamic families had expressed some hesitance to use donor breast milk, so representatives of several organizations, including the coalition, Children’s Minnesota, M Health Fairview, the Minnesota Milk Bank for Babies, and Brighter Health, met with religious scholars in the Twin Cities. On Nov. 16, the Minnesota Islamic Council officially issued the fatwa, encouraging the use of pasteurized donor breast milk for babies when their mother’s milk is not available. “Islam has many verses in the Qur’an and other texts that document the importance of breast milk, whether from the birth mother or shared milk,” said Mohamed Mahad, the imam who signed the fatwa.

• Children’s Minnesota now loans hospital-grade pumps to families who can’t afford to rent the high-quality equipment often necessary for babies in the neonatal intensive care unit. “Good quality, hospital-grade breast pumps are often necessary to establish milk supply for moms who aren’t able to be with their babies initially,” said Ashley Johnson, a nurse and lactation consultant at Children’s Minnesota. “They’re also much more comfortable, especially when you need to pump eight times a day.” The program began after a group of lactation consultants at the hospital noticed that some of their families didn’t have access to these pumps. They lobbied for a free loaner program, and since March, the hospital’s supply of 106 pumps has been in use almost every day, Johnson said. Moms report increased supply and the ability to pump longer and more often. “It makes a big difference,” she said, especially when used soon after giving birth. “Those first days and weeks are important for establishing a good supply.”

• The Minnesota Breastfeeding Coalition is also working to diversify lactation consultants in Minnesota, Shukri said. Most lactation consultants in Minnesota are white; Moore was the only Black International Board-Certified Lactation Consultant in Minnesota until 2022.

• Shukri also hopes to establish a Somali Breastfeeding Coalition, inspired by the Hmong and Indigenous Breastfeeding Coalitions. She plans to apply for funding to offer online lactation assistance in other languages, and to provide videos and handouts in multiple languages.

After her own quest to breastfeed her children, who are now 7 and 3, Shukri says she shares her experience with her Somali-American friends, hoping to encourage them to do the same. “For any negative comment from an auntie, sister, etc., find two or three friends or advocates you can call when you feel like, ‘I can’t do this anymore!’ to get positive reinforcement,” she said

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