Addressing Bias and Inequity in Breastfeeding Support: A Global Perspective

In this episode of Research Recap, we explore four new studies that shed light on how systemic racism, insurance disparities, maternal confidence, and substance use policies intersect to shape breastfeeding support in diverse settings. From Boston to Japan to the NICU, these findings highlight where the system is failing—and what IBCLCs can do about it.

1️⃣ Racial and Ethnic Disparities in Obesity-Related Breastfeeding Support

Citation:

Stuebe, A. M., Bryant, A. S., & Oken, E. (2024). Racial and ethnic disparities in obesity-related breastfeeding support: A conceptual framework and call to action. Obesities, 5(3), 38. https://doi.org/10.3390/obesities5030038

Takeaways:

• Black and Brown mothers in larger bodies face "triple jeopardy": racism, weight bias, and systemic inequities that reduce breastfeeding support.
• These are system-level failures, not individual ones.
• IBCLCs must adopt trauma-informed, inclusive practices and push for structural reforms in healthcare spaces.

2️⃣ Disparities in Lactation Support for Medicaid-Covered Births in Boston

Citation:

Muniz, J. L., Wharam, J. F., Land, T., Zera, C. A., & Perrin, J. M. (2025). Disparities in lactation support for Medicaid-covered births at Boston-area birthing hospitals, 2018–2020. BMC Public Health, 25, 1032. https://doi.org/10.1186/s12889-025-23084-6

Takeaways:

• Medicaid-covered births had 44% lactation support documentation vs. 76% for commercially insured births.
• Disparities existed within hospitals, not just between them.
• Insurance status was a strong, independent predictor of lactation support access.
• IBCLCs should advocate for standardized, universal access to lactation care.

3️⃣ Maternal Predictors of Early Introduction of Formula and Solids in Japan

Citation:

Hatsukawa, Y., Iwaoka, Y., Yoshida, H., Ota, E., & Fukui, K. (2024). Maternal predictors of the early introduction of formula milk and solid foods: A cross-sectional study using data from the Japanese Pregnancy and Birth Survey. Environmental Health and Preventive Medicine, 29, 3. https://doi.org/10.1265/ehpm.1401012737

Takeaways:

• Nearly half of mothers introduced formula before 1 month, and 16% introduced solids before 5 months.
• Key risk factors: primiparity, cesarean delivery, younger age, lower income, and shorter maternity leave.
• Low breastfeeding self-efficacy was one of the most consistent predictors of early supplementation.
• IBCLCs must provide proactive, confidence-building support—especially for first-time mothers and those returning to work early.

4️⃣ Marijuana Toxicology Screening and Breast Milk Use in NICU Policies

Citation:

Bae, E., Patil, U., Larkin, D., Jones, C. L., & Chamberlain, L. J. (2025). Toxicology screening for marijuana and impact on breast milk feeding policies in neonatal intensive care. Journal of Perinatology. Advance online publication. https://doi.org/10.1038/s41372-024-01726-6

Takeaways:

• A positive marijuana screen drastically reduced maternal milk use (19% vs. 83%).
• No standardized testing policy—decisions were subjective and provider-driven.
• Black and Hispanic mothers were disproportionately tested.
• IBCLCs must advocate for harm-reduction, evidence-based, and equitable policies in NICU lactation care.

Conclusion:

These studies highlight the ongoing need for IBCLCs to not only offer skilled lactation care—but also to advocate for systemic change. Bias, disparities, and inequities are not just individual challenges; they are institutional failures we must confront to create truly inclusive and supportive spaces for all families.

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