The fight to protect individual choices about reproductive care, including breastfeeding, is an ongoing battle. The central lesson of the reproductive justice movement is that choice means little without access. That lesson applies equally to breastfeeding.

Though laws, in the workplace and other contexts, are in place to protect the right to breastfeed, many low-income women and women of color face entrenched structural barriers that hinder their ability to breastfeed before they can even consider if it is the right choice for them. This problem is particularly acute for Black women, who have the lowest breastfeeding initiation rate of all racial groups at 69.4 percent, compared with 85.9 percent of white women, and 83.2 percent of women overall. They also have the shortest breastfeeding duration, with 44.7 percent of black women breastfeeding at 6 months compared with 62 percent of white women and 57.6 percent of women overall.

In honor of Breastfeeding Awareness Month and Black Breastfeeding Week, let’s take a look at the barriers Black people face in the workplace, healthcare system, and society when it comes to breastfeeding.

Many Black people work, and breastfeeding at work is hard

Black women’s labor participation rate of 60.2 percent is higher than the rate for all other women. Additionally, Black women are most likely to be the primary economic support for their families, with 70.7 percent of Black mothers as sole breadwinners and 14.7 percent as co-breadwinners. This means that shortly after birth, many Black women experience economic pressures that motivate them to return to the workplace earlier than any other race.

Black people are also less likely than their white counterparts to occupy jobs that offer greater flexibility, economic stability, and better benefits, such as paid family leave, which is associated with a longer continuation of breastfeeding.

Although provisions of the Patient Protection and Affordable Care Act (ACA) require employers to provide break time and a private location to nurse, many employers fail to comply with this mandate. This is particularly true in low-wage jobs, of which a disproportionate number of workers are Black women, trans people, and non-binary folk. Additionally, due to intersecting race and gender discrimination, many Black workers may feel like exercising their right to breastfeed is too risky to be an option. Merely raising the issue of breastfeeding accommodations with an employer can create tension. Many who have done so have faced adverse consequences, reduced work hours, demotion, job loss, and public shaming or harassment in the workplace.

Inequities in access to health care put breastfeeding out of reach for many Black people

More Black women have Medicaid as health insurance or are uninsured compared to other groups. Although the ACA requires coverage of all recommended preventive services, including breastfeeding education, lactation consultation, and breast pumps, these benefits are not available for the majority of people in the 14 states – many of which with large Black populations – that have opted not to expand Medicaid. As we might expect, states that have expanded Medicaid have seen improved Black maternal and infant health outcomes.

Black neighborhoods are also lacking in hospital practices supporting breastfeeding. Forty-five percent of Baby-Friendly hospitals – those that have adopted a set of policies to ensure that their facilities are supportive of breastfeeding – are concentrated in cities where Black people comprise 3 percent or less of the population. Hospitals in communities with an above-average Black population are significantly less likely to promote nursing than hospitals located in other neighborhoods. Black women are also more likely to experience in-hospital formula introduction, which is associated with lowered breastfeeding rates. 

The relatively low breastfeeding rate for Black people is a product of systemic racism that contributes to the overall poor Black maternal and infant health outcomes. To name a few, Black people experience the highest maternal mortality rate, highest infant mortality rate, one of the highest teen pregnancy rates, and lowest rate of contraception use. To effectively address inequitable health outcomes and access, we must promote policies that aim to improve the health of Black people across their life course.

The societal stigma of breastfeeding is heightened for Black and brown people

Society has sexualized breasts to the point that people are routinely shamed for breastfeeding. Compounding this is the fact that Black bodies have been historically over-sexualized and degraded. The perception of Black women as sexually promiscuous by nature is a persistent stereotype that negatively impacts the sexual health and rights of Black women. Additionally, the traumatic history of Black women during and after slavery as wet nurses for white women means that for some, breastfeeding is associated with a lack of choice. This history contributes to whether Black people have the social and societal support to initiate and sustain breastfeeding.

Advocacy around breastfeeding has been primarily led by white, cis-gendered women, and consequently centered on issues specific to that group. It is unsurprising that the choice to breastfeed has been primarily available to upper-middle-class, cis-gendered white women. Creating a new narrative, health and advocacy groups that center on the experiences of women of color are leading the charge to formulate an agenda that is inclusive of the unique experiences of Black women, as well as trans and non-binary folks who breast- or chest-feed.

Certainly, there are strong public health reasons to implement policies promoting breastfeeding. But breastfeeding promotion can also result in the pressure to breastfeed, putting those who choose not to or are unable to breastfeed and those without the ability to exercise their rights in a particularly impossible position. Battles to safeguard breastfeeding rights must be accompanied by efforts that remove barriers to making that right something everyone can exercise on equal terms. Neither where a person lives, works, and gives birth, nor a person’s race or gender should determine whether they have the option to breastfeed.

Amani Echols, Intern, ACLU Women's Rights Project

This post is also published in Florida Politics and South Florida Sun Sentinel.

I am 18 years old and, until January, I was a student at Marjory Stoneman Douglas High School in Parkland. I was there on Feb. 14, 2018 — Valentine’s Day — when a former student killed 17 of my schoolmates.

In fact, some of the people he shot were in the classroom right next to mine.

People wonder what it’s like to go through such a horrific event and how it affects you both short term and further on.

In my case, the shooting left me in shock.

At first, I remembered nothing of the actual events. I was consumed by checking with others at the school about the kids and teachers and who had made it out and who hadn’t. We weren’t being given names at first and that was agonizing.

It was only after days that I remembered having to step over bodies to get out of the school. I also recalled passing by a stairwell and ducking into my Spanish class just seconds before the shooting started.

Given how police later traced the shooter’s movements, he may have been in that stairwell as I passed.

If I had arrived at the classroom even seconds later, I might have been the first one shot. I think about that a lot.

 I was also extremely worried about one of my coaches because he had walked by me just before I entered the classroom. I later found out he was all right, but two other coaches had been killed.

What I went through left me badly shaken and, at first, not knowing who I was.

I didn’t know how to cope, how to grieve, how to move forward. I have been in therapy and it has taken time to find the skills to deal with what I lived through.

We went back to school two weeks after the shooting and those first days were difficult. Fire alarms kept going off; we assumed someone was pulling the alarms as a prank, but they were terrifying.

One day, someone was hammering a nail into a wall and that sounded just like gunshots to me.

Also, almost every day unknown people were writing posts on social media threatening to come back to Parkland and do it again. I’d wake up in the morning and find messages from friends: “Have you seen social media this morning!”

Twelve days after the shooting — before returning to classes — I was in Tallahassee testifying before members of the Florida Legislature.

I told them: “A person my age shouldn’t have to see what I saw.”

They were considering legislation to increase funding for mental health and to improve the communication between education officials and law enforcement to strengthen schools and I approved of all that. But I testified to the House of Representatives Appropriations Committee against the arming of teachers.

I think that is a terrible idea. I picture another shooter entering a school and when the police arrive, they find numerous people with guns. How do they know who is the killer? How do they know who to shoot? Do teachers end up dead?

If you’ve been through what I’ve been through, that’s what you imagine.

In January, I transferred to a private school. I decided I would never feel safe in a school where teachers carry guns.

At my new school, you enter by scanning your ID, which is associated with your fingerprint. The school also has facial recognition technology that does a background check immediately on any visitors to the campus and notifies the school administration.

Public schools don’t have that technology, presumably because they won’t spend the money.

What gets me about our society is that cars are much more regulated than guns. I need to register my car and buy insurance for it. I also need to pass written and driving tests to get my license, which takes time to schedule and do. No such process exists for guns.

To me, that’s crazy and incredibly irresponsible of our lawmakers.

Meanwhile, the killings continue. Look at El Paso and Dayton this past weekend. The “Never Again” movement goes on and on.

I’m planning to go to college and a major criterion for me is the safety of the campus. Most kids don’t think that way, but that is a major selling point for me, and also a long-term effect of what I lived through.

Another long-term effect is this: Feb. 14 will never be just Valentine’s Day for me ever again.

Annabel Claprood is a former student of Marjory Stoneman Douglas High School in Parkland, Fla., and a high school senior.