Dr. Flora Ukoli on How to Support & Uplift Black Breastfeeding Parents
A Black Breastfeeding Week interview with breastfeeding promotion & advocacy expert Dr. Ukoli
This Black Breastfeeding Week, we were thrilled to sit down with Dr. Flora Ukoli, M.D., MPH., IBCLC. Dr. Ukoli is a Professor of Community Medicine at Meharry Medical College in Nashville, Tennessee, the first historically Black four-year medical school in the South. She is a World Health Organization Breastfeeding and Lactation Master Trainer, and has engaged in extensive Baby-Friendly breastfeeding promotion and advocacy in Nigeria and the United States.
This interview has been edited for length & clarity.
A Better Balance’s Feroza Freeland: What inspired you to become so passionate about breastfeeding research and advocacy?
Dr. Ukoli: As a child, I knew that mothers breastfeed babies. I saw my mother, aunties, neighbors, and all their friends breastfeeding. Then as a medical student, I learned about the wonderful benefits of breastfeeding, both for the mother and the child. I assumed that once I became a mother, I would do the same. It was a big shock to me when the nurses in my teaching hospital did not help me breastfeed my newborn. In fact, they were very antagonistic when I asked to breastfeed. As far as they were concerned, formula feeding was the routine, and I should stop disturbing their routine.
Luckily for me, on the third day in the hospital, one nurse saw how sad I looked. She consoled me and wanted to know why I was so sad. I said, “Nobody is letting me breastfeed my baby!”
She told me not to worry, that I was going to breastfeed today, and she would bring me the baby at the right time. And she was talking to me and rubbing my shoulders, making me laugh and relax. When she brought the baby, you can guess what happened- the baby just latched and started breastfeeding! And from that day on, the baby was breastfed.
That was when I knew that for my own teaching hospital, there was a need for us to revise the routines so that people could breastfeed. Some years later, the baby-friendly initiative was introduced, and the director of the hospital was asked to choose a doctor to be the first breastfeeding program coordinator. He chose me! All of a sudden, I got all the training from the World Health Organization and became a certified Breastfeeding and Lactation Manager.
Fast forward almost two decades later, I moved to the United States and realized that the medical profession was where we were in Nigeria in the 1980s. They were still in the dark about the need to protect, promote, and support breastfeeding. I knew I needed to be involved with breastfeeding advocacy here in the United States, especially since I have the training.
Feroza: Based on what you’ve studied, what are the most important health benefits that breastfeeding provides to mothers and babies, particularly for communities of color?
Dr. Ukoli: The health benefits of breastfeeding have been established by numerous authorities and experts over several decades. The best way for anyone to remember is to look at immediate and long-term benefits for the mother and the baby.
Let’s first look at the immediate benefits for the mother:
- A woman who is breastfeeding will have decreased bleeding after giving birth, because breastfeeding will help the womb to contract and go back to what it used to be.
- We all know that labor is a little bit painful, but breastfeeding can provide immense joy.
Now, the long-term benefits for the mother:
- If a mother breastfeeds her baby, and nobody is stressing her with going back to work [too soon], that joy is long-lasting.
- It helps mothers to lose the baby fat.
- Research has shown that women who breastfeed have a reduced risk for ovarian cancer and breast cancer.
Now, what are the immediate benefits for the baby?
- It will protect the baby from infection. A mother’s milk contains the antibodies to all the infectious diseases in that environment where the baby lives.
- The milk that the mother produces contains the exact nutrients that the baby needs, and the nutrient composition changes as the baby grows.
- The bonding: to breastfeed a baby adequately, a mother needs about 20–30 minutes each time, if not more. Spend that amount of time together between any two people, and they will bond!
- The protein in human milk is the protein that human babies digest easily. The protein in any other milk is very difficult for babies to digest.
What are the long-term benefits for the baby?
- A baby who has been in the constant presence of their mother develops a lot of security. For example, if the baby is going for an immunization and it is painful, just put them to the breast and they’ll stop crying.
- Some research has shown that babies who are breastfed have a higher IQ.
- And finally, breast milk decreases the risk for many diseases, like childhood obesity, diabetes, leukemia, sudden infant death syndrome, ear infection, and allergies.
Feroza: What steps can we take here in the U.S. to eliminate racism and better support Black women in meeting their breastfeeding goals?
Dr. Ukoli: I decided to answer this out of the box. There is institutionalized racism, which is so obvious to those of us who are at the receiving end. One reason is that here in the U.S., nobody knows what everybody else is being paid. Such a system is open to abuse and favoritism. In other countries, people of the same qualifications and same years of experience are hired on the same salary. Promotion is then based on performance. But in this country, you can have 10 people with the same qualifications and years of experience, and their salary range is so wide, that somebody at the top of that range is making 3 times more than the person at the lower level. And usually, those people who earn the least are people of color. They tend to be the ones who are offered less than they deserve, while their white counterparts appear to have even more than what they deserve.
How does this affect the whole breastfeeding story? Sometimes, the Black woman is the chief breadwinner for her family, and she cannot afford to stay at home [without paid leave]. So, how do we protect, promote, and support breastfeeding across all races? Paid maternity leave! Or maternity grants, for people who are on wages. These are young mothers, low-educated mothers, and the working poor, and they are usually the minority women. All women need to have paid maternity leave. If we want to remove racism, this is something we need to do. California does this already [along with 7 other states and D.C.]. Women get some financial support, so they don’t have to go back to work 2 weeks after having a baby.
America is the only country that does not have a paid maternity leave policy. When I was in Nigeria, it was paid maternity leave for the first 6 months, and the second 6 months, you were allowed to be 2 hours late to work and close 2 hours early. Every large institution had to expand their in-house daycare to accommodate babies, and you were allowed to feed your baby whenever you wanted. Those things were in place even as far back as the early 1990s.
Feroza: That’s really great, and you can see that it makes a big difference for moms, right?
Dr. Ukoli: It does! When I had my second daughter, I was the chair of the department. There was a threat that if I was on maternity leave, they might give the chairmanship to somebody else. I said, “Don’t worry, I’m around,” because the baby was in the daycare and I could go there 10 times a day if I wanted! So, I kept my chairmanship position and breastfed my baby as much as I liked because the daycare was on campus.
Feroza: I’m so glad you had that experience, and I hope more people can have that, too. To end on a positive note, how can we better celebrate, uplift, and support Black women who are passionate about breastfeeding?
Dr. Ukoli: These mothers should know that they are a celebration of themselves already. They have uplifted themselves already by doing the best for their child. Nothing good comes easy. The child they have sacrificed for, that is their celebration, and it is all going to come back for their own benefit. Babies who are breastfed are more likely to meet their optimal potential, academically and socially.
If you want to uplift somebody, you show them that what they are doing is worthwhile. Taking care of a baby and breastfeeding a baby is a full-time job. Therefore, women should be paid full-time salary for doing a full-time job. That’s how we celebrate and uplift them.
Feroza: I completely agree! Thank you so much again for speaking with me. Is there anything else you want to add that we didn’t get to talk about?
Dr. Ukoli: The buy-in from the government needs to be more explicit. Just saying that they support breastfeeding is not enough. Their support needs to be very clear cut, such that everybody knows they mean it. The same goes for big-time employers in the private sector, and especially employers in the healthcare industry! Some have paid maternity leave for their workers, but we need all of them to do the same.