Background: Black women encounter many challenges to breastfeeding, including inequitable access to support and resources and medical racism. However, limited research investigates how Black women across generations interface with health care systems to initiate or continue breastfeeding and what factors facilitate or hinder their breastfeeding experiences. Objective: Using the social determinants of health (SDoH) theoretical framework, this study qualitatively explored how a multigenerational sample of Black mothers' interactions with health care systems facilitated or hindered their breastfeeding initiation and continuation. There were three areas of interest: (1) access and quality, (2) professional and personal support, and (3) literacy and resources. Materials and Methods: Four age cohorts and three breastfeeding length cohorts of Black mothers in Kentucky completed semi-structured interviews on their breastfeeding experiences. Responses to research questions (e.g., "What was your experience during the birthing process and how did it impact your decision to breastfeed?") informed by the SDoH were analyzed using thematic analysis. Results: Four themes emerged on how experiences within health care systems influence Black women's breastfeeding initiation and continuation: (1) health care access, (2) health care quality/bias, (3) health care-related support, and (4) health care resource use. Conclusions: Interpersonal and systemic barriers in health care related to access, quality, support, and resources hindered Black mother's breastfeeding across generations. Mothers across each age and breastfeeding cohorts emphasized a need for culturally tailored pro-breastfeeding health care systems to meet their breastfeeding needs.

Original languageEnglish
Pages (from-to)666-672
Number of pages7
JournalBreastfeeding Medicine
Issue number8
StatePublished - Aug 1 2022

Bibliographical note

Funding Information:
This research was supported by the University of Kentucky Center for Health Equity Transformation (PI: Stevens-Watkins). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the University of Kentucky.

Publisher Copyright:
© 2022 Mary Ann Liebert, Inc., publishers.


  • Black women
  • breastfeeding
  • health care
  • social determinants of health

ASJC Scopus subject areas

  • Pediatrics
  • Health Policy
  • Obstetrics and Gynecology
  • Maternity and Midwifery


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