The Relationship of Race and Ethnicity to the Perception of Visual Images of Breastfeeding Mothers

Document Type

Journal Article

Publication Date



Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine




bias; breastfeeding; cultural context; norms; social determinants of health


Breastfeeding biases, both implicit and explicit, can impact perceived norms of breastfeeding appropriateness in a variety of contexts and influence breastfeeding behaviors. The purpose of this research was to uncover breastfeeding biases, norms, patterns, and perceptions that potentially affect the decision to initiate or sustain breastfeeding and investigate how a diverse group of women perceive images of racially/ethnically similar and different women breastfeeding. Using a panel of nationally representative respondents (oversampling key racial/ethnic subpopulations), an online mixed-methods survey was completed by a sample of women who were primary caregivers of children under 3 in November 2020. The survey included diverse images of individuals breastfeeding in various settings and respondents were asked to generate word associations and indicate perceived appropriateness and ease of breastfeeding for each image in direct, timed comparisons. Respondents ( = 144) racial/ethnic identity influenced perceptions of breastfeeding ease and norms surrounding breastfeeding in public settings or in front of others. Furthermore, respondents perceived breastfeeding to be more or less appropriate based on racial identity, in particular, respondents of color seeing breastfeeding as less appropriate among racially and ethnically similar others. While respondents readily acknowledged the health benefits of breastfeeding and were generally supportive of images of others breastfeeding, biases about breastfeeding in public or in front of others and by race/ethnicity were apparent. Community, policy, and societal interventions are necessary to dismantle breastfeeding biases that may inequitably impact mothers' and infants' health.


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