Perceptions of Racism and Discrimination in Birthing Centers: Implications for Exclusive Breastfeeding Practices Among Black Mothers

BACKGROUND: Racial disparities in breastfeeding persist, with Black mothers experiencing significantly lower exclusive breastfeeding rates compared with White mothers. Limited research has examined how institutional bias and discrimination within birthing centers affect breastfeeding decisions, creating a gap in understanding the role of these environments in perpetuating lactation inequities. METHODS: A basic qualitative study guided by the social ecological model explored how perceived racism and discrimination in birthing centers shape exclusive breastfeeding initiation and duration among Black mothers. Ten participants were recruited through purposive sampling and completed semistructured virtual interviews. Data were coded inductively using ATLAS.ti 9 and verified through analyst triangulation and Krippendorff's α to ensure reliability. RESULTS: Four interconnected themes emerged: (1) individual level-birth trauma and pain dismissal reduced confidence in breastfeeding; (2) interpersonal level-racialized communication barriers and lack of lactation support undermined trust; (3) community level-formula-first norms and underrepresentation of Black lactation professionals limited culturally relevant care; and (4) institutional level-rigid policies and privacy violations reinforced inequitable treatment. CONCLUSION: Perceived racism and discrimination in birthing centers negatively influence Black mothers' breastfeeding experiences and outcomes. Equity-driven organizational reforms, anti-racist training, and diversification of the lactation workforce are essential to promote breastfeeding equity and improve maternal-infant health.