First Food Deserts in San Diego County
Written by Chardá Bell, CLEC, CCE, FSD
Food justice and chest/breastfeeding are inextricably linked. Institutionalized racism, and its many faces, has matriculated to prey on Black babies. First Food Justice is about infant feeding disparities in the first food system. In this sense, it highlights persistent barriers to chest/breastfeeding success in areas that are predominantly black folks, such as my hometown, Southeast San Diego. “First food deserts” are peppered throughout the United States, a term coined by the great Kimberly Seals Allers based on her research and community projects in Birmingham, AL, Jackson, MS, and New Orleans, LA. According to Seals Allers' research, a first food desert is defined as a geographical area where social and economic dynamics unequally constrain breastfeeding when compared with other locations. The healthiest first food is human milk, which is proven to have the best health and survival outcomes for humans. We must acknowledge that Black infants are more often limited, at times stunted, and face systemic barriers by being in a first food unfriendly habitat, born into an inequitable food system. In Sears Allers’ book, The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding, it states “(a first food deserts exists when) A persistent and widespread lack of culturally relevant healthcare support, peer support, and public spaces that facilitate breastfeeding. Where you live and work, then, unequally impacts what you feed and how you eat.”
Southeast San Diego is a mid-size area of the county, that is predominantly African American, low income to upper middle class, and some military, and various Asian populations that began to increase in the 90’s, particularly in Paradise Hills. It is a significantly under-resourced area in the county with limited access to perinatal, reproductive and chest/breastfeeding support and that needs to change. I also have pinpointed the limited resources and access to first foods and chest/breastfeeding support in the neighborhood and surrounding areas where I grew up. From Solola apartments in the community of Logan Heights and the “four corners of life” to Skyline and Paradise Hills. Skyline is a hilly urban neighborhood in Southeastern San Diego. It is bordered by Encanto to the west, Jamacha-Lomita to the North East, and Bay Terraces to the South. None of these communities have easy access to chest/breastfeeding support. In these very areas, we tell parents to chest/breastfeed and expect them to be successful when we don’t even have the basic infrastructure in place to make that support possible. Everything is hyper-local, meaning you have to travel a far distance to get decent quality food and support. A person shouldn’t have to go far and wide to have access to nutrition that is most optimal to support a successful chest/breastfeeding journey.
The community of Southeast San Diego is disadvantaged when it comes to chest/breastfeeding promotion factors, such as the lack of chest/breastfeeding support groups and Baby Friendly hospitals within reach. What we do have is a disturbing trend of chest/breastfeeding sabotaging factors, such formula advertisements on bus stops and health offices passing out formula to Black women at a disproportionate rate. We mostly have fast food and convenience stores selling a lot of fat, salt and sugar but not full service grocery stores with fresh wholesome food. These areas also correlate to poor infant and mother health outcomes, specifically for Black families. Every infant has the right to fair and equitable access to the first food of human milk. Every family deserves the support of their community if they choose to chest/breastfeed. We must also have an understanding of how the racial and social inequities around chest/breastfeeding adversely affect vulnerable populations. Human milk is proven to be the most efficient and nutritious first food available. It also happens to be the food that has all the components needed to reduce the risks for many diseases that affect black children more often such as type 2 diabetes, asthma, SIDS and childhood obesity. By increasing access to first foods, including human milk, we can have a resounding impact on infant nutrition and maternal health. When we look at the big picture in real time and take all things into account, we can better provide the needs of the community.
A contributing factor of these inequities may be related to historical and generational trauma that still haunts modern day Black folks. The theory of PTSS is a result of twelve years of quantitative and qualitative research by Dr. Joy DeGruy. Historian Wilma A. Dunaway, writes in the book, The African American Family in Slavery and Emancipation, “And since breastfeeding reduces fertility, slave owners forced black women to stop breastfeeding early so that they could continue breeding, often to the health detriment of their own infants.” Another problematic discovery contributing to the reason Black women have low in-hospital initiation rates is the simple fact that OBs and pediatricians, who are seeing feeding problems, don't refer out to lactation support groups or consultants upon discharge or at the pediatric appointment. If they do, these are not readily accessible and sometimes not very welcoming for black and brown folks when not led by a person that represents them. Most parents rely on their pediatrician for support, information, and resources for feeding, therefore we need providers to be in our corner. All chest/breastfeeding “help” is not created equal. If we are going to promote chest/breastfeeding, we must support all families.
As lactation professionals and medical providers, we have to stop telling people in areas we know are first food deserts to go chest/breastfeed and expect it all to work out for them when they try. It’s hard to find that in the field of lactation due to its advocacy efforts being white female dominated. We tell Black moms that chest/breast is best, but those same people saying it don’t host support groups or provide lactation support that make Black moms feel comfortable, secure and most of all heard without bias or judgments. For this reason, I recently started a breastfeeding support group with some Black birth workers, using Kimberly Seals Allers’ blue-print for a community-driven model for achieving first food justice in order to combat some of the issues we face with food deserts throughout San Diego. This is one of the best ways we can begin to elicit a change in our in-hospital initiation rates. Through steady exposure, easy access to support, and most importantly free education available to those who need it most. These resources will empower Black families and make chest/breastfeeding a traditional norm again. By improving chest/breastfeeding rates within the Black community, we will be achieving better overall health and well-being while reducing racial inequities for our entire community. We can accomplish this through continued education, support and advocacy for Black women and their families to not just survive, but to THRIVE. #BlackBabiesMatter #FeedSouthEast
For specific details about the in-hospital rates for chest/breastfeeding initiation and exclusivity by race, start at page 64 for San Diego, where it shows rates by county and then by hospital:
And, please consider donating to the San Diego Breastfeeding Center Foundation to help bring chest/breastfeeding access and basic infrastructure to areas like Southeast San Diego.