Applying Racial Equity to U.S. Federal Nutrition Assistance Programs - Flipbook - Page 59
Appendix 4: Why Culturally Appropriate Foods are Important
Food is an important part of people’s lives and identities, and on a more practical level, people usually cook with foods that
are familiar to them.
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Food as a source of identity. A person’s diet can be used to identify him or her as part of one group rather than another.
According to studies from anthropologists, food habit researchers, and sociologists, eating is a daily reaffirmation of
one’s cultural identity.272 273 In most cultures, food can be seen as a source of comfort and love. It is used to communicate
emotions, affirm community, or begin healing processes. In Indigenous communities, for example, traditional food has
long been used during ceremonies, dances, and prayers, and sometimes even to share oral history.274 The foods that we
eat are a core part of who we are. Confronting barriers to purchasing foods that are nutritious and culturally familiar
discourages people from expressing who they are.
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People cook and eat familiar foods. Offering only food options that are outside a person’s normal diet can create
additional barriers to good nutrition. People who are often already working long hours need to take time to learn to
cook the new food and develop an appetite for it. When nutrition programs choose instead to offer a variety of options in
food groups with similar nutrient content, it is more equitable and empowers recipients to use ingredients in culturally
relevant ways.
Appendix 5: History of Licensing in the Healthcare Field
Racism also marks the history of licensing in the healthcare field.275 Until the mid-20th century, many babies born in the
South, both African American and white, were delivered by African American women health providers. Known as “granny
midwives,” they did the work of today’s doctors, midwives, and doulas before hospital birth became the norm. In the era of
slavery, such women were of critical importance to slave masters, who depended on their expertise to safely deliver their own
babies as well as slave babies. During Jim Crow segregation, midwives were critical to African American health care, and they
were trained, respected healers in their communities.
Toward the end of the 19th century, childbirth among urban whites was becoming medicalized, but African American
communities, particularly in rural areas, were excluded from this trend. White healthcare providers still refused to treat
African American patients, so midwives remained critical to safe childbirth. By the 1970s, births in hospitals attended by
doctors (and later nurse midwives) had become the norm, and community midwives were phased out.276
This was made possible by (1) the passage of laws and policies regulating the practice of medicine, (2) the introduction
of certificate and degree requirements to work in the healthcare field, and (3) a racialized campaign to discredit African
American midwives. Because the new rules required medical training and licensure to provide childbirth services, African
American midwives who could not afford to receive training or pay licensing fees were forced out of the field altogether. In
addition, there was an organized racist campaign that portrayed midwives as uneducated, unsafe, and dirty. These factors led
to today’s lack of racial diversity in the healthcare field, which makes it less likely that mothers of color can receive supportive
care from other women of color. To see a video recounting this history, please click here.277
More recently, cost remains a barrier to entry into the healthcare field for many women of color. White women from
middle-class backgrounds are more likely to be able to meet the educational requirements to become International Board
Certified Lactation Consultants (IBCLC).278 Becoming a nurse or a doula, or undergoing a set number of hours of training
in addition to passing an exam,279 are sometimes required. Peer counselors often do not have the opportunity to fulfill all
the requirements. Jobs that require the IBCLC are often poorly paid unless the woman is also a registered nurse, so women
without other sources of income have limited opportunities to work in the industry.280 Licenses are expensive, and there is
a history of discouraging if not outright prohibiting black women from qualifying for them. Most recently, the Affordable
Health Care Act has limited reimbursement for expensive equipment such as breast pumps, which can cost up to $300, to
only IBCLCs who are in network.281
The result of this combination of factors is that lactation consultants are disproportionately white. There is a need for
more lactation consultants of color to increase breastfeeding rates among new mothers of color. Expanding the network
of providers WIC participants are allowed to see, along with training more women of color as lactation consultants,
could help ensure that more African American infants and other infants of color receive the nutritional benefits of
breastfeeding. Lactation is an issue where it is important to have culturally competent advice from people with whom one
feels comfortable.
A BREAD FOR THE WORLD INSTITUTE SPECIAL REPORT
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