Infant feeding, particularly breastfeeding, is oftentimes discussed in the context of choice. Anyone who has attempted breastfeeding knows this is rarely the case. A range of institutional barriers can interfere with a mother’s ability and decision to nurse.

Andrea Freeman’s new book, “Skimmed: Breastfeeding, Race, and Injustice,” utilizes the lens of critical race theory to interrogate the forces that discourage black mothers from breastfeeding. This book goes far beyond the simplistic (and frustrating) motto “breast is best” to uncover the broader issue of breastfeeding access where, Freeman argues, laws and policies seemingly neutral on their face are racist in their impact. Only two-thirds of black mothers attempt to breastfeed, and at six months only one-third are still breastfeeding. This is compared to more than 80 percent of white and Latinx mothers who begin breastfeeding, and a little more than half who are still breastfeeding at six months.

The primary case study in “Skimmed” is a miracle birth that ends in exploitation, abuse and child separation. In 1946, a black-Cherokee woman named Annie May Fultz gave birth to the first recorded identical quadruplets in the world in Reidsville, North Carolina, expanding her family with her husband Pete to 10 children. Immediately afterward, the white, Hitler-worshipping doctor who delivered them, Dr. Fred Klenner, began scheming about how to profit off of the babies’ newfound celebrity and elevate his professional status in the medical community.

Klenner began by naming the Fultz quads after the women in his own family, Mary Louise, Mary Ann, Mary Alice and Mary Catherine. Next, he began conducting medical experiments on his subjects. Without seeking parental consent, he injected them with 50 milligrams of ascorbic acid because he believed vitamin C had healing powers. He then negotiated with formula companies to auction off their fame to the highest bidder. After entering into a contract with St. Louis’s Pet Milk, which would indenture the girls to the company throughout their childhood, Klenner turned the family’s new tiny home on the top of a steep hill (purchased by Pet Milk) into a human zoo so visitors could gawk at them. With no local school nearby, Klenner made the decision to separate the girls at age 6 from their parents to live with another family so they could receive a formal education.

Pet Milk’s exploitation of the Fultz sisters spearheaded a new era in formula advertising that targeteds black mothers. And the federal government has been and continues to be complicit with this targeting.

The USDA subsidizes farmers who continue to grow too much corn, dairy, and soy. The surplus goes into infant formula. Formula is then given to low income mothers for free for the first six months of their babies’ lives as part of the federal supplemental nutrition program for Women, Infants, and Children, or WIC.

What’s more, the U.S. government has refused to sign on to the World Health Organization’s “International Code of Marketing of Breast-Milk Substitutes,” which restricts formula advertising. This allows formula companies to spend some $480 million dollars a year marketing formula to mothers.

There is a fine line between criticizing the racist and classist institutional structures that affect the breastfeeding rates of black mothers without treating black mothers as if they have no agency or autonomy in their own infant feeding narratives. Freeman succeeds in doing so by placing breastfeeding in the larger context of what she calls food oppression. In this light, the abundance of available formula to low income mothers provided through WIC is comparable to the abundance of fast food establishments in low income neighborhoods. Formula is simply more easily available (especially given the lack of parental leave and workplace accommodations for nursing), and clever advertising makes it difficult to discern the nutritional benefits of human milk over formula.

Freeman also analyzes the ways that corporations, federal agencies and the criminal justice system weaponize age-old harmful stereotypes of black mothers as bad mothers to justify intervening in how black mothers feed their infants. “Modern marketing continues to associate successful black parenting with formula use,” writes Freeman. “At the same time, popular images equate ideal parenting with white breastfeeding. The message is clear: because bad black mothers use formula, good white mothers can raise themselves above them by breastfeeding.”

The Fultz quadruplets are no longer alive, and their remaining relatives declined to be interviewed for “Skimmed.” This is understandable. As the object of white fascination and as a commodity for white corporate profit, the quads suffered grievously. Freeman instead relies on newspaper articles containing interviews with those who were close to the family.

Though Freeman’s prose is engaging and her research scrupulous, black voices would have provided a much needed dimension to “Skimmed.” The last two pages of the book touch on the viral Gap ad featuring a black mother breastfeeding her baby, an episode of “Black-ish,” where the character Bo uses an electric breast pump, and a short list of black-led organizations that offer education, counseling and support to black breastfeeding mothers. But the book otherwise lacks an in-depth discussion about how black breastfeeding advocates are working to change the statistics in their own communities.

In a narrative that focuses on black breastfeeding mothers and argues that feminism and racial justice have fallen short when it comes to addressing the racial disparity in breastfeeding, this absence of black mothers’ significant role in tearing down the barriers they face is a curious one. Certainly “Skimmed” provides a compelling framework to examine these issues. It simply needed to tell a more complete story.

NONFICTION

‘Skimmed: Breastfeeding, Race, and Injustice’

By Andrea Freeman

Stanford University Press

304 pages, $28