Scholar Story: Sarah Gonzalez-Nahm, PhD

My heritage motivates me to want to help people in whatever way I can.

As a nutrition researcher and a breastfeeding mother, Sarah Gonzalez-Nahm understands the many structural factors that affect a mother’s choice to breastfeed. Though breastfeeding is not the best choice for every family, regardless of socio-economic status or community, new moms should have the agency to decide for themselves whether they want to breastfeed their babies. Slack maternity leave policies and inflexible work climates, however, have removed that choice for many families—particularly those living in disadvantaged communities.

“People want to make the best choices that they can, but their choices are constrained depending on who they are, where they live, and where they come from,” she says. For Sarah, whose research focuses on maternal and child health—particularly nutrition and breastfeeding—these structural constraints are most evident in underserved populations, like the Latino and immigrant communities she has worked in since graduate school.

While some women choose not to breastfeed for personal reasons, without strong maternity leave policies for salaried and wage workers, many mothers in underprivileged communities are left without the opportunity to choose what’s best for the child and their family. As a result, there are significant racial and socioeconomic disparities in breastfeeding rates. African American women are 2.5 times less likely to breastfeed than white women, and a third of Latina women begin supplementing their baby’s diet with formula as early as the second day of life.

In addition to not having paid maternity leave, many workplaces do not have policies that support breastfeeding, Sarah adds. While the Affordable Care Act stipulates a blanket policy requiring employers to provide a “reasonable” unpaid breaktime for breastfeeding mothers in a private space, this language is vague and dependent on the employer’s interpretation. An employer can argue that the person is essential to the operation of the workplace and that taking frequent breaks would be a detriment to the workplace. On top of that, taking unpaid breaks may not be feasible for people living paycheck to paycheck, as pumping takes a significant amount of time.

“We’re not creating the ideal space for women to be able to breastfeed and go back to work,” Sarah comments. “We’re not making breastfeeding the easy choice.”

Removing these political and economic barriers to breastfeeding is the thrust behind Sarah’s research and advocacy for better maternal and child health. As a Latina woman, Sarah is deeply passionate about promoting health in immigrant communities where health choices are often dictated by outside factors.

Though she was born in Florida, Sarah spent eight years of her childhood living in Ecuador. While Sarah says she was fortunate not to experience many of the struggles and discrimination associated with Latino immigration to the U.S., she knows many family members and friends who have been affected by the social, political, and economic obstacles facing Latino immigrants.

“When you’re a Latino in the U.S., no matter where you come from you have a connection with other Latinos,” Sarah explains. “Latinos want to help each other. My heritage motivates me to want to help people in whatever way I can.”

While Sarah’s roots motivate much of her work in maternal and child health, those roots also inform her research, allowing her to become an outspoken proponent of change. “Because of my language skills and being a Latina myself, I connect with other Latinos more easily. They see me as a source of information, and as someone who can raise the visibility of issues pertinent to Latinos. As a Latina with an advanced education, I realize that what I do matters.”

Following her Master’s degree, Sarah worked as a nutrition counselor for the Durham County Health Department, working in an underserved area of Durham, North Carolina. There, she encountered the frustrating choices many families were forced to make about their health because of uncontrollable structural factors tied to immigration, maternity leave, and food affordability. Her frustration drove her to pursue a PhD in maternal and child health so that she can use her research to inform policymaking to help remove the complex socio-economic barriers facing underserved communities.

Sarah sees her New Connections grant research as the first step toward advocating for more equitable maternal and child health policies in the U.S. In her study, which is still in the analysis phase, Sarah assesses the breastfeeding policy landscape of each state, examining legislation that might affect breastfeeding—such as indecency laws, public breastfeeding laws, hospital laws, and maternity leave laws. She evaluates each law to identify whether it was created with equity in mind, considering socio-economic status, race or ethnicity, or the needs of nontraditional families. Her study uses two qualitative methods to assess each law. First, she conducts keyword searches for mention of race, ethnicity, income, or socio-economic status. Then, she uses a published framework from Brandeis University that further assesses equity in policies.

“What I’m finding so far, although it’s not definitive yet, is very few of these laws are created with equity in mind,” Sarah says. “It’s not really a surprise, but it’s never been formally documented. This provides a baseline for researchers to approach policy makers and highlight how this is inequitable and what we can do about it.”

Moving forward, Sarah wants to promote stronger maternity leave and breastfeeding policies with her research. The U.S. is the only developed country in the world where employers are not required to offer paid leave to new mothers. While eligible workers may receive 12 weeks of unpaid leave to care for a new child, this is not feasible for many mothers who live on the economic margins. This lack of a national mandate can have lifelong impacts on maternal and child health, Sarah notes, as infant nutrition and wellbeing can shape health trajectories later in life.

“It’s hard for women to make the choice to breastfeed because of these constraints and the policies in place in this country,” Sarah says. “If you’re unable to take an unpaid maternity leave, or if you only get 6-12 weeks maternity leave, it’s really hard to go back to work and have breastfeeding established.”

Sarah hopes to help make breastfeeding an easier choice for women, and she says the New Connections grant has given her a starting point. “Getting the RWJF grant has been a great opportunity for me. This research provides a strong baseline. I want to keep going and use the research to influence policy and bring on change.”