LFF Volume #29: Across Borders, a New Vision for Maternal Care

Why Maternal Care is a Justice Issue

Motherhood has become one of the defining fault lines of our time. From the dismantling of maternal health systems in Gaza to the ever-present crisis of Black maternal mortality in the U.S., the policies around and resources for caregiving are increasingly shaped by those who have the political and economic leverage to bypass restrictions created by our failing systems and institutions. Yet across these vastly different contexts and continents, the people at the center of intervention are often the same: midwives, nurses, lactation consultants, community organizers, and mothers themselves. 

From Gaza to Oakland, the work of nurturing mothers and children—and expectations around how mothers should nurture their children—reveal just how intimately braided social, environmental, and reproductive justice are. When maternal healthcare systems collapse, when clean water becomes scarce, and when communities lose the threads to traditional and intergenerational knowledge that once sustained them, the damage disrupts generations. These systems we’ve built often exploit both the planet and the people whose labor sustains it, especially women, caregivers, and communities on the frontlines of injustice.

These realities raise an urgent question for us all: what does it mean to care for life in a time of cascading crises? As ecosystems unravel, conflict displaces communities, and inequities deepen, the health of our societies is inseparable from the health of the living world. 

The most attuned solutions to ecological and social crises emerge by listening to the people closest to them. The Earth—our first mother—offers an abundance of models for generosity, interdependence, and regeneration. Nurse logs—old fallen trees—provide homes, water, and food for tiny new seedlings to grow. Fungi connect tree roots underground to trade water and nutrients through mycorrhizal networks. In wetlands marshes filter dirty water and renew the health of local rivers. These other mothers—the nurse logs, the tree roots, the wetlands—demonstrate how to sow the seeds of renewal and rebuild a village from the ground up. 

Their work challenges us to imagine a culture where care is recognized as essential infrastructure, where communities hold the wisdom to heal, and where the work of mothering, in all its forms, becomes a blueprint for building a more just and life-affirming future. It’s time to turn to our mothers and ask: what do you need in order to caretake safely, with dignity?

The following conversation brings together four women approaching this work from radically different vantage points: Brandi Gates-Burgess, founder of Breast Friends Lactation and Support Services, who has spent her career closing the breastfeeding gap in Black communities across the Bay Area; Sandra Adler Killen, an ER and pediatric nurse who has deployed to Gaza three times to train local clinicians in infant nutrition and lactation care amid famine and mass casualty; and Dr. Cindy Nelly, a global health consultant and midwife who has spent 25 years building health systems in conflict zones from Rwanda to the Democratic Republic of Congo to Gaza. Sandra brought everyone together, and journalist Tiffany McElroy facilitated the conversation.

What emerges is not a comparison of suffering, but something more like a shared diagnosis of what happens when the people closest to a crisis aren’t the ones being listened to, and what changes when they finally are.

What follows is an edited excerpt of a conversation recorded at the Bioneers 2026 conference.

TIFFANY: Why did you choose to get into the specific work you’re doing right now? Brandi, let’s start with you.

BRANDI: Black women are least likely to breastfeed their babies. There are enormous health disparities behind that fact, and it’s what drew me into this work.

I was 21, in college at UC Riverside, when I had my daughter. I breastfed her because I was a broke college student — but once I learned how critical breastfeeding is to Black maternal health, and how much it reduces infant mortality, I knew I had to get the word out. I changed my major to sociology so I could understand how these outcomes were shaping Black birth in this country.

The numbers are what convinced me this was my life’s work: Black women and birthing people are three times more likely to die in childbirth than any other race or ethnicity. If we can get Black families to breastfeed for at least six months, it changes the health trajectory of an entire community — lower rates of diabetes, asthma, allergies, obesity, breast cancer. Once I understood that, the mission became simple: We support each other, and we get moms breastfeeding for at least six months.

In 2023, I launched Breast Friends Lactation to bring that support to low-income families in the Bay Area, specifically pairing them with lactation consultants who look like them and understand what it means to navigate motherhood as a Black woman in America. We’ve been at it ever since, and we’re booked solid.

SANDRA: Nursing is actually my fifth career. I came to it late — I became a nurse at 50, after working in several very different fields, because I wanted to dedicate myself to this work. I worked as an ER nurse and a postpartum nurse, and I’d always wanted to do lactation support. I breastfed my own two children and saw firsthand the health benefits, the bonding, how emotionally powerful it was. So I became an IBCLC, just like Brandi.

For many years now, I’ve done international humanitarian work, first in Syria and Lebanon with refugee populations, and for the last two years in Gaza, training neonatologists, pediatricians, OB/GYNs, midwives, doctors, and nurses to deliver this kind of support in some of the most challenging environments imaginable.

CINDY: My own path, I’ll admit, wasn’t especially altruistic at the start. I began traveling early, and as someone very privileged to be able to do that, I started noticing the disparities around me. I wanted to keep traveling, but I wanted it to mean something — to give something back to the communities I was moving through. 

Then I had my daughter at 23. I chose a midwife without really thinking about why, but my great-grandmother had been a midwife, and somehow, through whatever force that is, maternal lineage, I knew that was how I needed to give birth. My first career had actually been in environmental science, but in that moment of giving birth, with that connection to my midwife, I realized: This is what I want to do.

As healthcare providers, we have incredible privilege. We’re present with people during the most painful, and sometimes the most joyful, most intimate moments of their lives. When else do we get that? It’s sacred. We can find that connection with trees, with plants, with nature — but connecting human to human in such a vulnerable space is powerful in a different way. 

For Further Complexity

We would be remiss in not touching on what often gets lost in the conversation around infant feeding: women’s choice. For some mothers, breastfeeding is an empowering and rewarding experience. For others, it can be physically difficult, medically contraindicated, or simply not possible.

Factors including low milk supply, infant feeding difficulties, workplace barriers, and the need to continue medications for mental or physical health can all shape feeding decisions. In these situations, discussions about infant nutrition can sometimes overlook the health, well-being, and autonomy of the mother herself. While public health messaging has emphasized the benefits of breastfeeding—which are real and substantial—many parents suffer from pressure and guilt when their circumstances do not align with that ideal. These considerations are especially relevant in communities where safe drinking water and infant formula are readily available, making formula feeding or combination feeding safe options. 

Holding these truths together means recognizing that promoting breastfeeding and centering maternal well-being are not competing priorities but complementary ones: children flourish when the women caring for them are healthy, supported, and empowered to make informed choices for themselves and their families. 

Some of the resources below offer additional perspectives on the complexities of infant feeding, including a “fed is best” perspective.

Featured Media

Watch: 

Indigenous Milk Is Medicine from director Missy Whiteman (Northern Arapaho and Kickapoo) and the American Indian Cancer Foundation

Andrea McLean on letting go of breastfeeding pressure from Giovanna Fletcher’s Happy Mum Happy Baby Podcast

Read: 

‘For the women who gave birth in the dark’: a portrait of motherhood in Gaza from The Guardian

When breast isn’t best by Laura Frances Callahan in Aeo

Listen:

Midwifing a Movement: Birth Centers and the Care Economy – Bioneers Radio & Podast episode

Trump Destroyed USAID. Now People Are Dying. Reveal Podcast episode