Skip to main content

Breaking barriers: doctoral student helps document breastfeeding challenges for Black mothers, shares their voices — and finds her own

(l-r): Doctoral student Christina Cook and Nandi Marshall, DrPH, associate professor in the Jiann-Ping Hsu College of Public Health and associate dean of Academic Affairs, were awarded the 2021 Health Innovation Award for their groundbreaking Savannah H.O.P.E. Photovoice Project.

A photo speaks louder than words. 

That’s the proverbial premise behind the Savannah H.O.P.E. Photovoice Project, a visual, community-based research project led by Georgia Southern University researchers that helps identify social, cultural and physical barriers that Black mothers in Chatham County face while breastfeeding. The project won a 2021 Health Innovation Award from Healthy Savannah.

As part of a Centers for Disease Control and Prevention’s $3.4 million grant, Healthy Opportunities Powering Equity (H.O.P.E.), the localized project allows those who seldom have the chance to voice their concerns share their experiences with the hope of creating social change.

Double Eagle Christina Cook (’13,’19) has assisted Savannah H.O.P.E. Photovoice Project lead Nandi Marshall, DrPH, associate professor in the Jiann-Ping Hsu College of Public Health (JPHCOPH) and associate dean of Academic Affairs, for the last three years. First serving as the JPHCOPH graduate assistant while completing a master’s in public health and now as Marshall’s graduate assistant in the public health doctoral program, Cook has taken pride in helping others amplify their voices. 

In turn, she found her own.

“Personally, what this has done for me is solidify my direction,” said Cook. “As someone who likes to navigate a lot of different paths, and someone who is an intuitive and does-this-feel-right type of person, doing the work has really led me down the path of what I want to do because I am very committed to a sense of justice.”

The photovoice method, a groundbreaking visual research methodology that empowers marginalized individuals to document their experiences and communicate their concerns, was utilized, as participants captured images that represent local breastfeeding barriers. Some snapped shots in corporate settings and public areas without access to breastfeeding areas, while others hinted at a lack of family support or pushback based on cultural norms, captured with photos in familial surroundings.

“A lot of them are physical barriers,” said Cook. “There is just not a space available. It was really surprising. Even in churches, one of the moms said that whenever she would go to church the only place for her to go was the bathroom. Or someone was ushered into the office to nurse there. 

“The other ones have been sociocultural like this is something that Black people don’t do or what family members would say. Or going into a public park and people just staring at the moms while they breastfed.” 

Sessions facilitated by Cook and Marshall allowed participants to talk about the photos, their perspectives and ideas for change with one another to help guide resolutions to overcome barriers for improved local breastfeeding equity. 

Most special for Cook has been “being able to connect with people, especially in the community and actually hearing what’s going on,” she said. “Everything in this research project has allowed me to do that and really understand what the issues are and how we can address them.”

The research and photos were compiled into a photobook, which serves as a tool for Cook and Marshall to share with local businesses and community organizations.

“The policy initiative we’re doing now is working with organizations to help them develop breastfeeding and chestfeeding policies for their employees so that women or mothers or parents aren’t forced to feed in a bathroom,” said Cook. “Or have to make that decision whether to stay home or quit their job, or return to work or spend a lot on childcare just to go back to work.”

Marshall praised Cook’s integral role in the project.

“She is by far an essential team member,” said Marshall. “Her involvement in community-based, participatory research allows her to implement her classroom knowledge while building on skills that will allow her to continue the work of achieving health equity when she graduates. Truly understanding how to engage communities and ensure they not only feel supported but cared for, is a skill that can’t be taught in the classroom. It comes from showing up, by being authentic, being present and keeping the needs of the community in the forefront. Christina continues to show up time and time again. She has proven to be invaluable and a tremendous asset in improving the health outcomes of the communities we work with.”

As someone who “stumbled” into public health after a stint as an anthropology undergraduate assistant at Armstrong State University, helping Somali immigrants seek equitable health care, Cook is grateful to have discovered a field that continually inspires her.

“It’s been a journey,” said Cook. “Sometimes we have those moments when Dr. Marshall and I meet and it’s that whole thing of, have we done enough? And our answer is usually no.

“But saying how much we’ve done, it’s a lot. But the journey ahead is also a lot. So we’re trying to take it as we can and try to pull in as many community members and partners as we can. The ones I’ve talked to so far have been really excited about it. 

“I always try to reach out to whoever is in human resources and a lot of those individuals have either had firsthand or secondhand experiences with breastfeeding or chestfeeding so they have been immensely helpful and incredibly excited to do as much as they possibly can to make sure that these barriers are addressed, and that nursing connections happen and as barrier-free as possible.”

Georgia Southern University, a public Carnegie Doctoral/R2 institution founded in 1906, offers approximately 140 different degree programs serving almost 27,000 students through 10 colleges on three campuses in Statesboro, Savannah, Hinesville and online instruction. A leader in higher education in southeast Georgia, the University provides a diverse student population with expert faculty, world-class scholarship and hands-on learning opportunities. Georgia Southern creates lifelong learners who serve as responsible scholars, leaders and stewards in their communities. Visit


Posted in Limited Release, Press Releases