Gathering More Voices: The Other Perspectives Crossing Cultural and Geographic Lines Panel at the 2014 Lactation Summit

Cross-Cultural PanelThe 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Other Perspectives Crossing Cultural and Geographic Lines. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., Hispanics in the U.S., North and South America, Asia Pacific, and Europe and Russia. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

Other Perspectives Crossing Cultural and Geographic Lines

A general panel addressed other important perspectives that are not unique to particular cultural, racial, and ethnic groups or countries/regions of the world.

LGBTQI Community
The lesbian, gay, bisexual, transgender, queer, questioning, intersex (LGBTQI) community is present in all communities of the world. However, acceptance is far from universal and affects how “out” or visible LGBTQI people can be. Non-acceptance such as social stigma and the lack of recognition, legal rights and protection, etc. can lead people to hide their sexual orientation (and relationship or family make-up) and/or their gender identity, due to fear of repercussions, including violence.

The diverse members of the LGBTQI community may have intersectional identities, so they will suffer discrimination in different and layered ways. For example, gay and lesbian members of the community may suffer less discrimination than transgender and bisexual individuals. LGBTQI people of color face complex layers of discrimination. Transgender people of color have been described in the literature as the most oppressed group in the United States.

Legislation still restricts activities of LGBTQI people worldwide. For example, one U.S. state (Arizona) recently proposed legislation that, if passed, would have allowed businesses to refuse to serve people from the LGBTQI community. Rampant discrimination, often under the guise of religious beliefs, has resulted in high stress levels, higher rates of breast and ovarian cancer, substandard health care, and refusal to be provided health care. Many families report they do not want to receive lactation care from a LGBTQI provider. Lack of knowledge among members of the profession about the needs and issues of the LGBTQI community are a confounding factor, making it more difficult to provide mentorship opportunities. Lactation texts and exam preparation materials barely acknowledge the existence of LGBTQI people.

Lay Breastfeeding Support Counselors
Although the lactation profession had its earliest beginnings in the lay breastfeeding support movement, the profession has taken on more clinical approaches through the years. Individuals representing the lay breastfeeding support field identified difficulties for peer support counselors to access mentors and afford clinical education opportunities. Several reported that the U.S. Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which supports a robust peer support program nationwide, does not encourage advancement of peer counselors to IBCLC positions, and many local WIC agencies do not provide positions or funding for peer counselors who become IBCLCs. Many also reported that they do not feel “wanted” by the lactation profession. They desperately seek recognition and support.

Remote Regions of the World
Many aspiring lactation consultants live in remote regions of the world and find it extremely challenging to access education, clinical experience, and resources. Transportation can be challenging and costly. Lack of community resources often means that few IBCLCs are available.

Male Lactation Consultants
Men comprise an extremely small proportion of the total numbers of IBCLCs worldwide. Major barriers include lack of acceptance among primarily female supervisors and directors, lack of male-friendly environments in health clinics and hospitals, and a feeling that males are not welcomed in the mostly female lactation consultant profession. For example, most lay breastfeeding support organizations completely exclude males. Even when infants are born, health providers tend to ignore the father, focusing most of the care and attention to the mother. The sense of feeling “invisible” causes many men to feel the lactation consultant profession is not for them.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Gathering More Voices: The Europe and Russia Panel at the 2014 Lactation Summit

Europe PanelThe 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Europe and Russia . Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., Hispanics in the U.S., North and South America, and Asia Pacific. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

Europe and Russia

The panel addressing issues in Europe and Russia noted that the three lactation organizations must be committed to truly being international. The processes to establish the profession and maintain it reflect the lens of the United States, and do not play out as intended in many countries of the world. Some of the significant issues addressed include:

  • Few number of IBCLCs – creates challenges in Russia and Europe. In Russia, where there are 146 million people, there are only 10 IBCLCs. In Italy, where there are 60 million people, there are only 198 IBCLCs. In Latvia, a country of 2.1 million, there are 3 IBCLCs. In Ireland, with 4.6 million people, there are 167. When the numbers are small, it is harder to promote the profession and access appropriate education and clinical mentorship opportunities.
  • The size of Russia – with 10 time zones within the borders of the country, access to education and clinical requirements is an uphill battle for aspiring IBCLCs.
  • Few resources and training opportunities – are available in the Russian language. Currently only those who also speak English are able to take the exam as it is not yet translated into Russian or many other languages. Also, there are no educational materials in Russian; candidates must call sites with English-speaking operators to register for the exam.
  • Only 13 of the 24 official languages approved by the European Union – are listed on the IBLCE website and only some information is translated; most key documents are not. ILCA has even fewer resources available in appropriate languages. English is spoken by around 50% of the peoples in Europe. Although many Europeans speak more than one language, English may not be one of them, or their understanding may be only at VERY basic levels. This is a significant issue since key documents and resources related to the exam are not available in the languages needed.
  • Financial costs – in Russia, the dollar to ruble exchange is currently 1 to 50, where it was 1 to 33 before. That means the cost for preparing for and taking the IBCLC exam has become much less affordable. There are similar concerns in European countries, as well.
  • Eligibility requirements – have affected many prospective IBCLCs. The required coursework is not readily available as individual courses, or affordable in Europe, and many online opportunities are available only in English.
  • Access to education and training resources – in the appropriate language and at an affordable cost remains an ongoing challenge. This affects not only initial entrance to the profession, but also maintenance of the certification once it is attained. Many Europeans and Russians do not own credit cards, making it difficult to access online education such as webinars, and exchange rates can make overseas learning prohibitive, especially for Eastern Europeans. One 100-hour breastfeeding course has been developed in Russia for web-based learning to address these issues.
  • Pathways are limited in Europe. Pathway 1 is effectively limited to health care professionals due to unavailability of individual university courses and limited range of required lactation education courses. There are no Pathway 2 programs, and mentorship through Pathway 3 is limited due to lack of mentors. This effectively blocks non-health care professionals, including experienced lay breastfeeding support counselors, from accessing the exam.
  • The IBCLC is not yet a recognizable profession in Russia – There is a certain mistrust that the profession is coming from western societies with certain rules and regulations that are not appropriate to other countries.
  • Making a living as an IBCLC – is rare in Europe. Many aspiring lactation consultants question whether navigating the significant obstacles is worth the cost and effort if they cannot support themselves or their families with a job in the field.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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ILCA Elections: Board of Directors, Bylaws, JHL Article of the Year

ILCALogo_full_text (2)This week, the ILCA Board of Directors presented a ballot asking ILCA voting members to vote for the following:

  • Board of Directors elections;
  • 2015 Bylaws changes; and
  • JHL Article of the year.

All IBCLC ILCA members, in good standing, should have received an email from ILCA on 9 April 2015 containing a link to the ballot. If you did not receive an email and you should have, please contact the ILCA Office at info@ilca.org (or) 1+ 919-861-5577 (or) 888-452-2478. Our ILCA staff is eager to make sure you get a ballot, so your vote can be counted.

To ensure a timely and secure election, all voting will take place through an online survey.

Prior to casting a vote, all voting ILCA members are encouraged to thoughtfully consider all information provided below. This will enable you to make an informed decision.

 Vote carefully: Once your vote is cast, it cannot be changed, repeated or cancelled.

The balloting commences 9 April 2015 and concludes 9 May 2015, at which time all electronic votes will be tallied by the ILCA staff.

Board of Director Elections

On behalf of the Board of Directors, we are pleased to present the 2015 ballot for election of Directors.

This slate of candidates for the Director of Membership & Affiliate Services position was presented to the ILCA Board of Directors by the ILCA Nominating Committee. After thorough review and analysis, the slate was approved as submitted.

The Director must now be elected by a majority of ILCA voting members. (Note: ILCA Bylaw 3.4 confers voting privileges to those dues-paying ILCA members who are also IBCLC certificants.)

Please take time to review the profiles of each nominee (click here) prior to casting your vote.

The ILCA Board extends a special thanks to the Nominations Committee for their efforts on behalf of the entire membership.

2015 Bylaws Changes

The ILCA Board of Directors supports the proposed changes.

The specific changes are summarized below or can be viewed in this revised bylaws document, (click here) edited with “tracked changes,” letting you compare the old version with the new.

Changes include revisions to the ILCA board makeup, size and term limits.

  • ILCA Board Members To Be Selected By Membership Vote

Change: In the proposed bylaws, all reference to Tier 1 Partner Affiliates Board Members has been removed.

Rationale: This wording was initially added to the Bylaws to accommodate the planned restructuring of the ILCA Board of Directors incorporating Tier 1 Affiliates. This restructuring was contingent upon the adoption of new affiliate agreements, which incorporated “bundled” or common membership among ILCA and the affiliate. The joint decision by ILCA and the former Partner affiliates to abandon this strategy and to “unbundle” membership voids the previous rationale.

The bylaws as currently written state that each Partner Affiliate (defined as separate organizations with an independent Board of Directors and governance, 100% of whose members are required jointly to be members of both ILCA and the Partner) will appoint or elect one board member.

As the condition of bundled membership has been removed, this structure no longer reflects the reality of ILCA leadership. The ILCA board proposes that all positions be filled by an election of its members.

 The proposed changes do not prevent board members of other organizations from entering board elections. Candidates for election are encouraged to share their qualifications to serve, which may include their active involvement in IBCLC and breastfeeding advocacy around the globe.

 These changes allow ILCA to more accurately reflect both the current reality of its structure and the needs of members worldwide.

  •  Reduction in board size

Change: The board will have no less than three and no more than nine members.

Rationale: A smaller board is proposed for two reasons.

The provision allowing for more board members was added last year to accommodate the addition of Tier 1 Partner Affiliates. This provision is no longer applicable.

A smaller board also makes organizational sense, as smaller boards tend to have lower costs while increasing levels of participation and generating higher quality decision-making.

  • Presidential Term Limit Clarification

Change: Provisions have been added to clarify that the second term of a member selected for the position of President may be extended up to two additional years to fulfill the term of President.

Rationale: Without this provision, many experienced Board Members (those selected for a second term) would be ineligible due to term limits. This is formal recognition of the current practice.

Best JHL Article of the Year (2014)

As in years past, you are also invited to cast one vote for the Best Article appearing in the 2014 issues of the Journal of Human Lactation. Click here for a complete list of articles published in a 2014 issue of the Journal of Human Lactation. 

Please learn all you can and join the conversation!

Can I discuss this with my colleagues before I vote?

Please do! The ILCA Lactation Matters blog, and other social media venues, encourage dialogue about ILCA’s governance! Use the comments section below to ask questions or make comments.

The Balloting Process

The balloting concludes 9 May 2015, at which time all electronic votes will be tallied by the ILCA office.

Questions? Comments? Share them here!

We want to hear from you.

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#ILCA15: Exploring Washington, DC

Blog Images (2)

In just a few short months, we’ll be gathering together for the 2015 Conference and Annual Meeting for the International Lactation Consultant Association® (ILCA®). Located in Washington, DC, USA, this year’s annual conference is shaping up to be an exciting celebration of “Leadership in Lactation: 30 Years & Moving Forward.” We’ll be learning new and innovative techniques, hearing from thought leaders in our field, and reflecting on the past 30 years as we also think towards the future.

While we’ve got a jam-packed schedule of plenary sessions, workshops, concurrents, and events, we hope you’ll be able to take some time to explore our host city. Washington, DC – the capital of the United States – is full of culture, adventure, history, and progress. Here are 5 local sites you won’t want to miss!

Tai Shan

Photo by Smithsonian’s National Zoo via Flickr’s Creative Commons

Smithsonian’s National Zoo: One of the treasures of Washington, DC will be one block away from our conference hotel. As one of the oldest zoos in the United States (and with free admission!), it is now home to thousands of animals housed in exhibits such as Amazonia, the Bird House, and the Giant Panda Habitat, which is home to Mei Xiang and Tian Tian, along with their “toddler” Bao Bao (you can read a bit about his weaning HERE). Check them out on the PANDA CAM!

Photo by Robert Lytle Bolton via Flickr Creative Commons

Photo by Robert Lyle Bolton via Flickr Creative Commons

Smithsonian Museums: In addition to the National Zoo, the Smithsonian Institution includes 17 museums in the Washington, DC area (in addition to two more in New York City, NY, USA). They include the National Portrait Gallery (including a temporary exhibit with TIME magazine covers from the 1960’s), the National Museum of American History (where you can view Julia Child’s Kitchen and Dorothy’s ruby slippers from the Wizard of Oz), and the National Air and Space Museum (check out the Wright Brothers plane) – all of which have extended hours during the week of our conference. Admission to all museums is FREE and most are easily accessible by the DC Metro.

Photo by Geoff Livingston via Flickr Creative Commons

Photo by Geoff Livingston via Flickr Creative Commons

National Memorials and Monuments: For many visitors to Washington, DC, the memorials and monuments are “must sees.” Among the most popular are the Washington Monument, the Lincoln Memorial, the Jefferson Memorial and Vietnam Memorial as well as the World War II Memorial. Many especially love to visit them at night as most are beautifully lit. In addition, there are a number of sightseeing tours that include on and off buses which stop at the monuments.

Photo by Photo Phiend via Flickr Creative Commons

Photo by Photo Phiend via Flickr Creative Commons

Washington National Cathedral: One of the largest cathedrals in the world, the Washington National Cathedral is the epicenter of the Episcopal Church in the United States. Located just over 1 mile from our conference hotel, it has been designated as the “National House of Prayer.” There are a number of tours available and you’ll want to make sure you don’t miss the Gargoyles and Grotesques (including one of Darth Vader!) Admission is $10 for adults for visits to explore the grounds and architecture. Worshiping, prayer, and other spiritual visits and all visits on Sundays are free.

Photo by Andrew Watt via Flickr Creative Commons

Photo by Andrew Watt via Flickr Creative Commons

Kennedy Center for the Performing ArtsThe place to go for theater, dance, ballet, as well as all forms of music is, undoubtably, the Kennedy Center. They offer a full calendar of events year-round (including an annual “Sing Along” version of Handel’s Messiah) and they are featuring a number of events while we’ll be in town, including two Tony Award Winning musicals, Once and The Book of Mormon. You can check out the full schedule as well as information about tours on their website.

What are you most looking forward to visiting while you are in Washington, DC for #ILCA15?

Want to coordinate a day trip with other conference goers? Visit the ILCA Facebook event here!

For more information about the conference and to register, please click below.

RegisterNow

 

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Gathering More Voices: The Asia Pacific Panel at the 2014 Lactation Summit

8The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Asia Pacific. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., Hispanics in the U.S., and North and South America. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

Asia Pacific – Japan, China, New Zealand, Australia

As in many other parts of the world, the needs and issues of both predominant and underrepresented communities vary throughout the Asia Pacific region. While enormous strides have been made to advance the lactation profession in this region of the world, access to the profession is difficult even for dominant cultures and those with socioeconomic resources. Inequities experienced by underrepresented aboriginal, Maori, and Chinese communities make access even more difficult.

Australia
It was noted that 240 years ago the population of Australia was mostly aboriginal. Today, 95% of the population of Australia consists of immigrants or descendants of immigrants. The cultural diversity throughout the country and large distances between communities means that lactation education must be taken to the people. While there are more than 1,000 IBCLCs in Australia, significant barriers abound, including:

  • Distance, transportation and cost – are barriers to acquiring required lactation education and clinical instruction.
  • Fears — that the IBCLC exam is too hard or difficult to attain.
  • Discrimination against aboriginal populations – make inequities an ongoing reality and concern.

China
Significant barriers to the profession exist in China. Despite the large geographic size and population of the country, only a small handful of IBCLCs exist there. This represents both a challenge and an opportunity. Common barriers identified include:

  • Language barriers – exist, with no comprehensive breastfeeding education texts in Chinese. This makes it virtually impossible to advance the profession in culturally appropriate ways unless people also speak English.
  • Education and exam costs – are prohibitive. In China, health care providers are not paid at levels similar to those in the United States.
  • Lack of educational opportunities – result in breastfeeding education not being readily available for health providers. This means it is also not available for aspiring IBCLCs.
  • Low numbers of IBCLCs – create a noticeable gap in professionals who can provide training and mentorship opportunities. Lack of knowledge about the IBCLC profession makes it hard for others to understand and accept it.
  • Enormous strides – have been made in a relatively short period of time. Over 200 peer counselors have been trained, and this core group is now energized to want to become IBCLCs. Another avenue for outreach is the field of mother-infant care specialists who provide breast massages, the only certificate that the government of China has issued. IBLCE has now included a simplified Chinese section to the IBLCE website, and a Chinese blog on lactation now has nearly a million followers from across the country. An online chat group has begun purchasing English texts and each member of the study group translates a portion of the book and then shares what they learned to help one another prepare for the IBCLC exam.
  • Resources and education – are desperately needed for Chinese IBCLC candidates. These aspiring IBCLCs need books and educational resources in Chinese, online training opportunities in Chinese, and opportunities in hospitals and private practices to acquire clinical experience hours. In addition, the IBCLC exam needs to be translated into Simplified Chinese in order for more people to be able to sit the exam. Lactation consultants from other countries are welcomed in China to provide training and assist in the growth of the profession.

Japan
Japan experienced phenomenal growth in the lactation profession from 1995 when the first IBCLC was certified to 2013, when there were 891 IBCLCs in the country. Much of this rapid growth was attributed to targeted outreach. Nonetheless, significant barriers make expanding the profession quite difficult.

  • Heavy reliance on the profession grounded in the medical field – makes it more difficult for others to feel welcomed into the profession. The majority of current IBCLCs in Japan are also midwives or nurses; 11% are also physicians.
  • Recertification – is a significant barrier for current IBCLCs. The time, energy, and cost required for continuing education are significant. The value of having become IBCLC certified is not always appreciated among current members of the profession in the country.
  • Exam entrance requirements – are difficult. The health science education required is expensive and difficult to locate and access. Many resources and training programs, including online programs, are not available in Japanese.
  • Significant language barriers – exist in Japan, making it difficult for many members of the community to access the education required. This is of special significance for minorities in Japan who often do not speak English and lack literacy in Japanese, as well. Internal communications remain a challenge in Japan.

New Zealand
In New Zealand significant issues exist with regard to the monetary exchange rate, which often makes it impossible to access U.S. based lactation courses, ILCA membership, and other resources. The Maori are the largest native community within New Zealand, yet they are not well represented in the profession of IBCLCs. High rates of teen pregnancy and lack of access to traditional resources, including basic Internet access, pose additional challenges.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Ethical Leadership: Meeting obligations under the International Code

by ILCA Board Member Lisa Akers MS, RD, IBCLC, RLC

ILCALogo_full_text (2)Organizations of all types have shown important advancements in ethical practices over the past century, even as the challenge of providing ethical leadership while following evidence-based practice and performance standards remains unchanged. ILCA® is dedicated to promoting a climate that facilitates ethical decision-making and commitment to the profession. As such, ILCA supports the hierarchy of infant feeding as specified in the Global Strategy for Infant and Young Child Feeding (2003)[1]. Upholding the International Code of Marketing of Breast-milk Substitutes[2] and all relevant subsequent World Health Assembly resolutions (i.e. International Code) is one way in which ILCA reflects an ethical climate and positively effects decision-making. ILCA has long taken steps to ensure that it “does not invest in, nor accept funding, donations, advertising, or sponsorship from corporate entities that do not meet their obligations” under the International Code.

More recently ILCA took the seriousness of its obligations for upholding the International Code to a higher level by forming an independent panel of International Code experts in November 2013. The International Code Expert (ICE) Panel is recognized for their training and experience interpreting the International Code. The ICE Panel was first introduced through the Lactation Matter blog in June 2014 and continues to provide expert guidance to the ILCA Board behind the scenes. The ICE Panel has enabled ILCA to re-examine sponsorship relationships. Among its responsibilities, the ICE Panel has been charged with determining “whether potential commercial affiliates are meeting their obligations under the International Code.” All potential commercial affiliates are now subject to an examination process by which the ICE Panel determines if they are meeting their obligation specified by the International Code. When a commercial affiliate is determined to not be meeting their obligation, the ICE Panel provides feedback to the organization on meeting International Code standards.

While the ICE Panel recognizes that mothers choose to use feeding bottles or other devices to give their expressed milk to their babies, this is not the same as direct breastfeeding and is specifically addressed in the Global Strategy. When there are clinical or medical problems that temporarily or permanently prevent direct breastfeeding, alternative feeding devices are clinically appropriate and instruction in their use should be taught by healthcare professionals (International Code Article 4). ILCA supports one-to-one instruction from the IBCLC® and health professionals[3] as the appropriate action.[4] Under its obligations of the International Code, ILCA does not support the public promotion of bottles and teats to the general public.

ILCA’s mission “to advance the International Board Certified Lactation Consultant® (IBCLC) profession worldwide through leadership, advocacy, professional development, and research” would not be realized without fostering a positive ethical climate. ILCA continually strives to uphold the International Code while remaining cost effective and considerate of the external patrons during the decision-making process. ILCA asks that members also support their obligation to the International Code through their personal interactions with mothers and commercial relationships.

[1] “The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.” World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[2] World Health Organization. (1981). International code of marketing of breast-milk substitutes. WHO Chron, 35(4), 112-117.

[3] World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[4] Global Strategy, article 19.

Lisa-AkersLisa Akers is a Registered Dietitian Nutritionist (RDN) and an International Board Certified Lactation Consultant (IBCLC). She has been working in the field of public health and human lactation for over 14 years. Her current position as the State Breastfeeding Coordinator is to support and promote breastfeeding endeavors for the Commonwealth of Virginia, which includes the development of public policy and media campaigns, curricula, publications and training; oversight of the Virginia WIC Breastfeeding Peer Counselor Program; and service as the Virginia Department of Health liaison to the Virginia Breastfeeding Advisory Committee. Lisa serves as the Director of Marketing on the ILCA Board of Directors. She also serves as the Chair of the Women’s Health Dietetic Practice Group (DPG) and is the Academy of Nutrition and Dietetics’ delegate to the United States Breastfeeding Committee.

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Gathering More Voices: The North and South America Panel at the 2014 Lactation Summit

7The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on North and South America. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., and Hispanics in the U.S.. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

North and South America – Canada, Mexico, South America

Many real-world stories were shared, noting similar barriers already described. Additional issues of transportation, costs, and language were noted. It should be noted that the South American representative to the Summit was unfortunately unable to attend; input from South America will be critical moving forward.

Canada
In the world’s second largest country, travel and transportation costs, as well as distance and access to appropriate resources were identified as significant barriers to accessing the profession.

  • Exam site assignments – do not always accommodate everyone. Some Canadians reported they had to take the take the exam in the United States, requiring passports and often significant travel expenses for airfare or mileage, hotel, meals, child care, and work replacement. Carpooling is often not possible as people are frequently assigned to take the exam at different sites in the U.S.
  • Language barriers – pose hardships for many aspiring lactation consultants. This is further complicated when office staff for IBLCE do not speak French, making it more challenging to register for the exam.
  • Racism – is a significant issue in Canada. For example, a painful history of killing First Nations children and outright abuse of aboriginals in Canada has resulted in continuing issues of discrimination and lack of access to appropriate health care among underrepresented groups. There is a great need for families to heal from intergenerational trauma.
  • Cultural practices – of First Nations peoples are not recognized or valued by those from the dominant culture in Canada.
  • Lack of IBCLC mentors – is a special concern within aboriginal communities. Because many aboriginals lack trust in the dominant culture, this is a significant need. Currently there is only one IBCLC in Canada from a First Nations tribe.
  • Cost and lack of jobs – are significant challenges to motivating people to become IBCLCs in Canada.

Mexico
Despite the large population of Mexico (over 20 million in Mexico City alone) there are relatively few IBCLCs (only 20). There are 67 native languages spoken in Mexico, and there are wide variances in beliefs and practices surrounding breastfeeding, with significant issues impacting the lactation profession.

  • The profession – is mostly unknown in the country. Lactation is not incorporated into medical training, and health providers are not knowledgeable about the profession.
  • Lactation knowledge – is lacking. Many health workers believe they are already lactation experts. Unified evidence-based standards are not shared between health providers, resulting in inadequate lactation care. There are few Spanish language lactation courses and continuing education programs available to educate health professionals and aspiring IBCLC candidates and help them maintain the credential.
  • Breastfeeding promotion – is challenging. Aggressive formula marketing practices have penetrated the indigenous communities in Mexico. Complementary feeding practices are not based on best practices in nutrition. While the Baby-Friendly Hospital Initiative (BFHI) is gaining momentum in the country, the public health department added 15 additional steps (for example, vaccinations) that make acquiring BFHI designation much more cumbersome and difficult to attain.
  • Time constraints and high turnover – add to issues of lack of motivation and knowledge about the profession.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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#ILCA15: Register NOW for our Clinical Skills Rotations

Blog Images (1)We are excited to once again offer our popular Clinical Skills Rotations. Participants will rotate between our skill stations in each two hour session. At each station, those attending will spend 25 minutes with an expert facilitator, who will provide a demonstration and support hands-on skill practice.

Clinical Skills Rotations are available for beginning practitioners (primary session) and for seasoned consultants (advanced sessions). You may register to attend on either Wednesday, Thursday, or Friday, depending upon the skill level you select. Expanding the offerings to three days doubles the number of participants who may take advantage of this popular offering!

Attendees are asked to register for only one Clinical Skill Rotation block  to allow sufficient room for others to participate. This is a popular feature of the ILCA conference so register early if you wish to participate!

Primary Clinical Skills Rotation (available Wednesday, 22 July 10:30am – 12:30pm and Thursday, 23 July 2:45pm – 4:45pm):

  • Breast Massage Influenced by Japanese Style. (Rika Dombrowski, RN, MS, MA, IBCLC)
  • Teaching Tools for Basic Breastfeeding Skills. (Sherry Payne, MSN, RN, CNE, IBCLC, CD)
  • Three Important Rules for the Beginner IBCLC. (Barbara Wilson-Clay, BSEd, IBCLC, FILCA)
  • Case Study Review: Reducing the mother’s anxiety to accept help. (Mireya Patricia Roman, LMHC, IBCLC)

 Advanced Clinical Skills Rotation (available Wednesday, 22 July 1:30pm – 3:30pm and Friday, 23 July 3:00pm – 5:00pm):

  • Being the IBCLC Detective: Where do the clues take us? (Carole Dobrich, RN, IBCLC, RLC)
  • Powers of Deduction: Tongue kinematics in normal infant suck. (Catherine Watson Genna, BS, IBCLC)
  • Handling the Pain: Use of therapeutic breast massage for the treatment of engorgement, plugged ducts and mastitis. (Maya Bolman, RN, BA, BSN, IBCLC)
  • Choosing Supplementation Methods and Devices. (Tanefer L Camara, IBCLC, MS-HCA)

Are you looking to increase your clinical skills? Join us!

RegisterNow

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Gathering More Voices: The Hispanic Panel at the 2014 Lactation Summit

6The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Hispanics in the U.S. Read our other posts on the assessments made by individuals representing the panel on African Americans in the U.S. and Native Americans in the U.S.. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

U.S. – Hispanic Panel

A multitude of barriers impact access to the lactation profession within Hispanic communities in the U.S. Although similarities were found with other groups, unique issues were noted among Hispanics in the United States.

  • Generalizations about Hispanic groups – are frequently made, clustering all groups that speak Spanish into one category of “Hispanic.” In fact, the word “Hispanic” is widely used to denote a single population group in national data, research methodologies, and general policies and programming. However, “Hispanics” are not a single group and are, instead, a diverse body of peoples from many different countries, traditions, and cultural practices. Even language variances are noted within Spanish-speaking cultures. One attendee noted, “Knowing one type of Hispanic means…knowing one type of Hispanic.”
  • Anti-immigrant/anti-Hispanic attitudes – are pervasive throughout the United States, and begin at an early age. Typical assumptions include the myth that people from Spanish-speaking countries (or for whom English is a second language) lack the education to attain the profession or cannot communicate in English and cannot perform well. These assumptions are hurtful and degrading, and result in a lack of the support that aspiring IBCLCs need to pursue the profession. Hispanic immigrants do not feel welcomed; the social, cultural and professional discomfort that many IBCLCs from the profession’s dominant culture feel about Hispanic immigrants erects barriers to their certification as IBCLCs, and to their advancement to positions of power and leadership within the IBCLC profession.
  • The immigrant experience – A fundamental lack of understanding of the immigrant experience is widespread throughout the dominant culture of the United States. The typical immigrant’s story is filled with human drama, with characteristics and qualities such as sacrifice, courage, loss, hope, tragedy, principle, fear, character, and sorrow. These qualities permeate and define every immigrant’s relationship to the U.S., its residents, and as a result, the IBCLC profession. To fail to understand this is to fail to understand immigrants.
  • Structural barriers – that keep mothers and babies from breastfeeding in traditional “Hispanic” cultural groups also keep people from becoming IBCLCs. Acculturation contributes to a significant decline in breastfeeding rates among people from Spanish-speaking countries.
  • Language barriers – are major issues in the United States among Spanish-speaking and English as a Second Language (ESL) communities. Often health providers do not know Spanish and rely on translation or interpretation services at health facilities, which are not always personal. These same language barriers make it difficult for Spanish-speaking people to access required coursework, appropriate clinical mentors, clinical hours, and continuing education.
  • Lack of knowledge – among those in the dominant culture about the educational opportunities in other countries. This lack of knowledge has led to assumptions that Spanish-speaking people are not well educated.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Great Lactation Consulting: Diana West, BA, IBCLC and Lisa Marasco, MA, IBCLC, FILCA

By Christine Staricka, BS, IBCLC, CCE, ILCA Medialert Team

Marasco BlogImagine creating an informal survey, hoping to gather 100 responses to a question you have wondered about for a long time. Now, imagine receiving 87 responses in the first hour, and then receiving thousands of responses during the survey period. That is exactly what happened to Lisa Marasco, MA, IBCLC, FILCA and Diana West, BA, IBCLC when they decided to poll mothers on what they look for in an International Board Certified Lactation Consultant® (IBCLC®). To top it off, not only did mothers respond, but IBCLCs responded in droves to request their own survey to answer that question as well.

Marasco and West shared their results at the 2014 ILCA Conference in their presentation Mothers Speak Out: Top Traits of a Great Lactation Consultant. This presentation has now been made available as a study module through the International Lactation Consultant Association® (ILCA®)’s CERPs onDemand portal and is worth 1 L-CERP and 1 contact hour.

The presentation is a dynamic, exciting, and fascinating look at what mothers say they want from their IBCLC.  It’s difficult to imagine that any IBCLC would not be interested in knowing what mothers themselves say about how their needs can best be met, particularly in light of a related session at ILCA2014 that covered meeting the needs of today’s generation, Lactation Support for the Next Generation: Communicating Effectively  with Millennial Moms, Co-workers and Interns (presented by Dr. Jane Heinig, PhD, IBCLC).

IBCLCs also expressed their opinions on what makes a great IBCLC. In many ways, they were in line with what mothers expressed though what clinicians value and know to be important can seem less significant to mothers who are working hard to be successful at breastfeeding. Marasco acknowledges that modern mothers are accustomed to having services available to them 24 hours a day, 7 days a week, and not all IBCLCs are able to make themselves accessible around the clock.

In this interview, Marasco and West highlight some of their thoughts on the survey:

CS: I definitely got the sense that you were overwhelmed at the response to your online poll.  When did you start to realize that this was huge, and it was going to be really groundbreaking?

LM & DW: Within the first hour that it went live. We were communicating as the survey hit, and could not believe how fast the responses came back, and how passionate some were.

CS: How do you feel about the results your research revealed in relation to Dr. Jane Heinig’s work on communicating with millennial mothers? Specifically, that they are less interested in hierarchy and more interested in hearing multiple expert opinions, that they seek information in many ways (mostly digital)?

LM & DW: Our survey did not directly explore how mothers seek out information. Rather, we sought their feelings regarding their experiences, and in that context we heard their stories. While they may hunt for info, I think it is clear that their interaction with the people they contact is important and plays a big role in who they choose for their care, as well as their expectations about the outcome.

LM: In this vein, I personally had a lot of mixed feelings regarding the things mothers valued, available not only in various ways, but also on-demand.  As a mother, I understand these desires, but as an IBCLC, I realize that I cannot give them everything they want all of the time, especially at this stage of my life. There is a huge variation on where IBCLCs draw their practice boundaries; some people are on call 24/7, others are not.  It is difficult to be there for moms all of the time, and I have to think about how to balance their needs with mine.

DW: Absolutely. And then there’s the aspect of where IBCLCs expend their energies, which is driven by their beliefs about the needs and desires of their clients. Since this survey has shown that mothers tend to value counseling skills over technical expertise, our colleagues may now choose to spend more time enhancing their interpersonal counseling skills.

With regard to millennial mothers, our data definitely showed that mothers tend to fact-check recommendations online and put more stock in their peers’ experiences and opinions than those of professionals and authority figures, which is consistent with Heinig’s and my own research about millennial mothers.

CS: I felt completely motivated to ensure that my skills in supporting pumping are really excellent and current.  Which feedback from this research have you personally put to use and why?

LM: More than anything, it reinforced my drive to keep up with things like new technologies and techniques for pumping, and also the importance of slowing down, listening, and taking the time to formulate a plan with mom so that she will own it.

DW: Yes, it really validated the professional practice philosophies I carried over from my volunteer work as a La Leche League Leader to meet mothers where they are, emphasize counseling over information, and respect the mothers’ knowledge of and instincts about their own babies and bodies.

As we found in this survey, the bottom line is that we all want to feel good about what we are doing – mothers and lactation consultants alike. Even when breastfeeding doesn’t go as planned, a mother’s perception of her breastfeeding experience can be greatly improved when her lactation consultant invests time in validating her feelings, respecting her search for the most accurate information, and empowering her decisions. Lisa and I are very grateful for the rich understandings this survey is able to provide to our fellow IBCLCs.


This enlightening session presents the essential traits of a great lactation consultant from the perspective of breastfeeding mothers, and encourages IBCLCs to reevaluate their accepted model of care.

CERPs onDemand from ILCA conferences are a great way to catch conference presentations that you missed while earning CERPs. You can access CERPs onDemand at the times that work best for you!

ILCA Members receive a 50% discount on all CERPs onDemand.

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MarascoLisa Marasco, MA, IBCLC, FILCA has been working with breastfeeding mothers for over 20 years. She holds a master’s degree in Human Development with specialization in Lactation, co-authored The Breastfeeding Mother’s Guide to Making More Milk, and is a contributing author to the Core Curriculum for Lactation Consultants. In addition, she serves on the editorial review board of Clinical Lactation and is a new Cochrane Collaborative author. Currently, she is employed by WIC of Santa Barbara County while maintaining a small practice, Expressly Yours Lactation Services. She also serves on the Breastfeeding Coalition of Santa Barbara County.

Diana WestDiana West, BA, IBCLC is a lactation consultant in private practice. She is the author of several popular breastfeeding books, including The Womanly Art of BreastfeedingThe Breastfeeding Mother’s Guide to Making More Milk, and Sweet Sleep:  Nighttime and Naptime Strategies for the Breastfeeding Family . She is on the Editorial Review Board for the Journal of Clinical Lactation, a La Leche League Leader, and the Director of Media Relations for La Leche League International.

Christine2Christine Staricka, BS is a hospital-based IBCLC. Christine is the co-owner of California Advanced Lactation Institute, which provides lactation education to professionals and expectant parents. She has contributed to USLCA’s eNews as well as this blog. She enjoys tweeting breastfeeding information as @IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of who have been or are still breastfeeding.

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