Gathering More Voices: The African American Panel at the 2014 Lactation Summit

The 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 African Americans in the U.S. To access information on each 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. – African American Panel

Racism in the United States permeates all aspects of American society. As Cynthia Good Mojab wrote, “Eliminating inequity in the field of breastfeeding requires that we understand that racism and all other systems of privilege/oppression exist at various levels: personally mediated, internalized, institutional, and systemic.” Racism is evident where white privilege affords opportunities that are disproportionately less available to people of color.

In the lactation profession, the original systems and processes set up to develop the IBCLC credential were based on values, understandings, and resources common among whites, the dominant racial group in the United States. Rethinking those systems and processes based on other values, understandings, and resources will be critical to begin an authentic process of dismantling barriers and welcoming people of color into the lactation profession. This goes beyond simply having diverse representation in the leadership of the lactation organizations, although this is a critical element. It also requires facilitating a process whereby people of color are actively engaged and taking the lead in addressing those barriers.

Many participants described overcoming intense struggles to attain and retain the IBCLC credential, and expressed that many African Americans are unable personally to fight the challenges that make it so difficult. Common barriers include:

• Lack of diversity – on all of the lactation profession organization boards and within the profession itself. With no African Americans at the table when processes and structures are developed that affect people of color, assumptions continue to be made based on the dominant race: white. The lack of diversity within the profession often leaves African Americans feeling uncomfortable and not truly welcomed.

• The application process – needs to be simplified. One person put it this way: “Trying to figure out how to get into the lactation profession was like going on a road trip across the country without a map or a GPS.” Suggestions were made to create an interactive smart-logic website to allow applicants to chart their best course and track their progress toward designation based on their background/prior learning and experience in a simple format.

• Educational and clinical prerequisites – are elusive to those who cannot afford postsecondary education or return to college to acquire the required courses. Suggestions were made to develop high-quality, affordable educational modules that do not require college enrollment. It was further suggested that verifiable work and life experiences could count toward educational requirements.

• Recertification process – is confusing to maintain, CERPs are difficult to track, and the cost is often out of reach to many in the African American community. Suggestions were made to regularly update current IBCLCs with information about their status obtaining and maintaining certification requirements with an online tracker system similar to the one instituted by the American Board of Pediatrics when it transitioned to a complicated Maintenance of Certification process.

• Significant cost barriers – for all aspects of obtaining and maintaining the IBCLC credential and participating in the life of the profession. Some must sacrifice multiple paychecks to afford coursework and pay for exam fees. Because many African Americans are underpaid and must work more than one job to make ends meet, this poses significant financial hardships. Suggestions included providing scholarships for lactation courses, high level advocacy by the lactation organizations for employer reimbursement of exam fees, and improved marketing of the importance of the IBCLC credential so aspiring African American IBCLCs will value it enough to make it a priority.

• Clinical pathways – have become so structured that they are now obstacles to anyone outside the medical field. One person said, “Women have been breastfeeding since the beginning of time. When did something so natural become so clinical?” The highly structured approach makes assumptions that devalue the role of community and social support that has been a vital part of the African American community for generations.

• Accessing clinical hours – is difficult for African Americans who do not hold professional credentials. The medical field is dominated by those of privilege (for example, over 83% of nurses in the U.S. are non-Hispanic whites), adding layers of inequity to African Americans wanting to become IBCLCs. Many hospitals are unwilling to hire aspiring IBCLCs seeking clinical hours, and many African Americans do not have the professional credentials to be hired in the health care field. Opportunities for volunteer positions are scarce. Other potential sources of clinical experience (for example, the WIC program) are often not sufficiently funded to hire peer counselors who simply need to work long enough to obtain clinical hours. Many WIC agencies hire Caucasian peer counselors, even in predominantly African American communities, so there are inherent inequities within WIC, as well.

• Recognized lay breastfeeding support organizations – have been touted as one way aspiring IBCLCs can gain their needed clinical hours, working as volunteers or paid staff. Historically, many lay breastfeeding support organizations have not been racially inclusive or diverse; thus many African Americans do not feel comfortable seeking support through currently recognized organizations. Additionally, the process of a lay breastfeeding support organization becoming certified by IBLCE is based on a structure that does not value the role of experience and peer learning. This adds layers of inequity through processes that are not attainable to African Americans participating in newly developed lay support organizations geared toward the needs of underrepresented minorities.

• Clinical mentors – are scarce among the African American community. Finding relational mentors is pivotal for African Americans to be able to relate culturally to those in their community. In addition to identifying African American mentors, it was recommended that lactation conferences, including ILCA, make a concerted effort to have non-dominant lactation consultants speak on clinical topics, not just topics related to diversity and cultural issues.

• IBCLC exam – features photos that primarily depict Caucasian mothers and babies. Summit attendees were reminded that many clinical conditions manifest differently depending on the degree of pigmentation of breasts. The exam needs to reflect cultural sensitivity and the diversity of families served.

• Inherent racism – continues to exist throughout American society. The ramifications are seen throughout the African American community, impacting their ability to become IBCLCs. Some Caucasian families do not want to be cared for by an African American breastfeeding counselor, making it difficult for an African American to obtain the needed clinical hours or to practice in the field after becoming an IBCLC. Some white lactation consultants make assumptions that African Americans will not be able to pass the IBCLC exam, and therefore do not provide the needed mentorship support.

• Lack of jobs – remains a significant barrier. Some African American IBCLCs reported that navigating the changing requirements was difficult enough, and some colleagues made assumptions that they would not be able to achieve them. Yet once they overcame these obstacles and achieved the IBCLC certification, they then faced new hurdles to employment. The doors to employment are often disproportionately closed to African Americans. Many hospitals continue to require additional professional credentials such as R.N. While this is a common concern of other ethnicities, it adds another layer of difficulty for African Americans who are underrepresented within the nursing profession, as well. Achieving employment thus means they must face the additional obstacles of penetrating yet another system of inequity within the nursing profession before they can practice as an IBCLC. Many WIC agencies do not have funding or internal structures to allow former peer counselors who have attained the IBCLC credential to do the work they are educated and qualified to do. Those who are able to get limited employment within WIC find that they must continue to work as peer counselors within the peer counselor scope of practice and at peer counselor pay even though they now have the IBCLC credential.

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